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Factor Analysis of Dynamic Series (FADS) in Somatostatin Receptor Imaging

Department of Nuclear Medicine, Centre Hospitalier Regional et Universitaire of Lille, Lille, France

Correspondence: For correspondence or reprints contact: Damien Huglo, MD, Service de Médecine Nucléaire, Hôpital Huriez, CHRU de Lille, 59037 Lille Cedex, France.

ABSTRACT

The aim of this article was to study the physiopathology of tumoral uptake of ¹¹¹In-pentetreotide using factorial analysis of dynamic series (FADS) and to assess the usefulness of this analysis in somatostatin receptor scintigraphy. Methods: Forty-one patients were included, 24 women and 17 men. After intravenous injection of 111 MBq ¹¹¹In-pentetreotide, dynamic image acquisition (68 images of 30 s) began in front of the suspected tumoral site: thoracic in 10 patients with medullary carcinoma of the thyroid and 2 patients with bronchogenic carcinoid, and abdominal in 12 cases of midgut carcinoid and 17 cases of other gastroenteropancreatic neuroendocrine tumors. FADS was performed with FAMIS software. Static images were obtained 4 h and 24 h later. For every patient, surgery and/or clinical follow-up (4 y) was used to classify results as true (T) or false (F) positive (P) or negative (N) and to evaluate both the sensitivity of static images and the usefulness of FADS. Results: Of the 14 cases of carcinoid tumor, 5 patients were TN; 9 patients were TP with static images but only 8 were TP with FADS (a bronchogenic carcinoid of 6 mm was missed). Of the 17 cases of gastroenteropancreatic neuroendocrine tumor, static images were TP in 9 patients, and FADS were TP in 5 of these patients (and 4 FN). Static images and FADS were FN in 4 patients and TN in 3 patients, and in the 2 last patients static images were FP, but FADS were TN. Of the 10 cases of medullary carcinoma of the thyroid, static images and FADS were TN in 1 patient, static images were TP in 3 patients and FADS were TP in 2 of these patients (and 1 FN). In the six last cases, static images were FN, but FADS were FN in 3 patients and TP in 3 patients, showing an infiltrate. Conclusion: FADS demonstrates that tumoral kinetics are similar to those of the spleen. FADS can show a diffuse tumoral uptake corresponding to tumoral infiltrate in medullary carcinoma of the thyroid or in hepatic miliaria, whereas static images were normal or doubtful.

Key Words: neuroendocrine tumors • somatostatin receptor imaging • ¹¹¹In-pentetreotide • factor analysis of dynamic structure • factor analysis of dynamic series