(dtpa-phe(1))-octreotide and Zollinger-Ellison-Syndrome

Scintigraphy with somatostatin analogs is a sensitive method for the staging and therapeutic management of patients with endocrine gastroenteropancreatic (GEP) tumors. The aim of this study was to compare prospectively somatostatin receptor scintigraphy (SRS) using 111n-pentetreotide with bone scintigraphy using 99mTc-hydroxymethylene diphosphonate for the detection of bone metastases.. One-hundred-forty-five patients with proven endocrine GEP tumors were investigated. Patients were classified according to the presence of bone metastases as indicated by CT, MRI or histologic data. Group I included 19 patients with confirmed bone metastases, and group II included 126 patients without bone metastases.. In group I, SRS was positive in all 19 patients with bone metastases, and bone scintigraphy was positive in 17 patients. Bone metastases were found to occur predominantly in patients with liver metastases. In group 11, 5 patients had recent bone surgery for fracture or arthritis. SRS showed bone uptake in 4 of these patients, and bone scanning showed abnormal uptake in 5. In 7 of the remaining 121 group II patients, SRS was negative and bone scanning showed abnormal bone uptake suggesting bone metastases. The detection of bone metastases was of major prognostic value, because 42% of group 1 patients died during a 2-y follow-up.. In patients with GEP tumors, the accuracy of SRS appears to be similar to that of bone scintigraphy for the detection of bone metastases.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Carcinoid Tumor; Digestive System Neoplasms; Female; Humans; Indium Radioisotopes; Male; Middle Aged; Octreotide; Pentetic Acid; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Somatostatin; Technetium Tc 99m Medronate; Zollinger-Ellison Syndrome

Gastric carcinoids are of increasing clinical concern because they may develop in hypergastrinemic states, especially with the increased chronic use of potent acid suppressants that can cause hypergastrinemia. However, gastric carcinoids are difficult to diagnose. Somatostatin receptor scintigraphy (SRS) has a high sensitivity and specificity for localizing carcinoids in other locations. The purpose of this study was to determine whether SRS could localize gastric carcinoids.. Two groups of patients with Zollinger-Ellison syndrome (ZES) with hypergastrinemia, each having a different increased risk of developing gastric carcinoids, were studied. One hundred sixty-two consecutive patients with ZES were studied prospectively, with 39 having multiple endocrine neoplasia, type 1 (MEN-1) (high increased risk), and 123 not having MEN-1 (low increased risk). Patients were admitted to the hospital initially and then yearly, undergoing SRS with SPECT, upper gastrointestinal endoscopy, and Jumbo Cup biopsies of any gastric abnormalities, as well as random biopsies of the gastric body. Tumor localization studies were also performed. Both the results of the routine SRS interpretation and the results of a masked review, with particular attention to the stomach of high risk MEN-1 patients, were correlated with the gastric biopsy results.. Gastric SRS localization was positive in 19 (12%) of 162 patients. Sixteen patients had a gastric carcinoid, and 12 of these patients had SRS localization. The sensitivity of SRS in localizing a gastric carcinoid was 75%, with a specificity of 95%. Positive and negative predictive values were 63% and 97%, respectively.. SRS is a noninvasive method that can identify patients with gastric carcinoids with a reasonable sensitivity and a high specificity. SRS should prove useful in the treatment of patients with hypergastrinemic states that have an increased incidence of gastric carcinoids. In patients with MEN-1, one must realize that localization in the upper abdomen on SRS may be caused by a gastric carcinoid and not a pancreatic endocrine tumor.

Topics: Carcinoid Tumor; Case-Control Studies; Female; Humans; Indium Radioisotopes; Male; Middle Aged; Multiple Endocrine Neoplasia Type 1; Octreotide; Pentetic Acid; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Receptors, Somatostatin; Sensitivity and Specificity; Stomach Neoplasms; Tomography, Emission-Computed, Single-Photon; Zollinger-Ellison Syndrome

Topics: False Positive Reactions; Humans; Indium Radioisotopes; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Spleen; Zollinger-Ellison Syndrome

Primary cardiac tumors are rare, and there are no reports of patients with a functional gastroenteropancreatic tumor syndrome caused by such a tumor. This case report describes a patient with a cardiac gastrinoma causing Zollinger-Ellison syndrome. Evidence is presented that this tumor represents a primary cardiac tumor. The exact identification of this gastrinoma in an extra-abdominal site was facilitated by the use of [111In-DTPA-DPhe1]octreotide scanning for somatostatin receptors, which these tumors characteristically possess in high numbers. The recent availability of this novel localization method may facilitate identification of extra-abdominal sites in an increasing proportion of patients with gastrinomas and related neuroendocrine functional tumors in which no intra-abdominal primary tumor is currently found.

