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Characterizing an Ectopic Secreting Carcinoid with Indium-111-DTPA-D-Phe-Pentetreotide

Department of Nuclear Medicine, Azienda Hospital Careggi–Florence
Department of Clinical Pathophysiology, University of Florence, Florence, Italy

Correspondence: For correspondence or reprints contact: vittorio Briganti, MD, U.O. Medicina Nucleare, Azienda Ospedaliera Caroggi-Firenze, Vie Morgagni, 85.50134 Firenze, Italy.

ABSTRACT

This report describes a technique that increases the specificity of ¹¹¹In-pentetreotide as evaluated in a patient with ectopic Cushing syndrome. Methods: Two separate SPECT studies were performed with different pharmacologic protocols, both including treatment with cold octreotide. The imaging protocol provides acquisition sat 4 and 24 hr after injection. The quantitative approach was based on the ROI activity (manually designed) of an area of pathological lung uptake (ROI-T) versus background (ROI-NT). Histological, histochemical and specific mRNA measurements confirmed the presence of an SSR2 receptor carcinoid in the lung. Results: The time course of ROI-T/ROI-NT is a linear increase between 4 and 24 hr. Washout with cold octreotide diminished the ROI-T activity content and the saturation protocol increased ROI-T/ROI-NT, confirming the specific nature of the uptake. Conclusion: Displacement and saturation protocols in ¹¹¹In-pentetreotide imaging demonstrated the specificity of tumor binding.

Key Words: somatostatin receptors • indium-111-pentetreotide • octreotide • ectopic Cushing syndrome

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