Lastoria S, Colao A, Vergara E, Ferone D, Varrella P, Merola B, Lombardi G, Salvatore M
Department of Nuclear Medicine, National Cancer Institute, Napoli, Italy.
Eur J Endocrinol. 1995 Jul;133(1):38-47. doi: 10.1530/eje.0.1330038.
We studied the tumor-seeking agent technetium-99m-labeled pentavalent dimercaptosuccinic acid (99mTcDMSA) to visualize 21 growth hormone (GH)-, nine prolactin (PRL)-, two mixed GH/PRL-, six adrenocorticotrophin (ACTH)-secreting and 15 clinically non-functioning pituitary adenomas, three craniopharyngiomas and one dysgerminoma of the sella. All non-adenomas and 31 out of 53 adenomas were studied before treatment: 22 after surgery and/or radiotherapy. Eight cases of acromegaly were studied before and after chronic treatment with octreotide, whereas three cases of acromegaly, one of prolactinoma and two of non-functioning adenoma were imaged before and after adenomectomy. As a control group, 27 patients without any clinical evidence of pituitary adenoma were studied: 10 of them were operated on previously and treated with iodine-131 for metastatic thyroid carcinoma, 10 had brain tumors and the remaining seven patients had functional pituitary hypersecretion (four Klinefelter's syndrome, two primary hypothyroidism and one Addison's disease). The scintigraphy was repeated after testosterone in Klinefelter's syndrome, L-thyroxine in primary hypothyroidism and cortisone administration in Addison's disease. Seventeen GH-secreting (81%), seven PRL-secreting (78%), three ACTH-secreting (50%), 15 non-functioning (100%) and one (50%) mixed adenoma significantly concentrated 99mTcDMSA, showing elevated tumor-to-background (T/B) ratios. The T/B ratios were similar in untreated and surgically treated adenomas (11.2 +/- 5.6 vs 11.8 +/- 6.2). Radiotherapy significantly lowered the 99mTcDMSA uptake to 5.1 +/- 2.8 (p < 0.1 vs untreated patients). Non-adenomatous lesions of the sella turcica did not concentrate 99mTcDMSA in the pituitary as well as brain tumors and 8 out of 10 metastatic thyroid cancers. The treatment with octreotide normalized GH and insulin-like growth factor I levels and reduced 99mTcDMSA from 15.7 +/- 4.8 to 13.5 +/- 3.9 (p < 0.05). Conversely, adequate substitutive therapy completely inhibited the uptake of the radiotracer in Klinefelter's syndrome, in primary hypothyroidism and in Addison's disease. The 99mTcDMSA scintigraphy showed an overall sensitivity of 81% (43/53) in detecting pituitary adenomas, which was increased to 95% for lesions greater than 10 mm in size. High-quality images with minimal total body radiation were obtained, enabling a good in vivo characterization of viable adenomatous tissue as well as an accurate monitoring of the effects of different therapeutic regimens.
我们研究了肿瘤寻靶剂锝-99m标记的五价二巯基丁二酸（99mTcDMSA），以对21例生长激素（GH）分泌型、9例催乳素（PRL）分泌型、2例GH/PRL混合型、6例促肾上腺皮质激素（ACTH）分泌型垂体腺瘤以及15例临床无功能垂体腺瘤、3例颅咽管瘤和1例鞍区无性细胞瘤进行显像。所有非腺瘤性病变以及53例腺瘤中的31例在治疗前进行了研究：22例在手术和/或放疗后进行了研究。8例肢端肥大症患者在使用奥曲肽进行长期治疗前后进行了研究，而3例肢端肥大症、1例催乳素瘤和2例无功能腺瘤患者在腺瘤切除术前和术后进行了显像。作为对照组，对27例无垂体腺瘤临床证据的患者进行了研究：其中10例曾接受手术治疗并使用碘-131治疗转移性甲状腺癌，10例患有脑肿瘤，其余7例患者存在功能性垂体功能亢进（4例克兰费尔特综合征、2例原发性甲状腺功能减退症和1例艾迪生病）。对克兰费尔特综合征患者给予睾酮、原发性甲状腺功能减退症患者给予左甲状腺素以及艾迪生病患者给予可的松后重复进行了闪烁显像。17例GH分泌型（81%）、7例PRL分泌型（78%）、3例ACTH分泌型（50%）、15例无功能型（100%）和1例（50%）混合型腺瘤显著摄取99mTcDMSA，肿瘤与本底（T/B）比值升高。未治疗和手术治疗的腺瘤的T/B比值相似（11.2±5.6对11.8±6.2）。放疗显著降低了99mTcDMSA摄取至5.1±2.8（与未治疗患者相比，p<0.1）。蝶鞍区的非腺瘤性病变以及脑肿瘤和10例转移性甲状腺癌中的8例在垂体中不摄取99mTcDMSA。奥曲肽治疗使GH和胰岛素样生长因子I水平正常化，并使99mTcDMSA从15.7±4.8降至13.5±3.9（p<0.05）。相反，适当的替代治疗完全抑制了克兰费尔特综合征、原发性甲状腺功能减退症和艾迪生病患者对放射性示踪剂的摄取。99mTcDMSA闪烁显像在检测垂体腺瘤方面的总体敏感性为81%（43/53），对于直径大于10mm的病变，敏感性提高到95%。获得了高质量图像且全身辐射最小，能够在体内很好地对存活的腺瘤组织进行特征描述，并准确监测不同治疗方案的效果。
