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The New Technology of Combined Transmission and Emission Tomography in Evaluation of Endocrine Neoplasms

Departments of Nuclear Medicine and Diagnostic Radiology, Rambam Medical Center, Haifa; The Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa; and Departments of Nuclear Medicine and Surgery A, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

The clinical value of a novel technology of combined transmission and emission tomography (TET) was assessed in patients with endocrine tumors. Methods: TET technology, which combines simultaneous acquisition of SPECT and CT images, using the same imaging device, allows correct fusion of images of both modalities. TET was performed on 27 patients with known or suspected endocrine tumors. The radiopharmaceuticals used for the emission part of the study were chosen according to the tumor type: ¹¹¹In-octreotide for patients with neuroendocrine tumors (n = 10), ^99mTc-sestamibi for patients with primary hyperparathyroidism (n = 8), ¹³¹I for patients with thyroid cancer (n = 4), and ¹²³I-metaiodobenzylguanidine and ⁷⁵Se-cholesterol for patients with adrenal masses (n = 3 and n = 2, respectively). The additional information provided by TET compared with scintigraphy was assessed for both image interpretation and clinical utility. Results: TET did not provide any additional data in 16 patients (59%), including 5 patients with normal scintigraphy. In 11 patients (41%) with abnormal SPECT findings, TET improved image interpretation by providing a better anatomic localization of SPECT-detected lesions. It showed unsuspected bone involvement in 4 patients, it identified the organs involved and the relationship of the lesions to neighboring structures in 5 patients, and it differentiated physiologic uptake from tumor uptake in 2 patients. TET provided additional information of clinical value in 9 patients (33%). It assisted in better planning of surgery in 2 patients with neuroendocrine tumors and in 2 patients with ectopic parathyroid adenomas. It changed the treatment approach in 2 patients with neuroendocrine tumors and 1 patient with thyroid carcinoma, and it altered prognosis in 2 patients with thyroid malignancy. Conclusion: TET enhances the already unique role of nuclear medicine procedures in the assessment and management of patients with endocrine neoplasms.

Key Words: endocrine neoplasms • combined imaging • fusion

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