technetium-tc-99m-tetrofosmin and Mediastinal-Neoplasms

In patients with non-small cell lung cancer (NSCLC), surgical resection offers the best chance of cure. The preoperative assessment of mediastinal lymph node involvement is crucial to selecting those patients for whom surgery is indicated.. To evaluate the possible clinical role of (99m)Tc-tetrofosmin scintigraphy in the presurgical detection of mediastinal node metastases from NSCLC, we performed a prospective comparative study with CT on 83 patients (48 men, 35 women; age range, 38-81 y) with primary NSCLC (36 adenocarcinomas, 39 epidermoid squamous cell carcinomas, and 8 large cell anaplastic carcinomas). They underwent chest SPECT 20 min after (99m)Tc-tetrofosmin injection (740 MBq intravenously). The metastatic involvement of mediastinal nodes was assessed by histologic examination after mediastinoscopy or thoracotomy. Both chest CT and (99m)Tc-tetrofosmin scintigraphy were performed within 2 wk before the surgical staging.. Metastatic mediastinal lymph nodes were found in 35 patients. (99m)Tc-Tetrofosmin imaging in assessing the mediastinal involvement yielded a sensitivity of 85.7%, a specificity of 89.6%, and an accuracy of 88.0%; CT results were 68.6%, 75.0%, and 72.3%, respectively. SPECT accuracy was significantly higher than CT accuracy (P < 0.05). However, precise anatomic localization of (99m)Tc-tetrofosmin uptake in the mediastinum was not always present on SPECT images. (99m)Tc-Tetrofosmin SPECT precisely detected the presence or absence of lymph node metastases in 33 of the 36 patients with positive CT findings (enlarged mediastinal nodes with a short axis > or =1 cm), with an accuracy (91.7%) significantly higher (P < 0.05) than that of CT (66.7%).. (99m)Tc-Tetrofosmin SPECT is a useful presurgical noninvasive method to assess mediastinal lymph node involvement in NSCLC. In particular, it could play a clinical role in reducing the number of invasive staging surgical procedures in selected patients, especially in those with enlarged lymph nodes at CT. Fusing SPECT with CT images could further improve the interpretation of the scintigraphic data.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Staging; Organophosphorus Compounds; Organotechnetium Compounds; Preoperative Care; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Technetium-99m-tetrofosmin is a radiopharmaceutical employed for myocardial imaging, which has recently emerged as useful in the visualization of tumors. In this study technetium-99m-tetrofosmin was evaluated for its accuracy in differentiating malignant from benign pulmonary lesions, and in detecting mediastinal node metastasis due to lung cancer. Eighty-one patients with a solitary lung lesion on the chest radiograph and/or CT scan were submitted to chest single photon emission computed tomography after technetium-99m-tetrofosmin injection (740 MBq i.v.). The scintigraphic findings were correlated to the final histopathological diagnosis, demonstrating abnormal tracer accumulation in 51 of 54 malignant lesions (sensitivity 94%) and in 4 out of 27 benign conditions (specificity 85%), yielding an accuracy of 91%. Mediastinal lymph-node involvement was evaluated in 35 patients with non small cell lung cancer who underwent mediastinoscopy and/or surgery. Tetrofosmin accuracy (89%) was significantly higher than that of CT (69%, p < 0.05); the false negative scintigraphic results were in nodes sized less than 1 cm. In conclusion, technetium-99m-tetrofosmin imaging is useful in distinguishing malignant from benign pulmonary lesions, and in non-invasively assessing mediastinal node metastases from non small cell lung cancer, especially in patients with enlarged nodes by CT scan.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Diagnosis, Differential; False Negative Reactions; False Positive Reactions; Female; Humans; Lung Diseases; Lung Neoplasms; Lymphatic Metastasis; Male; Mediastinal Neoplasms; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Aged; Female; Humans; Incidental Findings; Mediastinal Neoplasms; Myocardial Perfusion Imaging; Organophosphorus Compounds; Organotechnetium Compounds; Thymoma

Topics: Diagnosis, Differential; Humans; Male; Mediastinal Neoplasms; Middle Aged; Myocardial Perfusion Imaging; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Thymoma; Thymus Neoplasms; Tomography, Emission-Computed, Single-Photon

A 58-year old woman had felt some chest pains on effort for several days. She was admitted to the emergency room with severe and refractory chest pain after exercise. Electrocardiogram showed marked ST-segment elevations in II, III, aVF and V1-6 electrodes. Echocardiogram revealed neither wall motion asynergy in the left ventricle nor abnormal pericardial effusion. Chest X-ray showed normal findings, and mild elevation of C-reactive protein was observed in the blood chemistry data. Her chest pain was relieved by nitroglycerin administration. Emergent technetium-99m-tetrofosmin myocardial imaging did not show any abnormal perfusion in the left ventricle. However, an abnormal extra-cardiac mediastinal accumulation was detected in the planar image. Contrast-enhanced chest CT scanning also demonstrated an inhomogeneously enhanced tumor in the anterior superior mediastinum. The tumor was surgically removed and was finally diagnosed as an invasive thymoma. Technetium-99m-tetrofosmin scintigraphy happened to provide useful information for diagnosing acute pericarditis with mediastinal tumor.

Topics: Acute Disease; Female; Heart; Humans; Incidental Findings; Mediastinal Neoplasms; Middle Aged; Myocardium; Neoplasm Invasiveness; Organophosphorus Compounds; Organotechnetium Compounds; Pericarditis; Radionuclide Imaging; Radiopharmaceuticals; Thymoma

Topics: Aged; Carcinoid Tumor; Cardiomyopathies; Diagnosis, Differential; Heart; Humans; Male; Mediastinal Neoplasms; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Thymoma

Topics: Adenoma; Adult; Humans; Hypercalcemia; Male; Mediastinal Neoplasms; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Topics: Adult; Diagnosis, Differential; Humans; Male; Mediastinal Neoplasms; Neuroendocrine Tumors; Organophosphorus Compounds; Organotechnetium Compounds; Radiography, Thoracic; Radiopharmaceuticals; Tomography, Emission-Computed

Topics: Adult; Humans; Male; Mediastinal Neoplasms; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Seminoma; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

We present our experience in visualizing mediastinal tumours using 99Tcm tetrofosmin. Three patients with thymic tumours and two patients with a mediastinal tumour (seminoma and small cell carcinoma) were found to have anterior mediastinal masses on chest radiographs, and subsequently underwent computed tomography and magnetic resonance imaging. In addition, the patients underwent single photon emission computed tomography (SPECT) with 99Tcm tetrofosmin and 201Tl. Intense uptake was seen on early 99Tcm tetrofosmin images in three patients with thymoma, invasive thymoma and mediastinal tumour (small cell carcinoma). In the remaining two patients with thymic carcinoma and mediastinal seminoma, there was intense 99Tcm tetrofosmin uptake on early images which reduced on delayed images. 201Tl uptake was intense on both early and delayed images. These findings suggest that different 99Tcm tetrofosmin uptake in early and delayed imaging may offer new information on these mediastinal tumours.

Topics: Adult; Aged; Carcinoma, Small Cell; Humans; Magnetic Resonance Imaging; Male; Mediastinal Neoplasms; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Seminoma; Thallium Radioisotopes; Thymoma; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed