Hubalewska-Dydejczyk A, Fröss-Baron K, Mikołajczak R, Maecke H R, Huszno B, Pach D, Sowa-Staszczak A, Janota B, Szybiński P, Kulig J
Nuclear Medicine Unit, Department of Endocrinology, Medical College, Jagiellonian University, Cracow, Poland.
Eur J Nucl Med Mol Imaging. 2006 Oct;33(10):1123-33. doi: 10.1007/s00259-006-0113-7. Epub 2006 May 24.
At all stages of the disease, serious difficulties are encountered in the imaging diagnosis of carcinoids. Somatostatin receptor scintigraphy (SRS) holds great promise for detecting primary tumours and metastases. 99mTc-EDDA/HYNIC-octreotate should significantly improve the diagnosis of carcinoids in comparison with 111In-Octreoscan owing to the better affinity for SSR2 and the higher count rate. The aim of this study was to assess the diagnostic efficiency of 99mTc-EDDA/HYNIC-octreotate scintigraphy in the detection and staging of carcinoid tumours.
The study population comprised 75 patients (age 48.5+/-15.5 years): 46 with histological confirmation of carcinoid and 29 with suspected disease. 99mTc-EDDA/HYNIC-octreotate (740 MBq) SRS and CT were performed in all patients. Fifteen patients were examined with 111In-Octreoscan.
High-quality 99mTc-EDDA/HYNIC-octreotate images were obtained in all cases, with maximum tumour tracer accumulation 4 h p.i. The mean target/non-target ratios for whole body (WB) and SPECT scans were, respectively, as follows: primary lesions: 4.5 and 10.2; metastases: liver, 3.1 and 12.3; abdominal focal lesions, 2.7 and 5.8; lung, 2.7 and 8.3; mediastinum, 3.4 and 7.6; bones, 6.8 and 19.0. 99mTc-EDDA/HYNIC-octreotate WB scans revealed more metastases than 111In-Octreoscan, with better individual separation. 99mTc-EDDA/HYNIC-octreotate SRS revealed new metastatic lesions in seven patients with confirmed carcinoid, and in four with dissemination the primary focus was found. Five patients qualified for radioguided surgery and 11 were referred to 90Y-DOTA-TATE therapy. The sensitivity of SRS in comparison with CT was higher for primary lesions and liver and abdominal lymph node metastases. In the subgroup of patients with suspected neuroendocrine tumours, two duodenal carcinoids, one thymic carcinoid and one ileal carcinoid were found.
99mTc-EDDA/HYNIC-octreotate, with high imaging quality, is an excellent alternative to 111In-Octreoscan for staging of carcinoids, and it seems to be the method of choice for detection of the primary focus in patients with metastases from an unknown primary tumour.
在类癌的疾病各个阶段，其影像学诊断均面临严重困难。生长抑素受体闪烁显像（SRS）在检测原发性肿瘤和转移灶方面具有巨大潜力。与111In - Octreoscan相比，99mTc - EDDA/HYNIC - 奥曲肽由于对SSR2具有更好的亲和力以及更高的计数率，应能显著改善类癌的诊断。本研究的目的是评估99mTc - EDDA/HYNIC - 奥曲肽闪烁显像在类癌肿瘤检测和分期中的诊断效率。
研究人群包括75例患者（年龄48.5±15.5岁）：46例经组织学证实为类癌，29例疑似患有该病。所有患者均进行了99mTc - EDDA/HYNIC - 奥曲肽（740 MBq）SRS和CT检查。15例患者接受了111In - Octreoscan检查。
所有病例均获得了高质量的99mTc - EDDA/HYNIC - 奥曲肽图像，注射后4小时肿瘤示踪剂积聚达到最大值。全身（WB）和SPECT扫描的平均靶/非靶比值分别如下：原发性病变：4.5和10.2；转移灶：肝脏，3.1和12.3；腹部局灶性病变，2.7和5.8；肺部，2.7和8.3；纵隔，3.4和7.6；骨骼，6.8和19.0。99mTc - EDDA/HYNIC - 奥曲肽WB扫描显示的转移灶比111In - Octreoscan更多，且个体分离效果更好。99mTc - EDDA/HYNIC - 奥曲肽SRS在7例确诊类癌患者中发现了新的转移灶，在4例有播散的患者中发现了原发灶。5例患者符合放射性引导手术条件，11例患者被转诊接受90Y - DOTA - TATE治疗。SRS相对于CT在原发性病变以及肝脏和腹部淋巴结转移方面的敏感性更高。在疑似神经内分泌肿瘤的患者亚组中，发现了2例十二指肠类癌、1例胸腺类癌和1例回肠类癌。
99mTc - EDDA/HYNIC - 奥曲肽具有高成像质量，是111In - Octreoscan用于类癌分期的极佳替代方法，并且似乎是检测不明原发肿瘤转移患者中原发灶的首选方法。
