(dtpa-phe(1))-octreotide and Meningioma

This study aimed to evaluate the diagnostic utility of 111In-DTPA-D-Phe1-octreotide scintigraphy in the different situations that can be present when an examination is requested during the clinical course of the carcinoid tumor (CT).. We have performed 41 scintigraphies with 111In-octreotide (145-185 MBq) in 35 patients (19 females and 16 males) with clinically suspected or confirmed CT. The patients were classified into five groups: Group A: Indolent symptoms of CT (n=9); B: CT staging located in lung (n=4), stomach (n=2), cecum (n=1), thymus (n=1) and pancreas (n=1); C: Carcinoid syndrome (n=1); D: CT staging after surgery located in pancreas (n=1), ovary (n=1), cecum (n=1), stomach (n=1), appendix (n=1) and ileum (n=1); and E: Post-treatment follow-up (n=13), with CT located in bronchial tree (n=5), small intestine (n=3), appendix (n=2), thymus (n=1), ovary (n=1) and unknown primary tumor (n=1). Three patients of this group had one scintigraphic study before the treatment. Head and neck, thorax and abdomen images were obtained at 4 and 24 h in all of the patients and SPECT images of the abdomen (n=14), thorax (n=10), and brain (n=1) were obtained at 24 h in 25 patients.. Group A: In the 3 patients with a positive scintigraphy, the definitive diagnosis was meningioma, Hurtle cell's carcinoma and lung adenocarcinoma. The clinical follow-up in the six other patients, at least during one year, did not show any evidence of CT. Group B: Six of the 9 CT were detected with the scintigraphy. In 2 cases of bronchial CT, the scan showed sarcoidotic regional lymph node involvement and CT hepatic and bone metastases, respectively. Group C: The scintigraphy detected hepatic metastases from an unknown primary tumor. Group D: The scintigraphy was positive in 3 cases (hepatic or/and abdominal metastases) and was normal in the other 3. The scintigraphy was negative in one patient with peritoneal metastases. Group E: The scintigraphy was normal in 7 patients in concordance with the clinical follow-up. In 3 patients with a scintigraphy performed prior to treatment, the scintigraphy detected recurrence (thymic CT), progression of the metastatic disease (ovarian CT) and partial regression of the hepatic metastases (carcinoid syndrome). In the three other patients, the scintigraphy showed metastases located in liver in one patient and hepatic and extra-hepatic metastases in the two other patients. The sensitivity and specificity of 111In-Octreotide in the detection of the primary tumor and metastases were 72% and 84% respectively.. The 111In-Octreotide scintigraphy has a low diagnostic utility in patients with indolent symptoms of CT. However, it is the first line of diagnosis for the staging of the CT and to evaluate the follow up after therapy.

Topics: Adult; Aged; Bone Neoplasms; Brain Neoplasms; Carcinoid Tumor; Diagnosis, Differential; Digestive System Neoplasms; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lung Neoplasms; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Proteins; Octreotide; Pentetic Acid; Radiopharmaceuticals; Receptors, Somatostatin; Sarcoidosis; Thymus Neoplasms; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon

Topics: Gallium Radioisotopes; Humans; Indium Radioisotopes; Meningeal Neoplasms; Meningioma; Octreotide; Pentetic Acid; Radiopharmaceuticals; Receptors, Somatostatin; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

Topics: Carcinoma, Medullary; Diagnosis, Differential; Female; Head and Neck Neoplasms; Humans; Indium Radioisotopes; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Thyroid Neoplasms

Sixty-six patients with a clinical and neuroradiological diagnosis of CNS tumors were evaluated by 111In-octreotide scintigraphy. Planar images were acquired at 2-4 and 24 hours after the injection of 111-185 MBq of 111In-octreotide (Octreoscan, Byk-Gulden). In the positive scans the tumor/non-tumor ratio was evaluated using a standard ROI method, and an uptake index (U.I.) of the lesion was determined. In vitro binding assays were performed on frozen sections from surgical specimens from 17 patients. All 32 meningiomas demonstrated a positive 111In-octreotide scan with a high U.I. Only 13 of 21 gliomas showed a positive scan, but the U.I. was significantly lower (p < 0.001 by "t"-test); one lymphoma showed a faint tracer uptake. All the other histotypes evaluated yielded negative scans. In all cases the receptorial pattern shown by the immunohistochemical staining technique was concordant with the scintigraphic results. 111In-octreotide scintigraphy allowed a differential diagnosis of meningioma versus other CNS tumors in 6 patients (4 neurinomas, 1 brain metastasis of melanoma, 1 lymphoma). In conclusion, 111In-octreotide scintigraphy is a promising tool to evaluate the SS receptorial pattern of CNS tumors and to increase the diagnostic specificity of conventional imaging providing useful information in selected cases for the therapeutic strategy.

Topics: Brain Neoplasms; Central Nervous System Neoplasms; Diagnosis, Differential; Follow-Up Studies; Frozen Sections; Glioma; Humans; Immunohistochemistry; Indium Radioisotopes; Lymphoma; Melanoma; Meningioma; Neurilemmoma; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin

The recent availability of isotope-labelled somatostatin analogues has allowed one to detect somatostatin receptors in normal tissue as well as in endocrine or non-endocrine cranial tumours. The purpose of the present study was to establish the value of somatostatin receptor scintigraphy using an 111Indium-labelled somatostatin analogue, octreotide, in the diagnostic work-up of meningioma patients. Twenty-two patients (16 women, 6 men, aged from 19-70 years) with newly diagnosed, residual or recurrent cranial meningiomas were examined. 111Indium-labelled DTPA-octreotide was injected i.v.. Planar and tomographic images were obtained with a gamma camera 4-6, and 24 hours after injection. In all of the meningiomas studied a high density of somatostatin receptors was detected by scintigraphy. No false negative test result was found. Due to this, a 100% predictive value of a negative test was calculated. However, when the tumours were taken in culture differing staining intensity could be seen in the light- and electron microscopic level even on individual cells of a single culture when silver intensified somatostatin-gold was used as ligand. We conclude, that in vivo somatostatin receptor scintigraphy may aid in the pre-operative differential diagnosis of skull base tumours.

Topics: Adult; Aged; Biomarkers, Tumor; Female; Glial Fibrillary Acidic Protein; Humans; Indium; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Octreotide; Pentetic Acid; Radionuclide Imaging; Receptors, Somatostatin; Tumor Cells, Cultured

Somatostatin receptors have been demonstrated on various tumors of neuroendocrine and other origin. They have been detected in vitro by biochemical techniques as well as by autoradiography. The development of long-acting somatostatin analogs and the recent availability of radiolabeled octreotide have made the in vivo detection of somatostatin receptors possible. This preliminary study embraced 45 patients with meningiomas, brain tumors or pituitary tumors, which were imaged by planar and tomographic scintigraphy after intravenous injection of 111Indium-labeled octreotide. In all of the meningiomas studied (unifocal and multifocal tumors in various locations), a high density of somatostatin receptors was detected by scintigraphy. Pituitary tumors were slightly positive in 50% of cases only, independent of the endocrine activity. Gliomas with an intact blood-brain barrier showed no enhanced tracer uptake in vivo, while gliomas with disturbed blood-brain barrier had a high activity uptake. We conclude that in vivo somatostatin receptor scintigraphy, although not tumor-specific, may aid in the preoperative diagnosis and staging of intracranial tumors, especially skull base tumors.

Topics: Adult; Aged; Biomarkers, Tumor; Brain Neoplasms; Female; Growth Hormone; Humans; Indium Radioisotopes; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Octreotide; Pentetic Acid; Pituitary Neoplasms; Radionuclide Imaging; Receptors, Somatostatin

111In-octreotide (Octreoscan) planar scintigraphy was performed in 12 patients with suspected meningioma. The scan was positive in 10 patients with meningioma and negative in two patients with acoustic neurinoma assisting in the differential diagnosis. Good quality images were obtained as early as 2 h after injection and there was no increase in diagnostic quality at 24 h. No adverse effects were observed to radiopharmaceutical administration. The following conclusions are drawn: 111In-octreotide is a safe and fast test which can increase the specificity of traditional neuroimaging procedures.

Topics: Adolescent; Adult; Child; Female; Humans; Indium Radioisotopes; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Octreotide; Pentetic Acid; Radionuclide Imaging; Receptors, Somatotropin