To the Editor: Dr Lenders and colleagues1 concluded that measurement of plasma free metanephrines
has a 99% sensitivity for pheochromocytoma, and thus a negative test result
virtually excludes this diagnosis. The main problem of this study is that
there was no criterion standard to rule out pheochromocytoma in at least 98
of the 644 patients in the "pheochromocytoma excluded" group, and several
other patients only had computed tomography. By contrast, we found that magnetic
resonance imaging (MRI) has a high sensitivity of 97% for this diagnosis.2
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