HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) CME Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Patel, C. N. Articles by Scarsbrook, A. F. Search for Related Content PubMed PubMed Citation Articles by Patel, C. N. Articles by Scarsbrook, A. F. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Clinical Utility of Hybrid SPECT-CT in Endocrine Neoplasia

¹ All authors: Department of Radiology, St. James' University Hospital, Beckett St., Leeds LS9 7TF, United Kingdom.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —57-year-old man with persistent primary hyperparathyroidism after exploratory surgery. Planar scintigram obtained 20 minutes after administration of 99mTc-MIBI [methoxyisobutylisonitrile] shows intense focal uptake in left lower neck (arrow). No corresponding abnormality was detected on high-resolution sonography.

View larger version (37K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —57-year-old man with persistent primary hyperparathyroidism after exploratory surgery. Fused multiplanar images from SPECT-CT acquisition localize uptake to deep-seated left inferior parathyroid adenoma lying adjacent to anterolateral border of vertebral body (arrows). This was not seen on sonography because of its position posterior to the trachea. SPECT-CT guided minimally invasive surgical intervention, which confirmed a solitary parathyroid adenoma.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —59-year-old man with primary hyperparathyroidism. Planar scintigrams obtained 20 minutes (top) and 2 hours (bottom) after the administration of 99mTc-MIBI [methoxyisobutylisonitrile] show focal uptake in right lower neck (arrow) and left upper thorax (arrowhead).

View larger version (72K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —59-year-old man with primary hyperparathyroidism. Fused multiplanar SPECT-CT images localize uptake in upper chest to small nodule just above level of aortic arch (arrowheads). There was also a right inferior parathyroid adenoma (not shown). Accurate localization greatly aided surgical planning, and ectopic parathyroid adenoma was confirmed at surgery. Ectopic adenomas account for up to 20% of parathyroid adenomas. Note physiologic tracer uptake in submandibular glands (arrows).

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —28-year-old woman with previously treated differentiated thyroid carcinoma reviewed in clinic and found to have rising thyroglobulin level. Anterior planar image from whole-body 131I scintigram shows moderately increased focus of tracer uptake in mid abdomen (arrow). Note physiologic uptake in salivary glands (SG), stomach (St), and colon (GI).

View larger version (39K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —28-year-old woman with previously treated differentiated thyroid carcinoma reviewed in clinic and found to have rising thyroglobulin level. Fused axial (top) and sagittal (bottom) SPECT-CT images localize focus of uptake to right side of L2 vertebral body (arrow). Corresponding low-dose CT images showed lytic lesion at this site, which is consistent with bone metastasis (not shown). Patient underwent further treatment with radioactive iodine.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —34-year-old woman with papillary thyroid carcinoma who was recently treated with radioactive iodine. Anterior planar image from postablation whole-body 131I scintigram shows intense tracer uptake in residual thyroid tissue in neck. Note additional focus of increased uptake in right hemipelvis (arrow), which was believed to be suspicious for a metastatic lesion.

View larger version (29K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —34-year-old woman with papillary thyroid carcinoma who was recently treated with radioactive iodine. Fused axial (left) and coronal (right) SPECT-CT images localize tracer uptake in right hemipelvis to cecum (arrow). This was due to physiologic bowel excretion and avoided a potential false-positive interpretation.

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —67-year-old man with previously treated differentiated thyroid carcinoma and markedly raised thyroglobulin level. Whole-body iodine scintigraphy was negative. Anterior planar scintigram obtained 24 hours after administration of 111In-pentreotide shows intense uptake in right upper thorax (curved arrow), lower grade uptake in left hemithorax (arrowhead) and right shoulder region (straight arrow).

View larger version (67K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —67-year-old man with previously treated differentiated thyroid carcinoma and markedly raised thyroglobulin level. Whole-body iodine scintigraphy was negative. Fused axial SPECT-CT image (top right) and corresponding low-dose CT image (lung windows) (top left) localize uptake in thorax to bilateral lung metastases (arrows). Fused axial SPECT-CT image (bottom right) and corresponding image from low-dose CT (bone windows) (bottom left) localize tracer accumulation in right shoulder to bone metastasis in right scapula (arrowheads). Large focus of uptake in right upper chest was due to mediastinal nodal metastasis (not shown).

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —42-year-old man with medullary thyroid carcinoma and family history of multiple endocrine neoplasia (MEN) type IIa. Anterior planar image from 123I MIBG (metaiodobenzylguanidine) scintigram shows focal uptake in left side of neck consistent with known medullary thyroid carcinoma (large arrow) with more subtle focus in left upper neck (small arrow). In addition, note bilateral tracer uptake in upper abdomen (arrowheads), consistent with bilateral pheochromocytomas, which were confirmed on subsequent staging CT (not shown).

View larger version (28K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —42-year-old man with medullary thyroid carcinoma and family history of multiple endocrine neoplasia (MEN) type IIa. Axial low dose CT image (top) and fused SPECT-CT image (bottom) in same patient localizes uptake in left upper neck to nonpathologically enlarged cervical lymph node (arrows). Nodal metastasis was confirmed at surgery.

View larger version (33K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —54-year-old woman with previously treated medullary thyroid carcinoma and rising calcitonin level. Cross-sectional imaging was unremarkable. Anterior planar image from whole-body 123I MIBG scintigram shows low-grade focus of tracer uptake in left side of neck (arrow).

View larger version (42K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —54-year-old woman with previously treated medullary thyroid carcinoma and rising calcitonin level. Cross-sectional imaging was unremarkable. Fused axial (left) and coronal (right) SPECT-CT images localize abnormal uptake to left thyroid bed (arrows), suspicious for recurrent disease. This was confirmed at surgery.

