Technical and clinical recommendations for [¹⁸F]FDOPA PET/CT in oncologic applications

Abstract [¹⁸F]FDOPA PET/CT is a functional imaging modality that exploits the preserved ability of several neuroendocrine tumors to uptake, decarboxylate, and store amino acid precursors. Its oncologic role has expanded substantially, particularly for neuroendocrine neoplasms, pheochromocytoma/paraganglioma, and medullary thyroid carcinoma. Standardized technical and clinical guidance is necessary to optimize its diagnostic performance and ensure appropriate clinical use. This work summarizes current evidence and expert recommendations regarding patient preparation, acquisition protocols, image interpretation, indications, contraindications, radiation exposure, and reporting for [¹⁸F]FDOPA PET/CT or PET/MR in adult oncologic applications. Relevant literature, international guidelines, and clinical studies were reviewed to formulate practical procedural recommendations. To date, [¹⁸F]FDOPA PET demonstrates high diagnostic accuracy in selected neuroendocrine malignancies, particularly pheochromocytoma/paraganglioma, well-differentiated gastroenteropancreatic neuroendocrine tumors and recurrent medullary thyroid carcinoma with elevated calcitonin levels. Proper patient preparation, including short fasting and attention to physiological biodistribution, is essential. Acquisition typically occurs about 60 min after radiotracer injection, with protocol adaptations for specific indications. The modality provides high target-to-background contrast but may be affected by physiological uptake, excretory activity, genetic factors, and technical artifacts. Radiation exposure is moderate and primarily related to urinary excretion of the radiotracer. In conclusion, [¹⁸F]FDOPA PET/CT is a highly sensitive and clinically impactful imaging technique for selected oncologic indications. Adherence to standardized technical procedures and careful interpretation of physiological variants are crucial to maximizing diagnostic accuracy and clinical utility. These recommendations aim to support harmonized use of [¹⁸F]FDOPA PET imaging in routine oncologic practice.