Value of Peptide Receptor Scintigraphy Using 123I-Vasoactive Intestinal Peptide and 111In-DTPA-D-Phe1-Octreotide in 194 Carcinoid Patients: Vienna University Experience, 1993 to 1998
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E-Artikel
Titel:
Value of Peptide Receptor Scintigraphy Using 123I-Vasoactive Intestinal Peptide and 111In-DTPA-D-Phe1-Octreotide in 194 Carcinoid Patients: Vienna University Experience, 1993 to 1998
Beschreibung:
<jats:p> PURPOSE: To report our experience with both <jats:sup>123</jats:sup>I-vasoactive intestinal peptide (VIP) and <jats:sup>111</jats:sup>In-DTPA-D-Phe<jats:sup>1</jats:sup>-octreotide for imaging to identify primary and metastatic tumor sites in carcinoid patients. </jats:p><jats:p> PATIENTS AND METHODS: One hundred ninety-four patients with a verified or clinically suspected diagnosis of a carcinoid tumor were injected with <jats:sup>111</jats:sup>In-DTPA-D-Phe<jats:sup>1</jats:sup>-OCT for imaging purposes, while 133 patients underwent scanning with both <jats:sup>123</jats:sup>I-VIP and <jats:sup>111</jats:sup>In-DTPA-D-Phe<jats:sup>1</jats:sup>-OCT in random order. Imaging results were compared with computed tomography scans, results of conventional ultrasound, endosonography, and endoscopy, and results of surgical exploration in case of inconclusive conventional imaging. </jats:p><jats:p> RESULTS: Primary or recurrent carcinoid tumors could be visualized with <jats:sup>111</jats:sup>In-DTPA-D-Phe<jats:sup>1</jats:sup>-OCT in 95 (91%) of 104 patients; metastatic sites were identified in 110 (95%) of 116 patients. In 11 (51%) of 21 patients with suggestive symptoms but without identified lesions by conventional imaging, focal tracer uptake located the carcinoid tumor. In addition, metastatic disease was demonstrated in three patients after resection. In a direct comparison in the 133 patients who underwent both imaging modalities, <jats:sup>111</jats:sup>In-DTPA-D-Phe<jats:sup>1</jats:sup>-OCT was found to be superior to <jats:sup>123</jats:sup>I-VIP, with 35 (93%) of 38 versus 32 (82%) of 38 scans being positive in primary or recurrent tumors, 58 (90%) of 65 versus 53 (82%) of 65 being positive in patients with metastatic sites, and seven (44%) of 16 versus four (25%) of 16 being positive in patients with symptoms but otherwise negative work-ups. Overall, additional lesions not seen on conventional imaging were imaged in 43 (41%) of 158 versus 25 (25%) of 103 scans with <jats:sup>111</jats:sup>In-DTPA-D-Phe<jats:sup>1</jats:sup>-OCT and <jats:sup>123</jats:sup>I-VIP, respectively. </jats:p><jats:p> CONCLUSION: Both peptide tracers have a high sensitivity for localizing tumor sites in patients with ascertained or suspected carcinoid tumors, with <jats:sup>111</jats:sup>In-DTPA-D-Phe<jats:sup>1</jats:sup>-OCT scintigraphy being more sensitive than <jats:sup>123</jats:sup>I-VIP receptor scanning. Both, however, had a higher diagnostic yield than conventional imaging, as verified by surgical intervention or long-term follow-up. The combination of both peptide receptor scans does not seem to further enhance diagnostic information. </jats:p>