Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 1997; 36(07): 223-227
DOI: 10.1055/s-0038-1629830

Originalarbeiten — Original Articles

Schattauer GmbH

Evaluation of Pentavalent Tc-99m DMSA Scintigraphy in Small Cell and Nonsmall Cell Lung Cancers

^99mTc-(V) DMSA-Szintigraphie beim kleinzelligen und nichtkleinzelligen Bronchialkarzinom

T. Atasever

¹From the Gazi University, Faculty of Medicine, Nuclear Medicine Department and Atatürk Chest Diseases and Surgery Center, Ankara, Turkey

,

C. Gündoğdu

¹From the Gazi University, Faculty of Medicine, Nuclear Medicine Department and Atatürk Chest Diseases and Surgery Center, Ankara, Turkey

,

G. Vural

¹From the Gazi University, Faculty of Medicine, Nuclear Medicine Department and Atatürk Chest Diseases and Surgery Center, Ankara, Turkey

,

L. Ö. Kapucu

¹From the Gazi University, Faculty of Medicine, Nuclear Medicine Department and Atatürk Chest Diseases and Surgery Center, Ankara, Turkey

,

A. Karalezli

¹From the Gazi University, Faculty of Medicine, Nuclear Medicine Department and Atatürk Chest Diseases and Surgery Center, Ankara, Turkey

,

M. Ünlü

¹From the Gazi University, Faculty of Medicine, Nuclear Medicine Department and Atatürk Chest Diseases and Surgery Center, Ankara, Turkey

› Author Affiliations

Summary

Aim: The purpose of this study was to evaluate the clinical usefulness of Tc-99m (V) DMSA in patients suspected of lung cancer and determine whether this agent may have value in differentiation between small cell (SCLC) and non-small cell (NSCLC) lung carcinoma. Methods: Thirty-six patients with clinical and radiological suspicion of primary lung carcinoma were injected 450-600 MBq of Tc-99m (V) DMSA intravenously. Whole body and planar anterior, posterior thorax images were obtained 4-5 h after injection of the radioactive complex. Results: Histo-pathological results confirmed 23 NSCLC, 10 SCLC and 1 metastatic lung carcinoma and 2 lung abscess. Nineteen of the 23 (82%) NSCLC and all of the 10 (100%) SCLC cases showed Tc-99m (V) DMSA uptake. Single metastatic lung cancer also accumulated radiotracer. Lung abscess did not show uptake. Lesion/Nonlesion (L/N) ratio of SCLC (1.59 ± 0.32) and NSCLC (1.43 ± 0.19) tumour types did not show statistical difference (p >0.05). Tc-99m (V) DMSA whole body imaging also showed bone metastases. Conclusion: Tc-99m (V) DMSA is a noninvasive and cheap imaging method to detect malignant lung cancers and their bone metastases but, differentiation of SCLC and NSCLC is not possible.

Zusammenfassung

Ziel: Prüfung der klinischen Brauchbarkeit von ^99mTc-(V) DMSA bei Patienten mit Verdacht auf Bronchialkarzinom im Hinblick auf die Möglichkeit einer Differenzierung zwischen Kleinzeller (KLZ) und Nichtkleinzeller (NKLZ). Methoden: Bei 36 Patienten mit klinischem und radiologischem Hinweis auf Bronchialkarzinom wurden 450 bis 600 MBq ^99mTc-(V) DMSA i.v. appliziert. 4-5 h später wurden Ganzkörper- und planare Szinti-gramme des Thorax durchgeführt. Ergebnisse: Feingewebliche Untersuchungen bestätigten in 23 Fällen NKLZ, zehnmal KLZ, einmal ein me-tastasierendes Bronchialkarzinom und zwei Lungenabszesse. 19 der 23 NKLZ- (82%) und 100% der KLZ-Fälle zeigten eine ^99mTc-(V) DMSA-Speicherung ebenso wie das metastasierende Bronchialkarzinom. Die Abszesse speicherten nicht. Das Speicherverhältnis Tumor/Thoraxgegenseite betrug bei KLZ 1,59 ± 0,32, bei NKLZ 1,43 ± 0,19 und war nicht statistisch signifikant unterschiedlich. Die Ganzkörperszintigra-phien zeigten zusätzlich Knochenmetastasen. Schlußfolgerung: Die ^99mTc-(V) DMSA-Szintigraphie ist eine nichtinvasive und preiswerte Methode, um Bronchialkarzinome und deren Knochenmetastasen nachzuweisen; eine Differenzierung von Kleinzellern und Nichtkleinzellern ist dagegen nicht möglich.