View larger version (35K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —74-year-old man with previously resected midgut carcinoid tumor and rising tumor markers (chromogranin-A). Anterior planar scintigram obtained 24 hours after administration of 111In pentreotide shows intense focus of tracer uptake in thorax (arrow). Note physiologic uptake in liver, spleen, kidneys, and bladder.

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —74-year-old man with previously resected midgut carcinoid tumor and rising tumor markers (chromogranin-A). Fused axial (top) and sagittal (bottom) SPECT-CT images localize abnormal tracer uptake to anterior wall of right ventricle (arrows). Subsequent cardiac MRI confirmed that this represented an intracardiac metastasis. This is a rare but recognized site of metastatic disease. SPECT-CT was instrumental in accurately localizing anatomic site of disease.

View larger version (75K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —32-year-old man with suspected gastrinoma that had evaded detection on conventional imaging. Anterior planar scintigram obtained 24 hours after administration of 111In pentreotide shows abnormal focus of tracer uptake in midline of upper abdomen (arrow).

View larger version (55K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —32-year-old man with suspected gastrinoma that had evaded detection on conventional imaging. Axial SPECT (top), low-dose CT (middle), and fused SPECT-CT (bottom) images localize focal uptake to mid body of pancreas (crosshairs), consistent with pancreatic neuroendocrine tumor. Gastrinoma was confirmed after surgical excision. SPECT-CT was instrumental in preoperative planning in this case.

View larger version (63K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —59-year-old man with bronchial carcinoid tumor and extensive liver metastasis who was being considered for hepatic chemoembolization. Anterior planar scintigram obtained 24 hours after administration of 111In pentreotide shows multiple foci of increased tracer uptake in liver, consistent with known liver metastases. In addition, a subtle focal area of uptake is present in left pelvis (arrow).

View larger version (34K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —59-year-old man with bronchial carcinoid tumor and extensive liver metastasis who was being considered for hepatic chemoembolization. Fused axial (left) and coronal (right) SPECT-CT images localize pelvic uptake to occult left ischial bone metastasis (arrows). Note physiologic tracer activity in bladder on fused coronal image. In view of the extrahepatic disease, patient instead underwent systemic radionuclide therapy.

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —72-year-old woman with metastatic pancreatic neuroendocrine tumor (VIPoma [vasoactive intestinal polypeptide tumor]) who was being considered for radionuclide therapy. Anterior planar scintigram obtained 24 hours after administration of 111In pentreotide shows multifocal uptake in liver from known metastases. Note adjacent tubular uptake extending to midline (large arrow). In addition, more subtle focal uptake is shown in right upper thorax (small arrow).

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —72-year-old woman with metastatic pancreatic neuroendocrine tumor (VIPoma [vasoactive intestinal polypeptide tumor]) who was being considered for radionuclide therapy. Fused multiplanar images from SPECT-CT (top and middle) localize focal uptake in upper thorax to right second rib (curved arrow). Corresponding axial CT image on bone windows (bottom) shows cortical destruction (arrowhead), consistent with bone metastasis. Up to 30–40% of neuroendocrine metastasis are not visualized with conventional imaging techniques. Coronal SPECT-CT image shows tracer uptake from multiple liver metastases and portal vein tumor thrombus (straight arrow) that was subsequently confirmed on MRI (not shown).

View larger version (81K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —78-year-old man with previously treated midgut carcinoid tumor and slightly elevated tumor markers. Anterior planar scintigram obtained 24 hours after administration of 111In pentreotide shows focal uptake in left upper quadrant of abdomen that is suspicious for metastatic disease (arrow). Note physiologic tracer uptake in liver, kidneys, and bladder.

View larger version (71K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —78-year-old man with previously treated midgut carcinoid tumor and slightly elevated tumor markers. Fused axial SPECT-CT (top) and contrast-enhanced CT (bottom) images show focal uptake in left upper quadrant is physiologic and due to a spleniculus (arrows). SPECT-CT was important in this case in preventing false-positive interpretation.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13A —67-year-old man with malignant pheochromocytoma after adrenalectomy and resection of lung metastasis. Anterior planar scintigram obtained 24 hours after administration of 123I MIBG (metaiodobenzylguanidine) shows focal uptake in left skull (large arrow) and right mediastinum (small arrow). Note physiologic tracer uptake in salivary glands, lung, liver, bowel, and renal tract. Whether skull activity was artifactual due to skin contamination was unclear.

View larger version (40K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13B —67-year-old man with malignant pheochromocytoma after adrenalectomy and resection of lung metastasis. Fused axial (left) and coronal (right) SPECT-CT images show that left scalp uptake is in skull vault, consistent with bone metastasis (arrows). Right-sided thoracic uptake was localized to enlarged right hilar nodes (not shown). Patient subsequently underwent MIBG-labeled radionuclide therapy.

View larger version (78K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14A —3-year-old boy with previously treated neuroblastoma. Planar images on routine surveillance MIBG (metaiodobenzylguanidine) scan showed low grade focal uptake in right upper thorax. (Courtesy of Bradley KM, Oxford, UK) Multiplanar images from 123I-MIBG SPECT-CT acquisition localize focal uptake to supraclavicular fossa (crosshairs).

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14B —3-year-old boy with previously treated neuroblastoma. Planar images on routine surveillance MIBG (metaiodobenzylguanidine) scan showed low grade focal uptake in right upper thorax. (Courtesy of Bradley KM, Oxford, UK) Coronal T2-weighted image from subsequent MRI of right upper chest confirmed a minimally enlarged lymph node in the right supraclavicular fossa (arrow). This was resected and confirmed to be due to recurrent neuroblastoma.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati