Value of combined XCT/SPECT technology for avoiding false positive planar ¹²³I-MIBG scintigraphy

Summary:

Aim: The clinical value of combined XCT/SPECT technology in a single device in patients undergoing ¹²³I-MIBG scintigraphy was analyzed. Methods: 31 patients (19 men, 12 women; mean age 55 years, range: 31-79 years) demonstrating focal accumulation in planar ¹²³I-MIBG scan were further investigated with a double headed gamma camera with an X-ray tomograph mounted on the same gantry (GE Medical Systems, Millennium VG with Hawkeye, Milwaukee, USA) for anatomical definition of the focal ¹²³I-MIBG uptake. The patients were referred to ¹²³I-MIBG scintigraphy because of biochemically (81%) and/or clinically (19%) suspected pheochromocytoma. Results: In 23 out of 31 patients (74%) the fused images demonstrated physiological accumulation (i. e. intestinal, renal) of ¹²³I-MIBG. In two patients (6%) suspected adrenal MIBG-accumulation was caused by inhomogeneous liver uptake. In two patients (6%) focal abdominal accumulation was correctly localised in the adrenal glands. Furthermore, the differentiation of bone metastasis from a local recurrence for phaeochromocytoma was accurately possible for two patients (6%). Adrenal lesions mimicking liver foci were correctly localised in the remaining two patients (6%). Conclusion: Our study demonstrates the clinical value of XCT/SPECT in a single device in patients demonstrating focal ¹²³I-MIBG uptake in planar scintigraphy. The combined XCT/SPECT technology provides a higher diagnostic accuracy.

Zusammenfassung:

Ziel: Wir untersuchten die klinische Aussagekraft der kombinierten Röntgen-CT (XCT)/SPECT-Technologie bei der ¹²³I-MIBG-Szintigraphie von Patienten mit biochemischem (n = 25; 81%) und/oder klinischem (n=6; 19%) Verdacht auf Phäochromozytom. Methoden: 31 Patienten (19 Männer, 12 Frauen; mittleres Alter: 55 Jahre, Bereich: 31-79 Jahre) mit fokaler Anreicherung in der planaren ¹²³I-MIBG-Szintigraphie wurden im Anschluss daran mittels einer Doppelkopf-Gammakamera mit integriertem Röntgentomographen (GE Medical Systems, Millenium VG mit Hawkeye, Milwaukee, USA) zur anatomischen Lokalisierung der ¹²³I-MIBGHerde szintigraphiert. Ergebnisse: Bei 23 der 31 Patienten (74%) zeigten die Fusionsbilder eine physiologische MIBG-Anreicherung (z.B. intestinal, renal). Bei 2 Patienten (6%) war die mutmaßlich intraadrenale MIBG-Anreicherung durch eine inhomogene Leberspeicherung verursacht. Bei weiteren 2 Patienten (6%) wurden die verdächtigen Herde eindeutig in den Nebennieren lokalisiert. Des Weiteren konnte bei 2 Patienten (6%) eindeutig zwischen Knochenmetastase und Lokalrezidiv differenziert werden. Bei den übrigen 2 Patienten (6%) erwiesen sich Läsionen, die ursprünglich als Leberherde interpretiert worden waren, in der XCT/SPECT-Fusion als intraadrenal. Schlussfolgerung: Unsere Studie demonstriert die klinische Wertigkeit der kombinierten XCT/SPECT-Technik bei Patienten mit fokalen ¹²³I-MIBG-Speicherungen in der Planarszintigraphie. Diese Kombination bietet eine höhere diagnostische Genauigkeit.

Key words:

Phaeochromocytoma - MIBG scintigraphy - XCT/SPECT - image fusion

Schlüsselwörter:

Phäochromozytom - MIBG-Szintigraphie - XCT/SPECT - Fusion

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