Key words

Key words

Tc-99m (V) DMSA - lung tumors - small cell lung cancer - non-small cell lung cancer - inflammatory lesions

Schlüsselwörter

Schlüsselwörter

^99mTc-(V) DMSA - Bronchialkarzinom - Lungenkrebs - Kleinzeller - Nicht-kleinzeller - entzündliche Läsionen

References
1 Bourgorin P, Gousineas G, Lemire P. et al. Differentiation of radiation induced fibrosis from recurrent pulmonary neoplasm by CT. J Can Assoc Radiol 1987; 38: 23-6.
2 Clarke SE, Lazarus CR, Wraight P. et al. Tc-99m V DMSA, 1-131 MIBG and Tc-99m MDP An evaluation of three imaging techniques in patients with medullary carcinoma of the thyroid. J Nucl Med 1988; 29: 33-8.
3 Eising EG, Farahati J, Bier D. et al. Soma-tostatinrezeptor-Szintigraphie bei medullären Schilddrüsenkarzinomen, GEP-Tumo-ren und Karzinoiden. Nuklearmedizin 1995; 34: 1-7.
4 Hilditch TE, Connel JMC, Elliot AT. et al. Poor results with Tc-99m (V) DMSA and 1-131 MIBG in the imaging of medullary thyroid carcinoma. J Nucl Med 1986; 27: 1150-3.
5 Hirano T, Otake H, Yoshida I. et al. Primary lung cancer SPECT imaging with pentava-lent Technetium-99m DMSA. J Nucl Med 1995; 36: 202-7.
6 Jaghers O, Puttemans N, Urbain D. et al. Tc-99m (V) DMSA uptake by metastatic carcinoma of the prostate. J Nucl Med 1986; 27: 1223.
7 Kao CH, Wang SJ, Wey SP. et al. Using Tc-99m V DMSA to detect malignancies from single solid masses in the lungs. Eur J Nucl Med 1992; 19: 890-3.
8 Kashyap R, Babbar A, Sahai I. et al. Tc-99m (V) DMSA imaging: A new approach to studying metastases from breast carcinoma. Clin Nucl Med 1992; 17: 119-22.
9 Kirsch MC, Pawel J, Grau I. et al. In-Ill pentetreoide in the diagnostic work-up of patients with bronchogenic carcinoma. Eur J Nucl Med 1994; 21: 1318-25.
10 Kobayashi H, Kotoura Y, Hosona M. et al. Diagnostic value of Tc-99m (V) DMSA for chondrogenic tumours with positive Tc-99m HMDP uptake on bone scintigraphy. Clin Nucl Med 1995; 20: 361-4.
11 Kosuda S, Gokan T, Tamura K. et al. Clinical assessment of Tc-99m (V) DMSA abnormal uptake by malignant tumour. J Nucl Med (abst) 1986; 27: 1032.
12 Kwekkeboom D, Krenning E. Bakker et al. Radioiodinated somatostatin analog scintigraphy in small cell lung cancer. J Nucl Med 1991; 32: 1845-8.
13 Kwekkeboom J, Kho GS, Lamberts SWJ. et al. The value of Octreotide scintigraphy in patients with lung cancer. Eur J Nucl Med 1994; 21: 1106-13.
14 Lynn BE, Ayoub AW, Sanders MI. et al. Chest radiography or computed tomography to assess the response of lung cancer. Clin Oncol 1992; 4: 154-9.
15 Ohta H, Endo K, Fujita K. et al. Imaging of soft tissue tumour with Tc-99m V dimer-captosuccinic acid: A new tumor-seeking agent. Clin Nucl Med 1984; 9: 568-73.
16 Ohta H, Endo K, Fujita T. et al. Imaging of head and neck tumours with Tc-99m V DMSA a new tumour seeking agent. Clin Nucl Med 1985; 10: 855-60.
17 Ohta H, Yamamotomo K, Endo K. et al. A new imaging agent in medullary carcinoma of the thyroid. J Nucl Med 1993; 25: 323-5.
18 Reubi JC, Waser B, Sheppard M. et al. Somatostatin receptors are present in small-cell but not in non-small-cell primary lung carcinomas: relationship to EGF-receptors. Int J Cancer 1990; 45: 260-74.
19 Ugur Omer, Kostakoglu L, Guler N. et al. Comparison of Tc-99m (V) DMSA, Tl-201 and Tc-99m MIBI imaging in the follow-up of patients with medullary carcinoma of the thyroid. Eur J Nucl Med 1996; 23: 1367-71.
20 Watkinson JC, Lazarus CR, Mistry R. et al. Techenetium 99m V dimercaptosuccinic acid uptake in patients with head and neck squamous carcinoma experience in imaging. J Nucl Med 1989; 30: 174-80.
21 Webb WR. The role of MR imaging in the assessment of patients with lung cancer: a comparison with CT. J Thorac Imag 1989; 40: 65-75.
22 Webb WR, Gatsonic C, Zerhouni EA. et al. CT and MR imaging in staging non-small cell bronchogenic carcinoma: Report of the radiologic diagnostic oncology group. Radiology 1991; 178: 705-13.
23 Wulfrang DA, Kard HS, Small F. et al. Analogy between tumour uptake of Tc-99m (V) DMSA and Tc-99m MDP. Clin Nuc Med 1989; 14: 588-93.
24 Yokoyoma A, Hata N, Horiuchi K. et al. The design of a pentavalent Tc-99m dimercaptosuccinic acid preparation. Int J Nucl med Biol 1985; 12: 273-9.