Hubalewska-Dydejczyk A, Fröss-Baron K, Gołkowski F, Sowa-Staszczak A, Mikołajczak R, Huszno B
Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland.
Exp Clin Endocrinol Diabetes. 2007 Jan;115(1):47-9. doi: 10.1055/s-2007-948311.
Pulmonary carcinoids cause serious difficulties in imaging diagnostics in all stages of the disease. SRS holds great promise for detecting occult primary tu and metastatic lesions. (99m)Tc-EDDA/HYNIC-octreotate, a new scintigraphic agent, should significantly improve sensitivity of the diagnostics of carcinoids due to better affinity to SSR2 than (111)In-Octreoscan and the higher count rate obtained from (99m)Tc over (111)In. We present a case of a 40-year-old women operated on because of lung carcinoid tumour in 2002. The symptoms did not resolve after the operation and 5-OHIAA was still elevated. The thorax spiral CT revealed the focal lesion beneath carina. (111)In-Octreoscan and (99m)Tc-EDDA/HYNIC-octreotate SRS revealed two focal lesions in the mediastinum. (99m)Tc-EDDA/HYNIC-octreotate detected two additional lesions in the lower part of the right lung. Target/non-target count ratios of the lesions were as follows: (99m)Tc-EDDA/HYNIC-octreotate scans - 2,9, (111)In-Octreoscan- 2,1. PET-FDG examination revealed no pathology. Owing to severe bone pains and carcinoid symptoms the patient was referred for the 90Y-DOTA-octreotate treatment.
SRS with a new 99mTc marked somatostatin analogue - octreotate allows for a more sensitive detection of metastatic leasions in carcinoid tumours. The usefulness of 18F-FDG PET, widely used as a powerful imaging technique in clinical oncology, is limited in detection of carcinoid tumours due to the low proliferative activity.
肺类癌在疾病的各个阶段都会给影像诊断带来严重困难。SRS在检测隐匿性原发肿瘤和转移灶方面具有很大潜力。新型闪烁显像剂（99m）Tc-EDDA/HYNIC-奥曲肽，由于其对SSR2的亲和力优于（111）In-奥曲肽扫描剂，且（99m）Tc的计数率高于（111）In，应该能显著提高类癌诊断的敏感性。我们报告一例40岁女性病例，该患者于2002年因肺类癌肿瘤接受手术。术后症状未缓解，5-羟吲哚乙酸仍升高。胸部螺旋CT显示隆突下有局灶性病变。（111）In-奥曲肽扫描和（99m）Tc-EDDA/HYNIC-奥曲肽SRS显示纵隔有两个局灶性病变。（99m）Tc-EDDA/HYNIC-奥曲肽在右肺下部又检测到两个病变。病变的靶/非靶计数比分别为：（99m）Tc-EDDA/HYNIC-奥曲肽扫描为2.9，（111）In-奥曲肽扫描为2.1。PET-FDG检查未发现病变。由于严重的骨痛和类癌症状，该患者被转诊接受90Y-DOTA-奥曲肽治疗。
使用新型99mTc标记的生长抑素类似物——奥曲肽进行SRS，能够更敏感地检测类癌肿瘤的转移灶。18F-FDG PET作为临床肿瘤学中广泛使用的强大成像技术，由于类癌肿瘤增殖活性低，在检测类癌肿瘤方面的作用有限。
