technetium-tc-99m-medronate and Carcinoid-Tumor

Bone metastases are assumed to be rare in carcinoid disease and to be associated mainly with bronchial primaries. The aim of the present study was to evaluate the occurrence of bone metastases in patients with metastatic carcinoid tumours, and the role of various nuclear medicine modalities (bone scintigraphy, (111)In-pentetreotide and (131)I-MIBG) in its detection and clinical management. Nine (2 women, 7 men, median age 65 years) out of 86 consecutive carcinoid patients treated between 1987 and 1998 developed bone metastases (10%) with a median interval of 37 months between the diagnosis of metastatic carcinoid and bone metastases. Seven of them had non-bronchial primaries. (111)In-pentetreotide scintigraphy failed to detect the bone lesions in 50% of the cases, and (131)I-meta-iodobenzylguanidine(MIBG) scintigraphy in almost 80% of cases. Standard bone scintigraphy, however, was positive in all. Pain relief of bone metastases by means of radiation therapy was obtained in 5 of 6 patients. In another patient palliation of pain symptoms was obtained with Rhenium-186-hydroxyethylidene diphosphonate. Octreotide, Interferon of MIBG were ineffective for this purpose. It is concluded that bone metastases in carcinoid patients may be missed on (131)I-MIBG and (111)In-pentetreotide scintigraphy. Bone scintigraphy is a sensitive imaging technique. Diagnostic nuclear medicine modalities may be helpful in the clinical management of carcinoid disease.

Topics: 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Appendiceal Neoplasms; Bone Neoplasms; Carcinoid Tumor; False Negative Reactions; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasms, Unknown Primary; Octreotide; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Rectal Neoplasms; Technetium Tc 99m Medronate

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

In order to evaluate the diagnostic reliability of somatostatin receptor scintigraphy (SRS) in patients treated with somatostatin analogs, ten patients with metastatic neuroendocrine tumors were investigated before and during continuous treatment. Different somatostatin analogs were used for therapy: five patients received octreotide (Sandostatin, Sandoz, Switzerland) and five were treated with BIM 23014 (Lanreotide, Ipsen Biotech, France) within the scope of a clinical phase II study. The SRS findings were analyzed in terms of biodistribution of the labeled somatostatin analog and tumor visualization comparing the two studies in each patient. Whereas liver, spleen, and kidney uptake were decreased during octreotide treatment and increased on lanreotide therapy, tumor accumulation was intensified in all but one patient. Our results suggest that the diagnostic value of SRS is not necessarily restricted during treatment with somatostatin analogs. Indeed, tumor visualization may even be enhanced in this therapeutic setting.

Topics: Adult; Aged; Antineoplastic Agents; Biomarkers, Tumor; Carcinoid Tumor; Female; Humans; Indium Radioisotopes; Liver Neoplasms; Male; Metabolic Clearance Rate; Middle Aged; Octreotide; Pentetic Acid; Peptides, Cyclic; Radionuclide Imaging; Receptors, Somatostatin; Somatostatin; Technetium Tc 99m Medronate; Tissue Distribution

We present a case of thymic carcinoid, in which primary and metastatic lesions of lymph nodes and bones could be detected by [(18)F]fluoro-2-deoxy-D-glucose (FDG)-PET, but not by (123)I-meta-iodobenzylguanidine ((123)I-MIBG) SPECT, or by (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy. FDG-PET may be a useful tool for managing thymic carcinoids in patients with negative results on (123)I-MIBG SPECT or (99m)Tc-MDP imaging.

Topics: 3-Iodobenzylguanidine; Aged; Bone Neoplasms; Carcinoid Tumor; Fluorodeoxyglucose F18; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Male; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thymus Neoplasms

Surgery is the treatment of choice for bronchial carcinoid tumor (BCT), whenever the staging is adequate. There is little information about the capability of the somatostatin receptor scintigraphy (SRS) to detect bone metastases in the carcinoid tumor.. This work has aimed to evaluate retrospectively the diagnostic accuracy of the SRS in the detection of bone metastases in BCT.. Based on their clinical indication, the patients were classified into two different groups: Group A (n = 4), staging of a known BCT; and Group B (n = 6), treatment control. The SRS results could be correlated with the CT results in all 4 patients from the group A, and in one patient from the group B, and the SRS results were compared with the clinical follow up during at least one year in the other 5 patients.. The SRS scan detected the 4 BCT from the group A; in 2 of them the patient staging was superior when the SRS was used than with the CT, whereas the scan overestimated the tumor stage (BCT + sarcoidosis) in another patient. During the clinical course, one of these patients developed bone and liver metastases. The SRS was normal in 5 asymptomatic patients from group B, whereas the scan showed disseminated metastatic disease (liver, bone, spleen and lymph nodes) in another patient. In the 2 patients with bone metastases, the total number of bone metastases detected by the bone scan was 12, and by the SRS 8. The four lesions that were not detected by SRS were located in the ribs (n = 3) and 12-D (n = 1).. The capability of the SRS to detect bone metastases makes it more useful in BCT staging. Over the next few years, the role of the bone scan and SRS in the detection of bone metastases in carcinoid tumors needs to be established.

Topics: Adult; Aged; Biomarkers, Tumor; Bone Neoplasms; Bronchial Neoplasms; Carcinoid Tumor; Female; Humans; Indium Radioisotopes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Proteins; Octreotide; Pentetic Acid; Radiopharmaceuticals; Receptors, Somatostatin; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

At present, algorithms used in nuclear medicine to reconstruct single photon emission computerized tomography (SPECT) data are usually based on one of two principles: filtered backprojection and iterative methods. In this paper a different algorithm, applying an artificial neural network (multilayer perception) and error backpropagation as training method are used to reconstruct transaxial slices from SPECT data. The algorithm was implemented on an Elscint XPERT workstation (i486, 50 MHz), used as a routine digital image processing tool in our departments. Reconstruction time for a 64 x 64 matrix is approximately 45 s/transaxial slice. The algorithm has been validated by a mathematical model and tested on heart and Jaszczak phantoms. Phantom studies and very first clinical results ((111)In octreotide SPECT, 99mTc MDP bone SPECT) show in comparison with filtered backprojection an enhancement in image quality.

Topics: Algorithms; Carcinoid Tumor; Computer Simulation; Heart; Humans; Image Processing, Computer-Assisted; Neural Networks, Computer; Octreotide; Phantoms, Imaging; Radiopharmaceuticals; Spine; Stomach Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Major neuroendocrine tumors contain many somatostatin receptors. This feature allows for the localization of primary tumors and tumor metastases by scintigraphy with the radiolabeled somatostatin analog octreotide. We describe a patient with nonspecific clinical data and ultrasonography and CT that showed an isolated focal lesion in the liver. In-111 octreotide scintigraphy was essential in establishing the diagnosis of liver metastasis from a neuroendocrine tumor confirmed by pathologic findings. Because clinical symptoms recurred, ultrasonography and CT were performed a few months after surgery. Both were negative. However, In-111 octreotide scintigraphy suggested multiple bone metastases and established the diagnosis of bone metastases from a neuroendocrine tumor, which was confirmed by Tc-99m MDP bone scans and MRI.

Topics: Bone Neoplasms; Carcinoid Tumor; Follow-Up Studies; Humans; Indium Radioisotopes; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasms, Unknown Primary; Octreotide; Pelvic Bones; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

Superimposition of SPECT and computed tomography (CT) slices from the thoracoabdominal region was achieved without the use of external markers for 14 studies in 13 patients with endocrine carcinoma. Technical feasibility and clinical validation of this retrospective fusion method were assessed.. Patients had a history of thyroid cancer or of carcinoid tumor. To detect tumor sites, CT scan and dual-isotope tomoscintigraphy were performed, with 99mTc-hydroxymethylene diphosphonate for bone scintigraphy and with 111In-pentetreotide, 131I or 131I-metaiodobenzylguanidine for tumor scintigraphy (TS). A superimposition method previously developed for the pelvic region was adapted to the nonrigid thoraco-abdominal region. CT-bone scintigraphy and CT-TS superimposed images were obtained. Clinical validation of the information obtained from the superimposed images was obtained from surgery or follow-up imaging studies performed after clinical evolution of the disease process.. Reliable and reproducible registration was achieved in all patients. CT-TS superimposed images produced accurate localization of abnormal TS foci. Accuracy was limited primarily by variable relative displacements of the thoracoabdominal organs. For 10 sites in 8 patients, localization and/or characterization obtained from CT-TS images was confirmed by a reference technique. Superimposition enabled the localization of tumor sites that otherwise could not have been suspected from CT alone and allowed the characterization of CT suspicious masses and the confirmation of CT positive sites. Nonspecific tumor TS uptake sites were also localized.. With standard CT and dual-isotope SPECT acquisitions, SPECT-CT fusion is feasible in the thoracoabdominal region without the use of external markers. Fused images were validated in 8 patients for 10 sites. The use of this technique could probably improve the management and care of patients with endocrine carcinoma.

Topics: 3-Iodobenzylguanidine; Abdominal Neoplasms; Carcinoid Tumor; Carcinoma, Medullary; Feasibility Studies; Humans; Image Processing, Computer-Assisted; Indium Radioisotopes; Iodine Radioisotopes; Iodobenzenes; Octreotide; Pentetic Acid; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Medronate; Thoracic Neoplasms; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Compared to other primary neoplasms, bone metastases from carcinoid tumor are rare. Because some lesions may be clinically or radiographically occult, the radionuclide bone scan can be very helpful in delineating the extent of disease. The authors report a case of a patient with clinically occult widespread metastatic disease detected by bone scan, with radiographic correlation.

Topics: Bone and Bones; Bone Neoplasms; Carcinoid Tumor; Female; Humans; Middle Aged; Radiography; Radionuclide Imaging; Rectal Neoplasms; Technetium Tc 99m Medronate

Topics: Adult; Bone Neoplasms; Carcinoid Tumor; Humans; Male; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate