succimer and Thyroid-Neoplasms

Thyroid scans yield functional information useful in the differential diagnosis of thyroid nodules and are usually performed with TcO4-99m for its favourable physical properties, availability, low cost and good correlation with I123. Cold thyroid nodules are very frequent and generally due to benign diseases. To distinguish the minority representing carcinomas, classes of risk must be selected, according to multiple factors, including external radiation exposure, sex, age, iodine intake and thyroid morphology. These patients will undergo fine needle biopsy which can make the final diagnosis. Its accuracy is often preferred as a first line modality in the diagnostic approach to thyroid nodules. Tumour imaging agents are very useful in the staging and follow-up of thyroid carcinomas, but are rarely needed in the primary diagnosis of the disease.

Topics: Antibodies, Monoclonal; Biopsy, Needle; Diagnosis, Differential; Gallium Radioisotopes; Humans; Iodine Radioisotopes; Radionuclide Imaging; Succimer; Thallium Radioisotopes; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule

We have presented a case of sporadic medullary carcinoma of the thyroid with documentation of localization of tracer 131I-MIBG within the primary neoplasm. A review of the nuclear medicine literature of localization techniques for MCT demonstrates that 131I-MIBG, while an excellent choice for diagnosis of pheochromocytoma and neuroblastoma, produces low yield and unpredictable concentration in other neural crest apudomas, including MCT. A low incidence of true-positive results with 131I-MIBG uptake and a high incidence of false-negative results make this radiopharmaceutical a suboptimal choice for diagnostic studies, but a potentially promising one as a therapeutic agent.

Topics: 3-Iodobenzylguanidine; Aged; Antineoplastic Agents; Carcinoma; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Tomography, X-Ray Computed

Topics: Calcitonin; Carcinoembryonic Antigen; Carcinoma, Medullary; Humans; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Thyroidectomy

We report a case of metastatic insular carcinoma of the thyroid evaluated with 201TI, 99mTc-MIBI, 99mTc-(V)DMSA, 99mTc-MDP and 131I whole-body scans, which were obtained after total thyroidectomy. For the majority of lesions detected in the skeleton and soft tissue, 131I images were generally available, although most were visualized easier with 99mTc-(V)DMSA. Technetium-99m-MDP images were considered better than 99mTc-(V)DMSA images in showing bone lesions but not soft-tissue lesions. Both 201TI and 99mTc-MIBI scans provided sufficient advantage to exhibit neck and mediastinal metastases, but they did not surpass 99mTc-(V)DMSA in detecting abdominal or bony lesions. In this patient with various metastases from insular carcinoma of the thyroid, 99mTc-(V)DMSA seemed to be the tracer of choice for whole-body imaging.

Topics: Bone Neoplasms; Carcinoma, Medullary; Female; Humans; Iodine Radioisotopes; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Soft Tissue Neoplasms; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Neoplasms

Medullary carcinoma of the thyroid gland is a rare tumor. Its prognosis is mainly linked to surgery, because there is no valid alternative therapy to improve patients outcome. In this report, we discuss the recurrence of such a tumor in a 64-year-old female, focusing on magnetic resonance imaging and position emission tomography evaluation of this tumor.

Topics: 3-Iodobenzylguanidine; Carcinoma, Medullary; Deoxyglucose; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Iodine Radioisotopes; Iodobenzenes; Lymphatic Metastasis; Magnetic Resonance Imaging; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Recurrence; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Thyroidectomy; Tomography, X-Ray Computed

Radionuclide scanning with tumour-seeking agents such as pentavalent technetium-99m dimercaptosuccinic acid [99mTc(V)-DMSA], thallium-201 and technetium-99m sestamibi (MIBI) has been reported to be useful in the detection of medullary thyroid carcinoma (MTC). We undertook a study in 14 MTC patients to determine the comparative imaging potential of 201Tl, MIBI and 99mTc(V)-DMSA in the detection of recurrent or metastatic MTC. All patients underwent total thyroidectomy and had persistently elevated serum calcitonin levels after the surgery. Scintigraphic studies were carried out 20 min after the injection of 111 MBq of 201Tl or 555 MBq of MIBI and 2 h following the injection of 370 MBq of 99mTc(V)-DMSA. All scintigraphic findings were correlated with contemporaneous CT or MRI studies. CT, MRI and bone scans showed 42 (26 bone, 16 soft tissue) metastatic sites in 11 of the 14 patients. In the remaining three patients no lesions were detected during diagnostic evaluation. 99mTc(V)-DMSA showed all of the soft tissue metastases but could not show two bone lesions. On the other hand, MIBI imaging was false-negative in 22 (52%) sites and 201Tl was false-negative in 34 (80%) sites. Overall, lesion detection sensitivities for 99mTc(V)-DMSA, MIBI and 201Tl were 95%, 47% and 19% respectively. We conclude that 99mTc(V)-DMSA is clearly superior to MIBI and 201Tl in the follow-up of MTC patients.

