In-111 Pentetreotide Scanning in Gastrinoma Patients: Comparison of Imaging Methods

서지정보

· 발행기관 : 고신대학교(의대) 고신대학교 의과대학 학술지
· 수록지 정보 : 고신대학교 의과대학 학술지 / 18권 / 1호 / 104 ~ 111페이지
· 저자명 : 배상균, Clara C. Chen, James C. Reynolds

초록

Background Because multiple imaging sessions increase the cost and time of In-111 pentetreotide studies, we evaluated various imaging methods and times to see whether we could simplify the overall process while maintaining our ability to detect lesions in diagnosis of gastrinoma. Methods Seventy nine studies from 77 gastrinoma patients were reviewed, including twenty six studies in previously cured patients with normal basal and negative secretin stimulated serum gastrin levels. Fifty one patients with elevated serum gastrin levels were considered to have active disease. Whole body, planar spot and SPECT (orthogonal, reprojected) images were obtained 4 and 24 hours after administration of 222 MBq of In-111 pentetreotide and reviewed separately. Three Nuclear Medicine physicians reviewed 541 image sets in random order, blinded to patient identifiers and time of imaging (4 vs 24 hours). Lesions were graded using 5 categories: 0 - negative; 1 - unlikely; 2 - possible lesion; 3 - probable lesion; 4 - definite lesion. ROC analysis and comparison of sensitivity and specificity were performed. Biopsy and radiological imaging provided final diagnoses for 112 lesion sites: 51 with gastrinoma, 61 sites were negative. Results The area under the curve (AUC) for 4 hour imaging was always greater than for 24 hours, but the differences were not statistically significant. At both 4 and 24 hours, the AUC was greater with SPECT orthogonal imaging than planar imaging (4 hour, 0.94 vs 0.82, p<0.05; 24 hour, 0.89 vs 0.81, p=0.09). Using a cutoff of grade 3 or 4 as positive, the sensitivity was always greater at 4 hours than at 24 hours, but not significant. The specificity of 4 hour imaging also tended to be greater than or the same as that of 24 hour imaging. At both 4 and 24 hours, SPECT orthogonal imaging had significantly higher sensitivity than did planar imaging (4 hour, 84% vs 62%, p=0.01; 24 hour, 78% vs 44%, p<0.001), but planar imaging had better specificity (4 hour, 89% vs 98%, p<0.05; 24 hour, 88% vs 94%, p=ns). Conclusion In patients with gastrinoma, 4 hour In-111 pentetreotide imaging with SPECT provides the greatest diagnostic efficacy. SPECT imaging significantly increased the sensitivity of In-111 pentetreotide imaging with minor reductions in specificity. We conclude that a single imaging session at 4 hours after In-111 pentetreotide administration which includes SPECT imaging of the upper abdomen is sufficient for screening patients with gastrinoma. Guidelines for imaging this group of patients are presented.

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