Successful application of technetium-99m-labeled octreotide acetate scintigraphy in the detection of ectopic adrenocorticotropin-producing bronchial carcinoid lung tumor: a case report.

INTRODUCTION: The diagnostic efficacy of somatostatin receptor scintigraphy labeling with 111 indium in the localization of tumors has been assessed in a limited number of patients with contradictory outcomes. Here, we describe the case of a patient with an ectopic adrenocorticotropic hormone-producing bronchial carcinoid tumor diagnosed preoperatively using technetium-99m-labeled octreotide acetate scintigraphy. CASE PRESENTATION: A 29-year-old Asian man presented to our hospital with the typical clinical features of Cushing's syndrome, which he had had for a duration of 18 months. The results of a biochemical evaluation revealed he had adrenocorticotropic hormone-dependent Cushing's syndrome. The results of a spiral abdominal computed tomography scan showed he had bilateral adrenal hypertrophy. A magnetic resonance image of the patient's brain showed he had a normal hypophysis. Whole body technetium-99m-labeled octreotide acetate scintigraphy was performed to check for the presence of an ectopic adrenocorticotropic hormone-producing tumor. The scan results showed a small focal increase in uptake in the lower lobe of our patient's right lung, just above his diaphragm. A spiral chest computed tomography scan also revealed a small non-specific lesion in the same region. A transthoracic biopsy was then performed. Pathological evaluation confirmed the diagnosis of a carcinoid tumor, of the adrenocorticotropic hormone-producing type. After surgical removal, the patient's symptoms resolved and significant clinical improvement was achieved. CONCLUSIONS: This case report shows that technetium-99m-labeled octreotide acetate scintigraphy can effectively detect an ectopic adrenocorticotropic hormone-producing bronchial carcinoid.

Thallium-201 single photon emission tomography after injecting an antimuscarinic agent compared with computed tomography for the diagnosis of recurrent colorectal cancer. Report of three cases.

Thallium-201 chloride ((201)TlCl) is frequently used for imaging of a variety of malignant tumors viz., thyroid, lung, brain, bone and breast, however in patients with colorectal cancer, its role is not well established. In this case report we present three patients with colorectal cancer recurrence, with inconclusive computed tomography (CT) findings while (201)TlCl single photon emission tomography (SPET) after injecting an anti-muscarinic agent, showed findings corroborating with the final diagnosis. Correlating CT with (201)TlCl-SPET findings, recurrence of the colorectal cancer was diagnosed in two cases; surgical treatment accordingly planned, confirmed the diagnosis. In the third case, CT was falsely positive while (201)TlCl-SPET was negative, compatible with the final diagnosis.

A preliminary study of neuroSPECT evaluation of patients with post-traumatic smell impairment.

BACKGROUND: Most olfactory testings are subjective and since they depend upon the patients' response, they are prone to false positive results. The aim of this study was to use quantitative brain perfusion SPECT in order to detect possible areas of brain activation in response to odorant stimulation in patients with post-traumatic impaired smell in comparison to a group of normal subjects. METHODS: Fourteen patients with post-traumatic impaired smell and ten healthy controls were entered in this prospective study. All subjects underwent brain SPECT after intravenous injection of 740-MBq 99mTc-ECD and 48 hours later, the same procedure was repeated following olfactory stimulus (vanilla powder). RESULTS: In most of seven regions of interest (Orbital Frontal Cortex, Inferior Frontal Pole, Superior Frontal Pole, Posterior Superior Frontal Lobe, Parasagittal Area, Occipital Pole, and Cerebellar area) the post-stimulation quantitative values show increased cortical perfusion being more pronounced in normal volunteers than the anosmic patients (except cerebellar areas and the right occipital pole). Maximal activation was observed in orbitofrontal regions (right+ 25.45% and left +25.47%). CONCLUSION: Brain SPECT is a valuable imaging technique in the assessment of post-traumatic anosmia and could be competitive as an alternative to other imaging techniques, especially when functional MRI is unavailable or unsuitable. However, this procedure may benefit from complementary MRI or CT anatomical imaging.

Comparative evaluation of two fixed doses of 185 and 370 MBq 131I, for the treatment of Graves' disease resistant to antithyroid drugs.