Topics: Adolescent; Female; Gastrinoma; Heart Neoplasms; Humans; Magnetic Resonance Imaging; Myocardium; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Zollinger-Ellison Syndrome

To compare the sensitivity of somatostatin receptor scintigraphy done using [111In-DTPA-DPhe1]octreotide with that of other imaging methods in the localization of gastrinomas in patients with the Zollinger-Ellison syndrome.. Prospective study.. Referral-based clinical research center.. 80 consecutive patients with the Zollinger-Ellison syndrome.. Conventional tumor localization studies (ultrasonography, computed tomography [CT], magnetic resonance imaging [MRI], selective angiography, and bone scanning) and somatostatin receptor scintigraphy done using [111In-DTPA-DPhe1]octreotide with single-photon emission CT imaging at 4 and 24 hours. Patients with possible liver metastases had biopsies done for confirmation, and 15 patients had exploratory laparotomies done to assess primary tumor localization.. Extrahepatic gastrinomas or liver metastases were identified by ultrasonography in 19% of patients, by CT in 38% of patients, by MRI in 45% of patients, by angiography in 40% of patients, and by somatostatin receptor scintigraphy in 70% of patients. Somatostatin receptor scintigraphy was as sensitive as the other tests combined (59%), and when the results of all other tests were added to the somatostatin receptor scintigraphy results, tumors were localized in 75% of patients. Among patients with a possible primary tumor, the results of ultrasonography were positive in 9%, the results of CT were positive in 31%, the results of MRI were positive in 30%, the results of angiography were positive in 28%, and the results of somatostatin receptor scintigraphy were positive in 58%. Somatostatin receptor scintigraphy was as sensitive as all of the other imaging studies combined; when the results of scintigraphy were added to the results of the other studies, possible primary tumors were identified in 68% of patients. In 24 patients who had histologically proven metastatic liver disease, sensitivities for the detection of any metastatic liver lesions were 46% for ultrasonography, 42% for CT, 71% for MRI, 62% for angiography, and 92% for somatostatin receptor scintigraphy. Somatostatin receptor scintigraphy was significantly better than all of the conventional imaging methods in the identification of gastrinomas later found at surgery (P = 0.004), but it still missed 20% of gastrinomas.. Somatostatin receptor scintigraphy is the single most sensitive method for imaging either primary or metastatic liver lesions in patients with the Zollinger-Ellison syndrome. Because of its sensitivity, simplicity, and cost-effectiveness, it should be the first imaging method used in these patients. For patients with negative results on somatostatin receptor scintigraphy, guidelines about the use of other imaging studies are proposed.

Topics: Adolescent; Adult; Aged; Angiography; Bone and Bones; Female; Gastrinoma; Humans; Indium Radioisotopes; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Octreotide; Pentetic Acid; Prospective Studies; Radionuclide Imaging; Receptors, Somatostatin; Sensitivity and Specificity; Tomography, X-Ray Computed; Zollinger-Ellison Syndrome

To determine the value of somatostatin-receptor scintigraphy in the localization of various endocrine gastrointestinal tumors, we compared the results obtained with this new technique with the results obtained with computed tomography and sonography. We could not find an overall advantage of somatostatin-receptor scintigraphy as compared to computed tomography or sonography in the localization of intestinal carcinoids (n = 13), gastrinomas (n = 12), functionally non-active endocrine pancreatic tumors (n = 8) and various other endocrine pancreatic tumors (n = 4). In 2 patients with endocrine pancreatic tumors however, the tumors were localized preoperatively only by somatostatin-receptor scintigraphy. Somatostatin-receptor scintigraphy may occasionally be helpful in the localization of gastrointestinal endocrine tumors if these tumors are not localized by conventional imaging studies. Somatostatin-receptor scintigraphy does not solve the problem to localize small endocrine tumors.

Topics: Biomarkers, Tumor; Carcinoid Tumor; Gastrinoma; Gastrointestinal Neoplasms; Humans; Indium Radioisotopes; Insulinoma; Multiple Endocrine Neoplasia Type 1; Octreotide; Pancreatic Neoplasms; Paraneoplastic Endocrine Syndromes; Pentetic Acid; Receptors, Somatostatin; Tomography, Emission-Computed, Single-Photon; Zollinger-Ellison Syndrome

In patients with the Zollinger-Ellison syndrome, which is either sporadic or integrated into multiple endocrine neoplasia type 1, accurate localization of all the tumours is difficult and may have therapeutic implications. In an attempt to improve this localization, somatostatin receptor scintigraphy using [111In-DTPA-D-Phe1]-octreotide was performed prospectively in 48 consecutive patients with the Zollinger-Ellison syndrome. Thirty of them had the sporadic type of this disease. Scintigraphic data were compared with data obtained by conventional imaging methods, and also, in 32 selected patients, with those obtained by endoscopic ultrasonography. Somatostatin receptor scintigraphy showed abnormal tracer uptake in 39 patients (81%), in whom it correctly identified 50 of the 60 tumoral sites (83%) previously localized by the other imaging methods. In 17 patients (35%) somatostatin receptor scintigraphy disclosed abnormal tracer uptake at 18 different tumoral sites: 14 were located in the abdomen, including four in the liver and eight in the duodenopancreatic area, and four outside the abdomen, including two in the mediastinum. Six of the ten tumoral sites which were not correctly identified by somatostatin receptor scintigraphy were located in the duodenopancreatic area. However, in the 20 patients for whom conventional techniques failed to visualize any tumour in the duodenopancreatic area, somatostatin receptor scintigraphy was positive in ten (50%) whereas endoscopic ultrasonography was only positive in five (25%). In our patients with the Zollinger-Ellison syndrome, somatostatin receptor scintigraphy appeared to be a useful new addition to the battery of tests used for tumour detection.

Topics: Bone Neoplasms; Duodenal Neoplasms; Female; Humans; Indium Radioisotopes; Liver Neoplasms; Male; Mediastinal Neoplasms; Middle Aged; Multiple Endocrine Neoplasia Type 1; Octreotide; Pancreatic Neoplasms; Pentetic Acid; Prospective Studies; Radionuclide Imaging; Receptors, Somatostatin; Ultrasonography; Zollinger-Ellison Syndrome