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An Intrapatient Comparison of ^99mTc-EDDA/HYNIC-TOC with ¹¹¹In-DTPA-Octreotide for Diagnosis of Somatostatin Receptor-Expressing Tumors

¹ Department of Nuclear Medicine, University of Innsbruck, Innsbruck, Austria
² Institute of Biostatistics, University of Innsbruck, Innsbruck, Austria
³ Nuclear Medicine Research Laboratory, St. Bartholomew’s Hospital, London, United Kingdom

The aim of this study was to compare the imaging abilities of the recently developed somatostatin analog, ^99mTc-hydrazinonicotinyl-Tyr³-octreotide (^99mTc-HYNIC-TOC [^99mTc-TOC]), with ¹¹¹In-diethylenediaminepentaacetic acid-D-Phe¹-octreotide (¹¹¹In-OCT [Octreoscan]) in patients undergoing routine somatostatin receptor (SSTR) scintigraphy. Methods: Forty-one patients (20 men, 21 women; age range, 29–75 y; mean age, 56.7 y) with either histologically proven or biologically and clinically suspected endocrine tumors were enrolled in the study. Four groups were distinguished: (a) patients being evaluated for the detection and localization of neuroendocrine tumors (n = 6), (b) tumor staging (n = 19), (c) patients being investigated to determine the SSTR status of tumor lesions (n = 11), and (d) patient follow-up studies (n = 5). Each patient received a mean activity of 150 MBq ¹¹¹In-OCT and 350–400 MBq ^99mTc-TOC. Scintigraphy with ^99mTc-TOC was performed 4 h after injection and scintigraphy with ¹¹¹In-OCT was performed 4 and 24 h after injection. SPECT studies of areas of interest were performed 4 h after injection for both tracers as well as at 24 h after injection for ¹¹¹In-OCT. The time interval between the studies using each tracer ranged from 2 to 22 d (mean interval, 9.3 d). Results: ¹¹¹In-OCT and ^99mTc-TOC showed an equivalent scan result in 32 patients (78%), 9 cases showed discrepancies (22%), false-negative results with ¹¹¹In-OCT were seen in 6 cases (14.6%), whereas ^99mTc-TOC was false-positive in 2 cases (4.9%). ¹¹¹In-OCT was true-negative in both cases. The false-positive findings of the ^99mTc-TOC studies were caused by nonspecific uptake in the bowel. In 1 case, ^99mTc-TOC correctly identified a metastasis in the lumbar spine but both scan results were false-positive because of an inflammatory process. In 21 patients with SSTR-expressing tumors, the semiquantitative region-of-interest analysis showed that ^99mTc-TOC achieved higher tumor-to-normal tissue ratios than ¹¹¹In-OCT. Conclusion: This study revealed a higher sensitivity of ^99mTc-TOC as compared with ¹¹¹In-OCT as an imaging agent for the localization of SSTR-expressing tumors. To avoid false-positive findings with ^99mTc-OCT due to nonspecific tracer accumulation, additional scanning at 1–2 h after injection should be done.

Key Words: ^99mTc • somatostatin • hydrazinonicotinic acid • tyrosine-octreotide • scintigraphy

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