Radioiodine (131I) treatment is often applied for the treatment of Graves' disease (GD). The optimal dose of 131I for Graves' hyperthyroidism is debated. Various techniques suggest either fixed doses or varying doses based on elaborate calculations of the gland size, 131I uptake, and 131I turnover. Fixed dose regimens avoid dose calculations but there is no consensus on the actual dose to be administered. We compared two routinely recommended fixed 131I doses of 185 and 370 MBq for this purpose. Fifty nine patients with GD who had not been previously treated with 131I were randomized in two groups. Group A consisted of 33 patients who were treated with 185 MBq of 131I. Group B consisted of 26 patients who were treated with 370 MBq of 131I. Group A patients were 21% male and 78% female, mean age 38.1+/-14.4, range 15 to 77 y. Group B patients were 27% male and 73% female, mean age 40.7+/-11.7, range 27 to 72 y. All patients were reexamined every six months for two years. The following clinical outcomes were noticed: a) Persistent hyperthyroidism, which was considered as failure to treatment, requiring further 131I treatment. b) Hypothyroidism; requiring life-long replacement treatment. c) Euthyroid state. Euthyroid and hypothyroid states were considered as a response to treatment of hyperthyroidism. In Group A, 10 patients (30.3%) became euthyroid and 6 (18.2%) hypothyroid (an overall response of 48.5%), while 17 (51.5%) remained hyperthyroid by the end of the follow-up period. In Group B, 10 patients (38%) became euthyroid and 13 (50%) hypothyroid, an overall response of 88.5%. Non responders were 3 patients (11.5%). No correlation was noted between the outcome of treatment and age, sex, size of the thyroid gland or thyroid uptake in each Group of patients, while a significant correlation was noted between the disease outcome and the amount of administered 131I (P<0.003). The incidence of hypothyroidism by the end of two years of follow up was less in Group A than in Group B and the incidence of non responders to treatment was lower in Group A. In view of the higher cost of treatment, the longer time elapsing to treatment, the number of office visits by the patients and the higher number of patients with persistent hyperthyroidism in Group A, we conclude that a fixed dose of 131I of 370 MBq is more useful and effective for the treatment of GD as compared to 185 MBq of 131I.

Gonadal function in patients with differentiated thyroid cancer treated with (131)I.

The aim of this study was to evaluate the effect of treatment with radioactive iodine ((131)I) on gonadal function in males and females with follicular or papillary thyroid carcinoma. Consenting patients at reproductive age were grouped according to the cumulative dose of (131)I received and followed-up for at least 12 months. Overall, 246 patients (159 females, 87 males) were studied. In all males, serum levels of follicle-stimulating hormone (FSH), luteinising hormone (LH), and testosterone were measured before radioiodine treatment and 2, 6 and 12 months afterwards; fifty-three of all patients underwent semen analysis also. On females, tests for serum levels of LH, FSH, estrogen, and progesterone were performed. In 87.4% of males, there was an increase in serum FSH level after (131)I treatment and in 20.7% of them this level remained high during the follow-up period. The average serum level of FSH 2-6 months after each course of treatment was significantly higher than before treatment (p<0.01), and there was a significant correlation with the cumulative dose of (131)I received (p<0.001). Reduced sperm count was found in 35.8% of the male patients, among whom 73.7% also showed reduced motility. In 36.8% of the patients with reduced sperm count (13.2% of the total), this finding was persistent during the follow-up period. Increased level of FSH was correlated with reduced sperm count in all doses (p<0.005). There was no significant correlation between serum levels of LH and testosterone with (131)I treatment in males. In females, no significant correlation between gonadal-hypophyseal hormones and treatment with (131)I was found, and there were no signs and symptoms of sexual dysfunction. Infertility was not noticed in any patient neither was there any case of abortion. Although female gonads are resistant to radioiodine treatment for thyroid cancer, in males this treatment may result in impairment of the gonadal function, which is transient most of the times. Spermatogenesis is especially sensitive to the radiation effect of (131)I treatment, and this effect is related to the cumulative radioiodine dose. To reduce gonadal complications, especially in males, treatment with (131)I should use the lowest possible doses. Also all necessary measures should be taken to reduce radiation dose to gonads.

Semi-quantitative assessment of salivary gland function in patients with differentiated thyroid carcinoma after radioiodine-131 treatment.

Sialadenitis and xerostomia are well-known side effects of high-dose radioactive iodine ((131)Iota) treatment in patients with differentiated thyroid carcinoma (DTC). This study was undertaken to determine salivary gland function semi-quantitatively in patients with DTC given (131)I for the treatment of the thyroid remnant and/or metastases. Thirty-six patients, 11 males and 25 females, mean age 53.5 years, range 22-73 years, were studied. Scintigraphy of the salivary glands was performed with (99m)Tc-pertechnetate and the salivary excretion fraction (SEF) of the parotid and the submandibular glands was calculated as a measure of their function. Measurements were performed before (131)I treatment as a baseline study, and three weeks and three months later. The patients were clinically evaluated by a standardized subjective questionnaire. Results were as follows: Mean SEF at three weeks and three months after (131)I treatment was reduced as compared to baseline measurements. The total mean baseline measurements, those of three weeks and those of three months later were: 54.9%, 47.2% and 46% respectively; P<0.05 for both measurements (Table 1). The SEF decrease of the parotid glands was greater than that of the submandibular glands (P<0.05 as compared for both salivary glands before and three weeks and three months after (131)I treatment). This confirmed the higher radiosensitivity of the parotid glands as compared to the submandibular glands. In 12 patients (33%) there was no significant decrease of SEF in the salivary glands after (131)I treatment. The relation between the decrease of SEF after three weeks and after three months and the dose of (131)I administered, was for the right and left submandibular glands significant (P=0.016 and P=0.002), while for the parotid glands it was insignificant (P=0.22 and P=0.27 respectively) (Table 4). Reduction of SEF in the parotid glands three months after (131)I treatment was greater than after three weeks. This difference, as regards the submandibular glands, was not significant. Our results show that high dose (131)I treatment in DTC patients induces a significant effect on salivary gland function, which is dose-related in the submandibular glands, and more prominent in the parotid glands.