In-111 Octreotide Research Articles

The Value of F18-FDG PET/CT in Medullary Thyroid Cancer Patients with Persistent Elevated Calcitonin Levels

Purpose of the Study In this retrospective study, we reported our experience with FDG-PET/CT in evaluation of medullary thyroid cancer (MTC) patients with persistent elevated calcitonin levels. Materials and Methods A total of 33 F-18 FDG PET/CT scans and 9 somatostatin receptor imaging (SRI) (6 In-111 octreotide and 3 Ga-68 DOTATATE PET/CT) of 25 MTC patients with persistently elevated calcitonin levels, performed for staging and restaging, were analyzed retrospectively. The scans were compared lesion by lesion with histopathological data and other imaging methods. Because all patients had abnormally high calcitonin levels defined as persistent disease, negative F-18 FDG PET/CT scans accepted as false negative. Because there was no true-negative study, only sensitivity and positive predictive value (PPV) were calculated. Calcitonin levels and SUVmax values were assessed by Mann- Whitney U test and the ROC curve analysis. Results There were 11 true-positive, 11 false-positive and 11 false-negative F-18 FDG PET/CT scans. Sensitivity and PPV were 50% and 50% respectively. Difference of mean calcitonin level between true-positive cases and the others was nonsignificant. SUVmax of true-positive lesions were significantly higher than of the others. All 9 SRIs were negative. Conclusions FDG PET/CT scan appeared to be less sensitive. However, it should be considered that F-18 FDG PET/CT was performed to the patients with only no lesion had been detected by the other imaging modalities in this group. Because F-18 FDG PET/CT was not performed when a residual or recurrent lesion had clearly been detected before, sensitivity of 50% was considered to be acceptable.

MNGI-06. EFFICACY OF 177LU-DOTATATE THERAPY IN RECURRENT ANAPLASTIC MENINGIOMA

Abstract BACKGROUND 177Lu-Dotatate (177Lu-DOTA0-Tyr3-Octreotate) is a beta-particle emitting somatostatin analog recently FDA approved for the treatment of somastatin receptor-positive gastroenteropancreatic neuroendocrine tumors. Somatostatin receptors are highly expressed in almost all meningiomas, therefore 177Lu-Dotatate may be a reasonable treatment strategy for this disease. Furthermore, the short path length of the beta particle should allow for treatment of previously radiated patients with low risk of cerebral radiation necrosis. CASE STUDY: A 61 year-old male presented with a history of atypical meningioma (WHO grade II), recurrent as anaplastic meningioma (WHO grade III). His previous treatments included multiple surgical resections, fractionated radiation therapy, stereotactic radiosurgery, everolimus/octreotide LAR, bevacizumab and hydroxyurea. MRI imaging revealed rapid volumetric progression over the prior nine months with a near tripling in size from 29.9 cm3 to 80.4 cm3. In-111 octreotide confirmed the presence of somatostatin receptors within the tumor. 177Lu-Dotatate was administered intravenously at a dose of 200 millicuries per dose, every eight weeks for four cycles. Treatment was tolerated very well, with no significant adverse events. Tumor volume initially increased to 98.3 cm3 after cycle 1 of treatment, and subsequently decreased to 91.2 cm3 after cycle 2. Eight months after treatment onset, the tumor volume remained stable (93.4 cm3). CONCLUSION 177Lu-Dotatate may be a safe and effective strategy for the treatment of somastatin receptor-positive meningioma. The transient increase in tumor volume after the first dose in this case may have represented delayed treatment effect or pseudoprogression. A phase II clinical trial is currently being activated to determine the progression-free survival associated with 177Lu-Dotatate in patients with recurrent meningioma.

Visualization of Gallbladder with In-111 Octreotide Scan.

A 54-year-old woman underwent octreotide scintigraphy for evaluation of neuroendocrine tumor recurrence. The images demonstrated unusual uptake in gallbladder area in addition to physiologic uptake at other tissues. Whole-body planar and SPECT imaging were repeated after fatty meal ingestion at 28 hours in order to figure out whether this activity was physiologic or not. Since the unusual uptake in the gallbladder was still detected at these images, additional images were obtained 72 hours after radionuclide injection. The activity in the gallbladder disappeared at these images revealing the physiologic nature of this unusual accumulation.