Topics: Adult; Aged; Bone Neoplasms; Calcitonin; Carcinoma, Medullary; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Soft Tissue Neoplasms; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Neoplasms

99Tcm-tetrofosmin imaging was performed in 23 thyroid cancer patients and compared with whole-body 131I scans, neck ultrasonography and plasma thyroglobulin levels. Of 22 patients with differentiated thyroid cancer, 8 showed identical images on 131I scan and tetrofosmin; 1 patient with medullary cancer had identical images with 99Tcm-DMSA and 99Tcm-tetrofosmin, the findings being confirmed by sonography. The potential usefulness of 99Tcm-tetrofosmin imaging in the follow-up of thyroid cancers is discussed.

Topics: Biomarkers, Tumor; Follow-Up Studies; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Neoplasm Metastasis; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroglobulin; Thyroid Neoplasms; Ultrasonography

Topics: Carcinoma, Papillary; Female; Humans; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

A case of recurrent medullary thyroid cancer (MTC) was evaluated with 123I-MIBG, 99mTc(V)-dimercaptosuccinic acid (DMSA), and 201Tl scintigraphy. This patient had been operated on for MTC in the right thyroid. Recently a left neck mass was noticed, and was suspected of being a recurrence of MTC based on increased plasma calcitonin (CT) and carcinoembryonic antigen (CEA). He was operated on for the neck mass which revealed MTC, and papillary thyroid cancer was incidentally found in the left thyroid, but the CT and CEA levels remained high, and remaining MTC tumor was suspected. But the location of the tumor was unknown. Although 99mTc(V)-DMSA scintigraphy is generally believed to be superior in sensitivity to 123I-MIBG scintigraphy, it did not demonstrate the tumor site but 201Tl and 123I-MIBG did. Furthermore, 123I-MIBG scintigraphy has greater specificity for tumors which arise in the neural crest. Judging from the results of this case and cases reported in the literatures, both 123I-MIBG and 99mTc(V)-DMSA should be performed in the detection of recurrent MTC.

Topics: 3-Iodobenzylguanidine; Humans; Iodobenzenes; Male; Middle Aged; Radionuclide Imaging; Recurrence; Succimer; Thyroid Neoplasms

Detection of recurrence from medullary thyroid carcinoma (MTC) remains a diagnostic problem, especially when increased serum tumour marker levels suggest recurrence and conventional imaging techniques are non-diagnostic. In this study, we performed 111In-octreotide and 99mTc(V)-dimercaptosuccinic acid (DMSA) scans in a series of eleven patients with MTC presenting with elevated serum tumour markers after surgery. 111In-octreotide whole body studies detected tumour in six of the eleven patients studied and detected nine tumoral localizations. 99mTc(V)-DMSA whole body studies detected tumour in five of the eleven patients studied and eight tumoral localizations. 111In-octreotide and 99mTc(V)-DMSA studies detected recurrence in all four patients with basal calcitonin levels above 1000 ng/l. We conclude that 111In-octreotide and 99mTc(V)-DMSA studies have limited sensitivity to detect recurrence in patients with MTC, although their sensitivity may improve with high serum calcitonin levels. These radionuclide imaging techniques should be employed when conventional imaging techniques are negative or inconclusive or, in the case of 111In-octreotide studies, should be employed when we went to investigate the presence of somatostatin receptors that provide the basis for treatment with somatostatin analogues.

Topics: Adult; Biomarkers, Tumor; Calcitonin; Carcinoma, Medullary; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Octreotide; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

For this study, 24 patients with medullary thyroid cancer (MTC) and 10 with carcinoid-/GEP-tumours underwent scintigraphy with 123I-Tyr3-octreotide or 111In-DTPA-D-Phe1-octreotide (Octreoscan) or 99mTc-V-DMSA. Calcitonin and CEA were elevated in MTC patients, the other had tumour lesions on CT. Octreoscan-scintigraphy was positive in 68% of all suspicious cases. On the other hand, 123I-Tyr3-octreotide showed only rarely positive results. 99mTc-V-DMSA-scans in MTC patients were positive in 23%. Liver metastases could be seen only with Octreoscan in the non-MTC-group. These results showed better sensitivity of 111In-labelled octreotide.