Collimator performance evaluation for In-111 SPECT using a detection/localization task

In SPECT, the collimator is a crucial element in controlling image quality. We take a task performance approach to collimator performance evaluation in which an ideal observer is applied to the raw camera data without regard to the subsequent reconstruction stage. The clinical context of our collimator study is one of searching for and detecting neuroendocrine tumor metastases in the liver as seen in In-111 Octreotide SPECT. Our task involves detection and localization of a signal and thus differs from the conventionally used detection-only task. The scalar task performance metric is ALROC, the area under the localization receiver operating characteristic curve. Since In-111 emits photons at both 171 and 245 keV, the higher energy emissions can contribute significant septal scatter and penetration. Our collimator evaluations address a question previously considered by Mähler et al (2012 IEEE Trans. Nucl. Sci. 59 47–53) who used a different methodology: does allowing a limited amount of septal scatter and penetration yield improved task performance? We used simulation methods to evaluate five parallel-hole collimators. The collimators had roughly equal geometric sensitivity and resolution but a range of contributions from septal effects leading to variations in total sensitivity and resolution. We found that the best performance was obtained with a collimator that allowed a moderate amount of septal scatter and penetration.

The Value of Somatostatin Receptor Imaging with In-111 Octreotide and/or Ga-68 DOTATATE in Localizing Ectopic ACTH Producing Tumors

Objective: We aimed to evaluate the value of somatostatin receptor imaging (SRI) with In-111 octreotide and Ga-68 DOTATATE in localizing ectopic ACTH producing tumors.Methods: Nineteen patients who had In-111 octreotide somatostatin receptor scintigraphy (SRS) and/or Ga-68 DOTATATE PET-CT to localize ectopic ACTH producing tumors between the years 2000 and 2012 were included retrospectively in our study. The results of SRI were compared with clinical onset, radiological findings and surgical data of the patients.Results: Sixteen In-111 octreotide SRS and five Ga-68 DOTATATE PET-CT were performed in 19 patients. In eight out of 19 patients, ectopic ACTH secretion site could be detected. In five patients, SRS showed pathologic uptake. In four of these patients, surgery revealed pulmonary carcinoid tumors and in one patient pancreatic neuroendocrine tumor. In one patient, Ga-68 DOTATATE PET-CT revealed pathologic uptake in lung nodule which came out to be pulmonary carcinoid tumor. In another patient who had resection of metastases of atypical carcinoid tumor prior to scans, new metastatic foci were detected both with SRS and Ga-68 DOTATATE PET-CT imaging. In one patient, although SRS was negative, CT which was performed three years later showed a lung nodule diagnosed as pulmonary carcinoid tumor. In 11 patients, ectopic ACTH secretion site could not be detected. In 10 of those patients, scintigraphic and radiological imaging did not show any lesions and in one patient, Ga-68 DOTATATE PET-CT was false positive.Conclusion: SRI has a complementary role with radiological imaging in localizing ectopic ACTH secretion sites. PET-CT imaging with Ga-68 peptide conjugates is a promising new modality for this indication. Conflict of interest:None declared.

Treatment of ampullary neuroendocrine tumor by endoscopic snare papillectomy

Patient: Female, 45Final Diagnosis: Neuroendocrine tumorSymptoms: Abdominal painMedication: —Clinical Procedure: —Specialty: Gastroenterology and HepatologyObjective:Unusual setting of medical careBackground:Neuroendocrine tumor of the ampulla of Vater is extremely rare and is generally a low-grade endocrine cell tumor. The merits of radical vs. local resection remain uncertain.Case Report:A 45-year-old female patient presented with abdominal pain lasting for 2 months. Papilla that was tumor-like macroscopically was seen in the second part of the duodenum in endoscopic retrograde cholangiopancreatography. Biopsy was histologically confirmed as a low-grade neuroendocrine tumor. No lymphadenopathy or visceral metastasis was found on an abdominal CT scan, In-111 octreotide scan, and EUS. The ampulla was removed by endoscopic snare papillectomy. All margins of resection were negative for tumor.Conclusions:Endoscopic snare papillectomy may be the first step in the management of neuroendocrine tumors of the ampulla of Vater in high-risk surgical candidates and selected patients such as those with a well differentiated, low-grade, small tumor without regional/ distant metastasis. However, it can also be used in younger patients who wish to avoid surgical resection.

High management impact of Ga‐68 DOTATATE (GaTate) PET/CT for imaging neuroendocrine and other somatostatin expressing tumours

Ga-68 DOTATATE (Ga-octreotate, GaTate) positron emission tomography (PET)/CT has multiple advantages compared with conventional and In-111 octreotide imaging for neuroendocrine tumours and other somatostatin-receptor expressing tumours. This study assesses the management impact of incremental diagnostic information obtained from this technique compared with conventional staging. Fifty-nine GaTate PET/CT studies were performed over an 18-month period (52 proven or suspected gastro-entero-pancreatic or bronchial neuroendocrine tumours and seven neural crest/mesenchymal tumours). A retrospective blinded review was performed on the number of abnormalities (1, 2-5 or >5) within defined regions with comparison to conventional imaging to assess incremental diagnostic information. Subsequent management impact (high, moderate or low) was determined by clinical review and follow up to assess pre-PET stage, treatment intent and post-PET management change. Eighty-eight percent of GaTate studies were abnormal. Compared with conventional and In-111 octreotide imaging, additional information was provided by GaTate PET/CT in 68 and 83% of patients, respectively. Management impact was high (inter-modality change) in 47%, moderate (intra-modality change) in 10% and low in 41% (not assessable in 2%). High management impact included directing patients to curative surgery by identifying a primary site and directing patients with multiple metastases to systemic therapy. GaTate PET/CT imaging provides additional diagnostic information in a high proportion of patients with consequent high management impact. GaTate PET/CT could replace (1)In-111 octreotide scintigraphy at centres where it is available given its superior accuracy, faster acquisition and lower radiation exposure. Rapid implementation could be achieved by allowing substitutional funding in the Medicare Benefit Schedule.

Umbilical Hernia Simulating Recurrent Carcinoid on Octreoscan

Physiologic bowel activity on In-111 octreotide imaging is commonly seen. However, on occasion, normal bowel activity may mimic lesions in the abdomen, which can be very difficult to differentiate, particularly after surgical intervention. We report a case of focal bowel activity simulating a lesion in a patient who had an In-111 octreotide scan (Octreoscan), postoperatively, looking for recurrent carcinoid. SPECT/CT demonstrated that the uptake was localized in the anterior abdomen, and corresponded to a loop of bowel within a ventral hernia at the site of surgical incision. The correlation with CT as well as the precise localization made possible by the fusion images helped avoid misinterpretation of this finding as possible recurrent carcinoid.

Simultaneous Occurrence of Typical Carcinoid and Non–Small-Cell Lung Cancer in the Same Lung Lobe

The present report demonstrates the usefulness of nuclear medicine in differentiating different pulmonary tumors. A 79-year-old woman presented with a suspicious peripherally located lesion of the right lower lobe in the costophrenic angle. During bronchoscopic evaluation, a centrally located intrabronchial lesion was found, which was positive on a subsequent In-111 octreotide examination. The histologic examination of this central lesion confirmed a typical bronchial carcinoid. The FDG PET examination revealed a high uptake just in the peripherally located lesion, which was then confirmed to be non-small-cell lung cancer. This is the first report of nuclear medicine methods evaluating simultaneous occurrence of a typical bronchial carcinoid and a non-small-cell lung cancer in the same lung lobe.

Efficacy of adding high-dose In-111 octreotide therapy during Sandostatin treatment in patients with disseminated neuroendocrine tumors: clinical results of 14 patients

This study aimed to assess the outcome of high-dose In-111 octreotide treatment and efficacy of long-acting Sandostatin LAR in patients with disseminated neuroendocrine tumors. A total of 14 patients (mean age 51.8±13.2years; 10 female, 4 male) receiving high-dose In-111 octreotide in our centre for the treatment of neuroendocrine tumors were included in the study. Monthly treatment with long-acting somatostatin analogue [Sandostatin long-acting release (Novartis Pharmaceuticals)] was continued in nine cases. During a 3-year period, a total of 45 courses of high-dose In-111 octreotide treatment were delivered to 14 patients. In seven patients receiving an average of four treatment courses (6 carcinoid tumors, 1 thymoma, patients: 2, 4, 5, 11-14) stable disease was achieved (50%). In two patients with carcinoid tumors (patients 1 and 3) who received four treatment courses, partial response was observed (14%). Five patients (36%; 4 NET, 1 gastrinoma; patients 6-10) died due to progressive disease following on average two treatment courses. On average, deaths occurred 2months after the last treatment dose. No complete responses were seen. Partial response was achieved in two of the nine patients receiving Sandostatin LAR, while four had stable disease. Both treatments were associated with acceptable tolerability. High-dose In-111 octreotide can be safely administered in conjunction with somatostatin analogue in patients with disseminated NET and this treatment may help to stabilize the disease.

Metastatic Rectal Carcinoid on In-111 Octreotide SPECT-CT Imaging

A 65-year-old asymptomatic male who tested positive for fecal occult blood was found to have a rectal mass on colonoscopy. Staging workup included a CT scan of the abdomen which showed a neoplasm in the liver, with neuroendocrine features on fine needle aspiration. Planar 24 hours whole body In-111 octreotide scan showed a small focus of mildly increased activity in the lateral left lower chest, a very large focus of intense uptake in the liver, and 4 distinct foci of mild to moderately increased uptake in the lower abdomen and pelvis. SPECT-CT images localized these abnormalities to: focal uptake in the rectal wall thickening, 2 presacral lymph nodes, the liver mass, and multiple bone metastases (left ilium, L5 pedicle, and the left 6th rib). This rare case highlights the importance of SPECT-CT in staging carcinoid tumors with In-111 octreotide imaging.

Patient specific computer automated dosimetry calculations during therapy with 111In Octreotide

The aim of this study was to calculate the absorbed dose of 22 patients that were diagnosed for neuroendocrine tumours in liver and had received therapeutic dose of 111In octreotide. In-111 Octreotide infusion, via intrahepatic catheterization is well established technique in our Institution in hepatocellular carcinoma and neuroendocrine tumours treatments. The patient specific dosimetry calculations, for this way of treatment, were based on anterior and posterior scintigraphy images that were acquired immediately after radiopharmaceutical infusion, through hepatic arterial port and at 24 and 48 h post-infusion. Gamma – camera was calibrated in order to estimate source organ activity considering count rate, patient’s body diameter and source organ size. The results showed that the tumour absorbed dose ranged from 2.5 to 18.4 mGy/MBq, depending on the lesion size. Patient specific dosimetry calculations helps the physician to optimize the planning of the treatment, avoid side effects to healthy tissue and assign administered dose to treatment results.

High-Administered Activity In-111 Octreotide Therapy with Concomitant Radiosensitizing 5FU Chemotherapy for Treatment of Neuroendocrine Tumors: Preliminary Experience

High-administered activity In-111 octreotide (HA-Oc) therapy has been used for patients with disseminated neuroendocrine tumors (NET) with high somatostatin receptor (SSR) expression. Combining HA-Oc with radiosensitizing 5-fluorouracil (5FU) chemotherapy could enhance efficacy. Our other aim was to assess whether concomitant 5FU would contribute to significant additional toxicity. Fifteen (15) consecutive patients who received 3 cycles of HA-Oc+5FU were evaluated. Symptomatic, octreoscan, computed tomography (CT), hormonal responses, and toxicity were reviewed at 3 months post-last treatment. Long-term follow-up was performed to death or April 2008 to assess late toxicity and time to progression requiring retreatment. At 3 months post-treatment, 67% of patients had symptomatic improvement, with 20% experiencing a complete resolution of symptoms. Overall, 90% achieved stabilization or a decrease in hormone levels. Octreoscan improvement/stabilization occurred in 95% and CT stabilization in 80% of patients with previously progressive disease, but no partial or complete regression by Response Evaluation Criteria in Solid Tumors criteria. Transient lymphopenia and nausea were the most common side-effects, and there was no significant renal or grade 4 hematologic toxicity. Subacute side-effects included a peripherally inserted central catheter line thrombosis (1 patient), discomfort/pain associated with lesion necrosis, and 1 lymph node swelling. Median time to retreatment was 23 months (range, 6-34) for 10 patients. Six (6) patients deceased (no deaths directly related to 5FU); 9 patients (60%) are alive at 36-139 months. HA-Oc+5FU achieve a high rate of symptomatic response associated with stabilization/improvement in hormonal and functional scan abnormalities. Combination treatment achieved disease stabilization in the majority of patients with previously progressive disease. There was no significant observed increase in toxicity with additional 5FU, making it a promising adjunct to radiopeptide receptor therapy for progressive NET.

Increased In-111 Octreotide Uptake due to Paget Disease and a Low Midline Pelvic Kidney

Increased In-111 Octreotide Uptake due to Paget Disease and a Low Midline Pelvic Kidney

Somatostatin Receptor Scintigraphy in Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is a nonlymphomatous, squamous cell carcinoma that originates in the epithelial lining of the nasopharynx. We report a case of intense In-111 octreotide uptake of an intracranial tumor situated in the base of the skull in a patient referred for scintigraphy for evaluation of a possible meningioma. The presence of an In-111 octreotide positive cervical node justified histologic diagnosis. Biopsies revealed an unsuspected nasopharyngeal carcinoma at the base of the skull. A cervical lymph node metastasis was confirmed by fine needle aspiration.

Intramuscular Metastasis of Carcinoid Tumor

A 43-year-old man presented with a 2-month history of left upper lobectomy due to an atypical lung carcinoid tumor. The patient was referred to our department for further evaluation. An In-111 octreotide (Octreoscan) whole body scan and single photon emission computed tomography were performed. The scans showed slightly increased diffused tracer uptake in the apex of the left lung, most probably due to postoperative changes. A focal area of increased uptake in the right lower abdomen was also noted. Fusing octreotide tomographic construction with CT images allowed accurate determination of the area of increased uptake to be in the right transverse abdominal muscle.

Increased Activity on In-111 Octreotide Imaging Due to Radiation Fibrosis

Indium-111 octreotide scintigraphy is a useful investigation in the diagnosis and staging neuroendocrine or nonendocrine malignancies such as carcinoid, granulomas, small cell lung cancer, medullary thyroid carcinoma, and others. Tumors with large numbers of somatostatin receptors can be accurately imaged and this can be useful in guiding treatment. Although uncommon, false-positives studies have been reported and often the cause is unexplained but assumed to be a high number of somatostatin receptors in other pathology. We present a case with increased uptake resulting in a scan due to pulmonary fibrosis.

Visualization of gallbladder with In-111 labeled octreotide in post prandial state

Somatostatin receptor scintigraphy is widely used in the management of neuroendocrine tumors. Somatostatin receptors are present in both neoplastic and normal tissues, which may lead to misinterpretation of the scans. Here, a patient with lung carcinoid imaged with In-111 octreotide is presented. Imaging was performed 4 and 24 hours after an intravenous injection of 185 MBq In-111 octreotide in the post prandial state. Whole body and SPECT images showed accumulation of radioactivity in the gallbladder. Imaging was repeated after fatty meal ingestion to differentiate abnormal activity and physiological uptake in the gallbladder. The abdominal SPECT studies at 28 hours revealed no uptake in the gallbladder, and the scintigraphic study was reported as normal so further excessive diagnostic procedures were prevented. Gallbladder can be visualized on somatostatin receptor scintigraphy even in the post prandial state. Delayed images after fatty meal administration are important for differential diagnosis.

Adult Medulloblastoma Relapse Visualized by In-111 Octreotide Scintigraphy

A 31-year-old woman with a history of desmoplastic medulloblastoma in the right cerebellar hemisphere had undergone a resection. Magnetic resonance imaging (MRI) was indicated with the aim of ruling out a relapse, but the results were inconclusive. in-111-DTPA octreotide scintigraphy was performed. Planar images and SPECT scan obtained after radiolabeled octreotide injection revealed elevated uptake in the posterior fossa suggestive of relapse. The patient underwent a craniotomy for surgical resection. Although medulloblastoma is the most common. pediatric central nervous system malignancy, it is rare in adults with few cases studied with somatostatin receptor scintigraphy and described in the existing literature.

Chest Wall Metastasis of Ileal Carcinoid Tumor Detected With In-111 Octreotide Scan

Abstract: Carcinoid tumors are potentially malignant, generally being related to regional lymph node and liver metastases. Rarely, metastases to other sites such as the breast have been reported. Radiolabeled peptide analogs such as In-111 octreotide play a useful role in the localization and potentially in the management of carcinoid tumors and their distant metastases. The authors report a case of ileal carcinoid tumor with unusual presentation of a chest wall metastasis. Chest radiograph was normal. Thoracic CT scanning showed a soft tissue mass in the chest wall. In-111 octreotide scintigraphy revealed increased uptake in the anterior chest wall and liver. A biopsy of the lesion showed carcinoid tumor.