Topics: Adult; Aged; Calcitonin; Carcinoembryonic Antigen; Carcinoid Tumor; Carcinoma, Medullary; False Positive Reactions; Female; Gastrointestinal Neoplasms; Humans; Indium Radioisotopes; Iodine Radioisotopes; Liver Neoplasms; Male; Middle Aged; Octreotide; Organotechnetium Compounds; Pancreatic Neoplasms; Pentetic Acid; Radionuclide Imaging; Receptors, Somatostatin; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Local and lymphnodal recurrences of medullary thyroid carcinoma (MTC) in thyroidectomy patients with elevated plasma levels of calcitonin and/or CEA can be detected using 111In-pentetreotide (Octreoscan: OCT) scintigraphy, although the sensitivity of this technique in localizing an intrathyroid recurrence of tumor is affected by the low target/non-target uptake ratio. The survival rate of patients with MTC, who have undergone thyroidectomy and who show evidence of a rise in plasma levels of calcitonin and/or CEA is closely linked to the number and localization of the metastases. However the role of conventional imaging techniques (X-rays, US, CT, and MR) in the follow-up after thyroidectomy is controversial. Numerous radiocompounds are currently being used to detect local and distant recurrences of MTC. The present study evaluated OCT and pentavalent 99mTc-dimercapto-succinic-acid (99mTc-DMSA-V) scintigraphy performed in 13 patients with a histologic diagnosis of MTC and in one with MEN 2A, all of whom had undergone thyroidectomy between 3 months and 15 years before. The patients also underwent 123I (NaCI) scintigraphy to evaluate the sites and extension of thyroidal remnants. 111In-pentetreotide scintigraphy was positive in 9/14 patients (64%); the 99mTc-DMSA-V was positive in 5/14 patients (35%). 111In-pentetreotide scintigraphy recognized 18 sites of abnormal uptake (12 in the neck); 9mmTc-DMSA-V detected 9 MTC recurrences in the same patients. In conclusion, 111In-OCT scintigraphy represents, in the authors' experience, a useful method, more sensitive than 9mmTc-DMSA-V, to detect MTC recurrences in patient follow-up post-thyroidectomy.

Topics: Adult; Aged; Calcitonin; Carcinoembryonic Antigen; Carcinoma, Medullary; Diagnostic Imaging; Female; Follow-Up Studies; Humans; Indium Radioisotopes; Iodine Radioisotopes; Lymphatic Metastasis; Male; Middle Aged; Multiple Endocrine Neoplasia Type 2a; Neoplasm Recurrence, Local; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Somatostatin; Succimer; Survival Rate; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Thyroidectomy

We have investigated the presence of somatostatin receptors on the cell surface of metastatic medullary thyroid carcinoma in vivo using 111In-Octreotide scintigraphy. Five patients were studied before and three months after therapy with octreotide (300-600 micrograms/day). After each 111In-Octreotide scintigraphy the target/background (T/B) radioactivity ratio was calculated for each detectable metastases. A total of 14/18 metastases showed a reduction in the T/B ratio after therapy, suggesting saturation or down-regulation of the somatostatin receptors on metastases induced by octreotide therapy. Patients also showed a reduction in serum calcitonin levels after therapy. We conclude that 111In-Octreotide scintigraphy may be useful in medullary thyroid carcinoma to evaluate the rationale for somatostatin therapy and to monitor the effect of treatment.

Topics: Adult; Aged; Antineoplastic Agents, Hormonal; Calcitonin; Carcinoma, Medullary; Down-Regulation; Female; Follow-Up Studies; Humans; Indium Radioisotopes; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Octreotide; Organotechnetium Compounds; Radiopharmaceuticals; Receptors, Somatostatin; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The aim of this study was to evaluate the effectiveness of a recently developed radiolabelled somatostatin analog (111In-pentetreotide) for the detection and localization of both medullary thyroid carcinoma (MTC) and carcinoid tumors, and to compare the results obtained with the results of 99mTc(V)-DMSA, and radioiodinated MIBG imaging. 111In-pentetreotide scintigraphy was performed in 9 patients with MTC and in 9 patients with carcinoid tumor. Whole body and SPECT studies were performed at 4 and 24 hours post-injection. SMS scintigraphy gave a positive result in 5 out of 7 patients with proven MTC lesions, and in 7 out of 9 patients with known lesions of carcinoid tumor. It gave a negative result in 2 MTC patients with high levels of calcitonin but with no evidence of disease at conventional diagnostic modalities. The scintigraphic results were comparable with those obtained with 99mTc(V)-DMSA in MTC and were superior to those of radioiodinated MIBG in both MTC and carcinoid tumors. When compared with the modifications of calcitonin levels brought about by the acute administration of octreotide ("Octeotride test"), these correlated well in 8 out of 9 patients studied.

Topics: 3-Iodobenzylguanidine; Adult; Aged; Antineoplastic Agents, Hormonal; Calcitonin; Carcinoid Tumor; Carcinoma, Medullary; Female; Follow-Up Studies; Humans; Indium Radioisotopes; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Octreotide; Organotechnetium Compounds; Radiopharmaceuticals; Somatostatin; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon

Topics: Adrenal Gland Neoplasms; Adult; Breast Neoplasms; Carcinoma, Medullary; False Positive Reactions; Female; Fibrocystic Breast Disease; Humans; Multiple Endocrine Neoplasia; Organotechnetium Compounds; Pheochromocytoma; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

We describe a simple method of pentavalent technetium-99m dimercaptosuccinic acid [99mTc(V)-DMSA] preparation for the imaging of medullary carcinoma of the thyroid using commercially available kits. 99mTc(V)-DMSA is available at high pH (approximately 7.5) by adding NaHCO3 solution in the presence of a small amount of reducing agent (SnCl2). On the other hand, trivalent 99mTc-DMSA [99mTc(III)-DMSA] can be obtained at low pH (below 3) in the presence of an excess amount of reducing agent. In the clinical evaluation of a patient with a medullary carcinoma of the thyroid, only 99mTc(V)-DMSA revealed an area of intense accumulation.

Topics: 3-Iodobenzylguanidine; Aged; Carcinoma, Medullary; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Organotechnetium Compounds; Radionuclide Imaging; Reagent Kits, Diagnostic; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thallium; Thallium Radioisotopes; Thyroid Neoplasms

Topics: Carcinoma, Medullary; Female; Humans; Lymphatic Metastasis; Middle Aged; Neck; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Patients who undergo thyroidectomy for medullary carcinoma of the thyroid gland (MTC) often have elevations of postoperative serum calcitonin levels, which are indicative of metastatic or residual disease. It has been extremely difficult to localize tumor in these patients with standard diagnostic studies such as ultrasonography, computed tomography, or magnetic resonance imaging scans. Previous studies have suggested that planar technetium 99m (V) dimercaptosuccinic acid (DMSA) scintigraphic scans can localize MTC in these patients. We have recently increased the sensitivity of planar scintigraphic images by using single-photon emission tomography (SPECT). This study was performed to compare the sensitivity of planar DMSA scans with that of SPECT DMSA scans.. Two normal volunteers and three patients with occult MTC after previous total thyroidectomy underwent planar and SPECT DMSA scans. Each patient subsequently underwent surgical exploration based on the DMSA scans.. Physiologic DMSA uptake was noted in the nasopharynx, axial skeleton, breast, liver, spleen, heart, kidneys, urinary bladder, great vessels, and skeletal muscles in both normal volunteers and patients with occult MTC. Planar DMSA scans and dynamic computed tomographic scans failed to localize MTC in any of these patients who had minimal disease. SPECT DMSA scans correctly localized cervical MTC in two of three patients, as proved by subsequent surgical resection. One patient who had a negative cervical exploration is presumed to have had a false-positive SPECT DMSA scan.. SPECT DMSA scans appear to be a sensitive, safe, and noninvasive localization technique for patients with occult MTC who have undergone previous thyroidectomy.

Topics: Adult; Carcinoma, Medullary; Female; Humans; Male; Preoperative Care; Succimer; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon

In a patient with metastatic Hurthle cell carcinoma of the thyroid, a subgroup of follicular carcinoma, scintigraphy with pentavalent 99mTc-labeled dimercaptosuccinic acid (V)DMSA showed a significant uptake of the radiopharmaceutical in all tumor sites. We suggest that the accumulation of 99mTc-(V)DMSA within metastases of Hurthle cell thyroid tumor may have a useful role in the staging of these patients, especially when radioiodine fails to concentrate.

Topics: Adenoma; Female; Humans; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

The 10-year survival rate for medullary carcinoma of the thyroid (MCT) is 50%; thus, good tumor-seeking radiopharmaceuticals are needed to localize foci of recurrence and metastasis during follow-up. Two patients with metastatic MCT were studied with Tl-201, I-131 MIBG, Tc-99m (V)-DMSA, and Tc-99m MIBI. A SPECT study with the latter agent allowed the visualization and precise localization of a metastatic mediastinal lymph node. More studies need to be done to evaluate the role of Tc-99m MIBI in the detection of recurrence and metastases of MCT.

Topics: Adult; Aged; Carcinoma, Medullary; Evaluation Studies as Topic; Female; Humans; Lymphatic Metastasis; Male; Neoplasm Recurrence, Local; Organotechnetium Compounds; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Sestamibi; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon

To compare the effectiveness of thallium chloride 201 and technetium 99m pentavalent dimercaptosuccinic acid in evaluating medullary carcinoma of the thyroid (MCT), eight patients with a history of MCT underwent imaging with both radiopharmaceuticals. Thallium 201 consistently gave superior images, as well as providing one less false-negative scan. Positive scans were obtained in patients with elevation of basal calcitonin levels to more than 1,000 ng/L. All of the patients with positive scans had clinical evidence of local recurrence. Improved imaging with thallium 201 was obtained by early scanning.

Topics: Calcitonin; Carcinoma; Female; Follow-Up Studies; Humans; Male; Neoplasm Recurrence, Local; Organotechnetium Compounds; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thallium Radioisotopes; Thyroid Neoplasms; Tomography, Emission-Computed; Whole-Body Counting

Ten patients with suspected primary, recurrent or metastatic medullary carcinoma of the thyroid (MCT) were studied prospectively with Tc-99m(V) DMSA. Of these, two patients had primary disease, seven patients were asymptomatic but had persistent and serial elevations in serum calcitonin following previous thyroid resections for MCT, and one asymptomatic patient with normal serum calcitonin was studied because of suspected hilar nodes metastases. The serial calcitonin peak in the patients was 0.04-43ng/ml (normal less than 0.08ng/ml). Scintigraphy was considered positive in seven of the asymptomatic patients and equivocal in one. The two patients with primary disease had increased uptake before but not after thyroidectomy. Primary disease, localized recurrence and distant metastases in soft tissue (nine patients) and bone (one patient) were detected in these patients, and this resulted in early surgical resection (five patients) and radiotherapy (one patient). We conclude that Tc-99m(V) DMSA is a useful imaging agent in the evaluation of asymptomatic MCT patients with hypercalcitonemia.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Soft Tissue Neoplasms; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

To search for the tumour localization mechanism of Tc(V)-DMS, a polynuclear pentavalent technetium complex of dimercaptosuccinic acid [Tc(V)-DMS], the development of medullary thyroid carcinoma (MTC) bearing mouse model was considered. Subcutaneously transplanted tumour was allowed to grow for 2, 4 and 6 weeks, and the influence of the tumour stage on the biodistribution of Tc(V)-DMS was screened. High radioactivity uptake in the tumour tissue was observed, and this accumulation showed a direct correlation with tumour growth and calcitonin secretion, the MTC marker detectable in the blood serum. The gathered data implicated some calcitonin-related factors as the mediator in the Tc(V)-DMS localization; participation of a phosphate-like oxoanion, TcO4(3-), is strongly suggested not only by the high radioactivity accumulation in the calcitonin-producing tumour but also by the accumulation in the bones of this model animal.

Topics: Animals; Calcitonin; Carcinoma; Male; Mice; Mice, Inbred BALB C; Mice, Nude; Neoplasm Transplantation; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Tissue Distribution

Topics: Carcinoma; False Positive Reactions; Humans; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

This case report describes 99mTc(V)-dimercaptosuccinic acid (DMSA) accumulation in a pheochromocytoma in a patient with Sipple's syndrome. Scintigraphy with 99mTc(V)-DMSA demonstrated uptake in medullary carcinoma of the thyroid gland (MCT). Iodine-131 metaiodobenzylguanidine (MIBG) scintigraphy showed the bilateral pheochromocytomas but did not demonstrate uptake in the MCT.

Topics: 3-Iodobenzylguanidine; Adrenal Gland Neoplasms; Carcinoma; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Multiple Endocrine Neoplasia; Organotechnetium Compounds; Pheochromocytoma; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

99mTc(V)-DMSA scintigraphy is a non-invasive diagnostic tool for diagnostic differentiation and localisation of medullary carcinoma of the thyroid. For primary tumours its sensitivity is 77%. This diagnostic means is not only helpful for the diagnosis of primary tumours, but is especially informative for recidives and metastases of the medullary carcinoma of the thyroid. Its sensitivity for recidives and metastases is 66%. The sensitivity obtained in our study, which included four patients, corresponded to that reported in the literature.

Topics: Aged; Carcinoma; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Many noninvasive high-quality imaging tests are widely available to assist in the evaluation of thyroid nodules. These include thyroid scans, computed tomography, ultrasonography, and magnetic resonance imaging. These procedures and other less commonly performed tests are reviewed. Their routine role in the diagnosis of thyroid carcinoma, however, has been, for the most part, obviated by the convenience and accuracy of fine needle aspiration cytology. Special situations in which imaging tests are most useful are discussed.

Topics: 3-Iodobenzylguanidine; Adolescent; Adult; Child; Citrates; Citric Acid; Contrast Media; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Magnetic Resonance Imaging; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thallium Radioisotopes; Thyroid Neoplasms; Tomography; Ultrasonography

Topics: Aged; Carcinoma; Female; Humans; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

I-MIBG and 99Tcm(V)-DMSA have been recently proposed as scintigraphic markers of the medullary thyroid carcinoma (MTC). Thirty two patients were examined with 131I- or 123I-MIBG and 26 of these were re-examined with 99Tcm(V)-DMSA (planar and SPECT). From our experience we can draw the following conclusions: (1) the scintigraphic attempt was useless in patients with normal levels of plasma calcitonin (CT): (2) in patients with high plasma CT levels, the sensitivity of the MIBG was better in familiar (3/3 true positive) than in sporadic disease (7/21 true positive; overall sensitivity = 42%); the 99Tcm(V)-DMSA was positive in 16/19 cases, (overall sensitivity = 84%) even in cases which had been false negative with MIBG (6 patients); (3) no false positive results were found; (4) the scan with 99Tcm(V)-DMSA is then suggested as the first imaging approach during the follow up in patients affected by MTC and still having high levels of plasma CT. The MIBG scan should be limited to the patients in whom the possible use of MIBG therapy has to be investigated.

Topics: 3-Iodobenzylguanidine; Biomarkers, Tumor; Calcitonin; Carcinoma; Humans; Iodine Radioisotopes; Iodobenzenes; Neoplasm Staging; Organometallic Compounds; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Tomography, Emission-Computed

Topics: Carcinoma; Humans; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

In the follow-up of five patients with histologic proven medullary thyroid carcinoma (MTC) and raised serum calcitonin and CEA levels the pentavalent Tc-99m-(V)-DMSA and the Tc-99m-MDP bone scan had the highest sensitivity in the localisation of metastases. Both methods are not tumor specific. A false positive Tc-99m-(V)-DMSA uptake in an old osteomyelitis of one vertebra could be demonstrated. The J-123-MIBG and In-111-F(ab2)' antibody scan did not allow to localise one of the above described metastases. In conclusion in the follow-up of patients with MTC and elevated tumor marker concentrations the Tc-99m-(V)-DMSA and the Tc-99m-MDP bone scan should be the second diagnostic procedures after sonography has been performed.

Topics: Adult; Bone Neoplasms; Calcitonin; Carcinoma; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Whole body scintigraphy with [99mTc] (v)dimercaptosuccinic acid (pentavalent DMSA) was performed in seven patients with histologically confirmed medullary carcinoma of the thyroid (MCT). Six of these patients had undergone previous thyroid resections for MCT and, although asymptomatic at the time of pentavalent DMSA scintigraphy, had persistent and serial elevations in their plasma calcitonin levels. One additional patient was scanned before and after total thyroidectomy for MCT. The pentavalent DMSA scintigram demonstrated either local neck recurrence (three patients) or distant metastases (two patients) in five of the six asymptomatic patients. In one asymptomatic patient only equivocal neck uptake was demonstrated. Since he had only minimal calcitonin elevations, repeat neck exploration was not performed. The one patient studied before thyroid resection for MCT demonstrated neck uptake before, but not after, total thyroidectomy. The results of the scintigrams had significant impact on patient care and resulted in neck re-exploration (three patients), neck biopsy (one patient), and lumbar spine biopsy and subsequent radiotherapy (one patient). These data demonstrate pentavalent DMSA to be a sensitive localizing agent in the evaluation of asymptomatic MCT patients with hypercalcitonaemia. Accurate targeting of treatment may be shown in due course to have a beneficial impact on survival.

Topics: Adult; Calcitonin; Carcinoma; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Thyroidectomy

99mTc (V) dimercaptosuccinic acid (DMSA) is a new tumor imaging agent that has been successfully used to image patients with medullary thyroid carcinoma (MTC). Since 1986, studies have been performed in 32 patients with histologically proven MTC at Guy's Hospital, London, England. Five patients with primary tumor were studied prior to surgery, four patients were studied after successful removal of the primary tumor, and 26 patients with biochemical evidence of recurrence were studied. Eight patients were studied serially to assess progression of disease, and four patients were studied before and after surgery. Twenty-one of the 26 patients with disease had positive scans with four false-negative scans and three true negative scans. One patient had a false-positive scan (sensitivity 80%, specificity 75%). Two of the false-negative scans were obtained in patients with moderate but stable elevations of calcitonin but no other evidence of recurrence. One false-negative scan was obtained in a patient who was discovered on screening to have an abnormal pentagastrin response, and a small 1 cm tumor was subsequently removed. Uptake in local neck recurrence was frequently intense, but uptake at sites of bone metastases was less marked. 99mTc (V) DMSA is an inexpensive radiopharmaceutical which produces good quality images and has been shown to have an acceptable sensitivity and specificity in the follow-up of patients with MTC and thereby contributes significantly to the management of these patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma; False Negative Reactions; Female; Humans; Male; Middle Aged; Multiple Endocrine Neoplasia; Organotechnetium Compounds; Recurrence; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Tomography, Emission-Computed

Recently developed radiopharmaceuticals have been proposed for imaging medullary thyroid carcinoma (MTC) with some having therapeutic potential. This study compares the imaging results obtained with radioiodinated meta-iodo-benzylguanidine (MIBG), 99mTc (V) DMSA, and 131I F(ab')2 anti-carcinoembryonic antigen (anti-CEA) in a group of MTC patients. In 23 patients 131I MIBG imaging showed a high specificity (no false-positive results) but a less satisfactory sensitivity (50%). In 12 patients 99mTc (V) DMSA revealed a better sensitivity (77%) but a lower specificity (three false-positive results). Positive results were obtained in two of three patients studied with 131I F(ab')2 anti-CEA. These data suggest that the highly sensitive 99mTc (V) DMSA should be considered as a first choice procedure followed by the highly specific radioiodinated MIBG to confirm the initial results. Since radioiodinated MIBG imaging may have therapeutic usefulness, 131I MIBG was evaluated in an integrated treatment protocol in four cases of proven MTC. The preliminary results obtained were encouraging.

Topics: 3-Iodobenzylguanidine; Adolescent; Adrenal Gland Neoplasms; Adult; Aged; Carcinoembryonic Antigen; Carcinoma; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Multiple Endocrine Neoplasia; Organotechnetium Compounds; Pheochromocytoma; Prognosis; Recurrence; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Tomography, Emission-Computed

The diagnostic value of 123/131I meta-iodo-benzylguanidine (MIBG) and 99mTc (V) dimercaptosuccinic acid (DMSA) was investigated in 12 patients with proven medullary thyroid carcinoma (MTC). Scintigraphic imaging with DMSA was negative in nine of 12 patients. Scintigraphy with MIBG was positive in only one case. In proven primary or recurrent disease, DMSA sensitivity was 50% and MIBG sensitivity was 25%. Such sensitivities become much lower in subjects with high calcitonin (CT) levels who have had negative surgical explorations: DMSA 17% and MIBG 0%. DMSA detected tumor in 25% of the patients and MIBG in only 8%. The positivity of these scintigraphies appears to be unrelated to carcinoembryonic antigen and CT plasma levels. Such data suggest that scintigraphies with MIBG and DMSA are only modestly useful in the diagnosis of MTC.

Topics: 3-Iodobenzylguanidine; Adolescent; Adult; Aged; Calcitonin; Carcinoma; Child; Female; Humans; Iodobenzenes; Male; Middle Aged; Multiple Endocrine Neoplasia; Organotechnetium Compounds; Radionuclide Imaging; Recurrence; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Thyroidectomy

Nine patients with histologically proven medullary carcinoma of the thyroid (MCT) were imaged using pentavalent [99mTc]dimercaptosuccinic acid [(V)DMSA], [131I] metaiodobenzylguanidine (MIBG) and [99mTc]methylene diphosphonate (MDP). Technetium-99m (V)DMSA demonstrated most of the tumor sites in eight patients with proven metastases, with an overall sensitivity of 95% in lesion detection. Iodine-131 MIBG showed definite uptake in some of the tumor sites in three of the nine patients imaged, with equivocal uptake seen in a further one patient, with sensitivity of only 11% for lesion detection. Technetium-99m MDP demonstrated bony metastases only, in four of the patients imaged yielding a sensitivity of 61%. Technetium-99m (V)DMSA has been demonstrated in this study to be a useful imaging agent in patients with MCT, showing uptake in significantly more lesions and with better imaging qualities than [131I]MIBG, and with the ability to detect soft tissue as well as bony metastases.

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Carcinoma; Humans; Iodine Radioisotopes; Iodobenzenes; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Thyroid Neoplasms

99mTc(V)-DMSA kits developed by the Radiopharmaceutical Division, Bhabha Atomic Research Centre, have been evaluated for potential use in scanning medullary carcinoma of the thyroid and its metastases. There were 15 patients with proved medullary carcinoma and 6 patients with other differentiated thyroid carcinoma. Amongst the 15 patients with medullary carcinoma, 12 (80%) showed positive localisation either in the primary or one or more metastatic sites. None of the six patients with carcinoma other than medullary showed increased concentration of 99mTc(V)-DMSA. Of the 37 known metastatic sites in 15 patients with medullary carcinoma, 24 showed concentration of 99mTc(V)-DMSA (64.9%). In addition, 99mTc(V)-DMSA concentration was seen in 14 sites where no evidence of metastasis was revealed. The incidence of 99mTc(V)-DMSA concentration in soft tissue and bone metastasis was similar.

Topics: Adult; Carcinoma; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Organometallic Compounds; Radionuclide Imaging; Reagent Kits, Diagnostic; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Medullary thyroid carcinoma (MTC), a calcitonin-producing tumor that occurs in familial and sporadic forms, can be monitored satisfactorily with measurements of calcitonin and CEA in serum. However, locating the tumor site may be difficult. In the current review of the experience with four new radionuclide tracers for MTC, the relative value of each of these procedures is outlined. Total body imaging using TI-201 chloride and Tc-99m(V) DMSA are both sensitive techniques that can be used for the detection and follow-up of MTC. Imaging using I-131 MIBG and I-131 anti-CEA antibodies/fragments should be performed once the diagnosis and the tumor site have been established, to evaluate if patients might be amenable for therapy with one of these radiopharmaceuticals.

Topics: 3-Iodobenzylguanidine; Antibodies, Monoclonal; Carcinoma; Humans; Iodine Radioisotopes; Iodobenzenes; Organometallic Compounds; Radioactive Tracers; Radioisotopes; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thallium Radioisotopes; Thyroid Neoplasms

Considering the favourable nuclear properties of 99Tcm over 67Ga, we have developed a new tumour-seeking agent, 99Tc(V)m dimercaptosuccinic acid (Tc(V)-DMSA). In order to evaluate the clinical usefulness of Tc(V)-DMSA scintigraphies, 492 patients were studied with Tc(V)-DMSA, and in some cases, where possible, the results were compared with conventional 67Ga citrate scintigraphies. There was a high degree of usefulness of Tc(V)-DMSA in patients with head and neck tumours, medullary thyroid carcinomas and soft tissue tumours. But in patients with carcinomas of the lung, liver and gastrointestinal tract, malignant melanoma and lymphoma, Tc(V)-DMSA was of no or little use.

Topics: Drug Evaluation; Gallium Radioisotopes; Head and Neck Neoplasms; Humans; Neoplasms; Organometallic Compounds; Radionuclide Imaging; Soft Tissue Neoplasms; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Topics: 3-Iodobenzylguanidine; Humans; Iodine Radioisotopes; Iodobenzenes; Organometallic Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Topics: Adult; Carcinoma; Female; Humans; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

This case report describes the localization and categorization of tumors using 99mTc(V)-dimercaptosuccinic acid and [131I]metaiodobenzylguanidine scans in a very uncommon case of medullary thyroid carcinoma associated with pheochromocytoma (Sipple's syndrome) and hepatocellular carcinoma. Technetium-99m(V)-dimercaptosuccinic acid showed accumulation only in medullary thyroid carcinoma, but [131I]metaiodobenzylguanidine scans were positive in both medullary thyroid carcinoma and pheochromocytoma. In advanced Sipple's syndrome, combined use of [99mTc(V)]dimercaptosuccinic acid and [131I]metaiodobenzylguanidine may be useful for the categorization of tumor mass lesions and planning appropriate therapy.

Topics: 3-Iodobenzylguanidine; Adrenal Gland Neoplasms; Aged; Carcinoma; Carcinoma, Hepatocellular; Humans; Iodine Radioisotopes; Iodobenzenes; Liver Neoplasms; Male; Multiple Endocrine Neoplasia; Neoplasms, Multiple Primary; Organometallic Compounds; Pheochromocytoma; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

In order to assess the role of 99Tcm pentavalent dimercaptosuccinic acid (99Tcm (V)DMSA) scanning in the management of patients with medullary carcinoma of the thyroid, we imaged 10 patients with histologically proven disease. Nine of the 10 patients were scanned after removal of the primary tumour, but with symptomatic or biochemical evidence of recurrence. One patient was imaged prior to thyroidectomy. In eight of the 10 patients 99Tcm(V)DMSA successfully identified tumour deposits, and it has been shown in this study to be a cheap, convenient radiopharmaceutical for studying this group of patients, producing high-quality images with low radiation doses, and contributing significantly to patient management.

Topics: Adolescent; Adult; Aged; Carcinoma; Female; Humans; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Topics: 3-Iodobenzylguanidine; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Carcinoma; Evaluation Studies as Topic; Humans; Iodine Radioisotopes; Iodobenzenes; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Organometallic Compounds; Radionuclide Imaging; Soft Tissue Neoplasms; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Topics: Carcinoma; Humans; Hydrogen-Ion Concentration; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thallium Radioisotopes; Thyroid Neoplasms

Topics: Adult; Aged; Carcinoma; Female; Humans; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Topics: Carcinoma; Humans; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Consequent to the promising results reported with 99mTc(V)-DMSA for imaging certain types of soft tissue tumors, we have developed methods to prepare this radiopharmaceutical in three ways: from freshly prepared reagents, through the use of a two component kit and use of the standard renal DMSA kit by a modified recipe. The 99mTc(V)-DMSA complex has been subjected to paper electrophoretic and chromatographic procedures and also biodistribution studies. The distinctly different behaviour of this new product compared to that of the well known renal DMSA complex has been clearly established. Scintiimaging in a preliminary clinical trial in patients with medullary carcinoma of the thyroid has been encouraging.

Topics: Carcinoma; Humans; Organometallic Compounds; Radionuclide Imaging; Reagent Kits, Diagnostic; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Topics: Humans; Organometallic Compounds; Radionuclide Imaging; Reagent Kits, Diagnostic; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

The value of [99mTc(V)]DMS and [131I]MIBG in imaging medullary carcinoma of the thyroid was investigated in five patients. Results with [99mTc(V)]DMS were negative in all five patients as well as with [131I]MIBG in four patients; however, there was significant tumor uptake in one patient with [131I]MIBG.

Topics: 3-Iodobenzylguanidine; Adult; Aged; Carcinoma; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Topics: Adult; Carcinoma; Carcinoma, Papillary; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Tissue Distribution

Topics: 3-Iodobenzylguanidine; Adult; Carcinoma; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Middle Aged; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms

Thyroid scintigraphy, using 99mTc(V) dimercaptosuccinic acid, was performed in four patients with pathologically confirmed medullary thyroid carcinoma and elevated serum calcitonin values. Significant uptake of the tracer was found in the clinically palpable cervical tumor masses, metastatic sites, and residual tumor. This finding, probably specific for medullary thyroid carcinoma, could be of great use in the diagnosis and the surgical follow-up.

Topics: Adenocarcinoma; Adult; Calcitonin; Carcinoma; Diagnosis, Differential; Female; Humans; Lymphoma; Male; Middle Aged; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms