ROC-Analyse der Tumorerkennbarkeit mit 201T1 (I) Chlorid und 99mTc (I) Hexakis (2-Methoxy-2-Isobutylisonitril)

S.P. Müller; Margarete Paas; Chr. Reiners

doi:10.1055/s-0038-1629671

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 1994; 33(01): 15-23
DOI: 10.1055/s-0038-1629671

Original Article

Schattauer GmbH

ROC-Analyse der Tumorerkennbarkeit mit ²⁰¹T1 (I) Chlorid und ^99mTc (I) Hexakis (2-Methoxy-2-Isobutylisonitril)

ROC Analysis of Tumor Delegability Using ²⁰¹Tl (I) Chloride and ^99mTc (I) Hexakis (2-Methoxy-2-Isobutylisonitrile)

S.P. Müller

¹Aus der Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Essen. FRG

,

Margarete Paas

¹Aus der Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Essen. FRG

,

Chr. Reiners

¹Aus der Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Essen. FRG

› Institutsangaben

Abstract

Zusammenfassung

Wir untersuchten die Tumorerkennbarkeit bei Bronchialkarzinomen mit ²⁰¹TI und ^99mTc-MIBI in planarer und SPECT-Technik. Diese Phase-IiI-Studie umfaßte 30 Tumorpatienten und 7 Patienten mit koronarer Herzkrankheit. Durch unabhängige Befundung der in 6 Abschnitte partitionierten Lunge konnte eine ausreichend große Stichprobe tumorfreier Referenzregionen generiert werden. Wir berechneten die Teststärke für den Vergleich der Sensitivitäten bei einer vorgegebenen Spezifität von 95% (TPF-Test) und zeigten, daß durch die Partitionierung der Lunge und durch den Einsatz des bivariaten binormalen ROC-Modells ein objektiver Methodenvergleich auch bei den kleinen Stichprobenumfängen unserer Studie möglich ist. Für beide Befunder ergab sich kein signifikanter Unterschied zwischen ²⁰¹TI und MIBI, ein Vorteil von MIBI gegenüber ²⁰¹TI für die Tumorszintigrafie war also nicht nachweisbar. SPECT war der planaren Szintigrafie signifikant überlegen und sollte bei der Tumorszintigrafie im Thoraxbereich bevorzugt werden.

Summary

We investigated tumor detectability of bronchial carcinoma using ²⁰¹TI and ^99mTc-MIBI with planar scintigraphy and SPECT. We studied 30 tumor patients and 7 patients with coronary artery disease in a clinical phase III trial. The lung was partitioned into 6 areas, which were read independently, to provide a sufficiently large sample of tumor-free reference regions. We calculated the statistical power for the comparison of sensitivities at a given specificity of 95% (TPF-test) to demonstrate that the subdivision of the lung and the application of the bivariate binormal ROC model allows an objective assessment of diagnostic performance even for the small sample size of our study. There were no significant differences between ²⁰¹TI and ^99mTc-MIBI for both observers; therefore, no advantage of ^99mTc-MIBI over ²⁰¹TI for tumor scintigraphy could be demonstrated. SPECT was significantly superior to planar scintigraphy and should be preferred for tumor detection in the thorax.

Schlüsselwörter:

²⁰¹TI - ^99mTc-MIBI - Tumorszintigrafie - SPECT - ROC-Analyse - bivanates ROC-Modell

Key words

²⁰¹TI - ^99mTc-MIBI - tumor scintigraphy - SPECT - ROC analysis - bivariate ROC model

Volltext

Referenzen

Literatur
1 Ando AA, Ando I, Katayama M. et al. Biodistribution of TI-201 in tumour bearing animals and inflammatory lesion induced animals. Eur J Nucl Med 1987; 12: 567-72.
2 Bayhan H, Aktolun C, Kir KM, Öztürk E, Giinalp B, Ogur E. Tc-99m MIBI imaging in patients with intrathoracic malignant tumors. Eur J Nucl Med 1991; 18: 675.
3 Begg CB, McNeil BJ. Assessment of radiological tests: Control of bias and other design considerations. Radiology 1988; 167: 565-9.
4 Brendel AJ, Guyot M, Jeandot R, Lefort G, Manciet G. Thallium-201 imaging in the follow-up of differentiated thyroid carcinoma. J Nucl Med 1988; 29 (Suppl. 09) 1515-20.
5 Briele B, Hotze A, Kropp J. et al. Vergleich von ^20lTI und ²⁰¹T1-MIBI in der Nachsorge des differenzierten Schilddrüsenkarzinoms. Nucl Med 1991; 30: 115-24.
6 Bronskill MJ, Henkelman RM, Poon PY. et al. Magnetic resonance imaging, computed tomography, and radionuclide scintigraphy in detection of liver metastases. J Can Assoc Radiol 1988; 39: 3-9.
7 Burman KD, Anderson JH, Wartofsky L, Mong DP, Jelinek JJ. Management of patients with thyroid carcinoma: application of thallium-201 scintigraphy and magnetic resonance imaging. J Nucl Med 1990; 31 (Suppl. 12) 1958-64.
8 Caner B, Kitapci M, Erbengi G, Ugur O, Bekdik C. Increased accumulation of Hexakis (2-methoxyisobutylisonitrile) Technetium (I) in osteosarcoma and its metastatic lymph nodes. J Nucl Med 1991; 32: 1997-8.
9 Carlin RD, Jan K. Mechanism of thallium extraction in pump perfused canine hearts. J Nucl Med 1985; 26: 165-9.
10 Carvalho PA, Chiu ML, Kronauge JF. et al. Subcellular distribution and analysis of Technetium-99m-MIBI in isolated perfused rat hearts. J Nucl Med 1992; 33: 1516-21.
11 Charkcs ND, Vitti RA, Brooks K. Thallium-201 SPECT increase detectability of thyroid cancer metastases. J Nucl Med 1990; 31 (Suppl. 02) 147-53.
12 Culver CM, Dworkin HJ. Comparison of personnel radiation dosimetry from myocardial perfusion scintigraphy: Technetium99m-sestamibi versus thallium-201. J Nucl Med 1993; 34: 1210-3.
13 Delmon Moingeon L, Piwnica Worms D, Van den Abbeele A, Holman BL, Davison A, Jones AG. Uptake of the cation hexa-kis(2-methoxyisobutylisonitrile)-techne-tium-99m by human carcinoma cell lines in vitro. Cancer Res 1990; 50 (Suppl. 07) 2198-202.
14 Freedman LS. Evaluating and comparing imaging techniques: a review and classification of study designs. Br J Radiol 1987; 60: 1071-81.
15 Hanley JA. The robustness of the »binormal« assumptions used in fitting ROC curves. Med Dec Making 1989; 8: 197-203.
16 Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29-36.
17 Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983; 148: 839-43.
18 Harwood SJ, Carroll RG, Anderson M. SPECT gallium scanning for lymphoma and infection. Clin Nucl Med 1987; 12: 694-704.
19 Hassan IM, Sahweil A, Constantinides C. et al. Uptake and kinetics of Tc-99m hexakis 2-methoxyisobutylisonitrile in benign and malignant lesions in the lungs. Clin Nucl Med 1989; 14 (Suppl. 05) 333-40.
20 Hoefnagel CA, Delprat CC, Marcuse HR, de Vijlder JJM. Role of thallium-201 total body scintigraphy in follow-up of thyroid carcinoma. J Nucl Med 1986; 27: 1854-7.
21 Höffken H, Joseph K, Alexander C. et al. 99mTc-2-methoxy-isobutyl-isonitrile in the diagnosis of coronary heart disease: results of a multicenter study. Nucl-Med 1990; 29 (Suppl. 04) 135-43.
22 ICRP Radiation dose to patients from radiopharmaceuticals. ICRP Publication 53. Oxford: Pergamon; 1988. Annals of the ICRP; vol 53.
23 ICRP.. Radiation dose to patients from radiopharmaceuticals. Addendum 1 to ICRP publication 53. Oxford: Pergamon; 1993. Annals of the ICRP; vol 53.
24 Jones AG, Abrams MJ, Davison A. et al. Biological studies of a new class of technetium complexes: the hexakis (alkylisonitri-le) technetium (I) cations. Int J Nucl Med Biol 1984; 11: 225-34.
25 Judy PF, Swenson RG. Display thresholding of images and observer detection performance. J Opt Soc Am (A) 1987; 4: 954-65.
26 Kao CH, Wang SJ, Lin WY, Hsu CY, Lio SO, Yeh SH. Differentiation of single solid lesions in the lungs by means of single-photon emission tomography with techne-tium-99m methoxyisobutylisonitrilc. Eur J Nucl Med 1993; 20: 249-54.
27 Keycs JW, Singer D, Satterlcc W. Liver-spleen studies with the rotating gamma camera II: Utility of tomography. Radiology 1984; 153: 537-41.
28 Krasnow AZ, Collier BD, lsitman AT, Hellman RS, Peck DC. The clinical significance of unusual sites of Thallium-201 uptake. Sem Nucl Med 1988; 18: 350-58.
29 Krumholz H, Tselfes J, Parker JA, Donohoe KJ, Kolodny GM. Comparison of digital and analog (film) displays in fhe interpretation of Thallium images. J Nucl Med 1992; 33: 1003.
30 Leppo JA, Meerdink DJ. Comparison of the myocardial uptake of a technetium-labeled isonitrile analogue and thallium. pre Res 1989; 65 (Suppl. 03) 632-9.
31 Marshall RC, Leidholdt EM, Zhang DY, Barnett CA. Technetium-99m hexakis 2-methoxy-2-isobutyl isonitrile and Thallium-201 extraction, washout, and retention at varying coronary flow rates in rabbit heart. Circulation 1990; 82: 998-1007.
32 McClish DK. Analyzing a portion of the ROC curve. Med Dec Making 1989; 9: 190-5.
33 McNeil BJ, Hanley JA. Statistical approaches to the analysis of receiver operating characteristic (ROC) curves. Med Dec Making 1984; 17: 439-48.
34 Meerdink DJ, Leppo JA. Experimental studies of the physiologic properties of techne-tium-99m agents: myocardial transport of perfusion imaging agents. Am J Cardiol. 1990 66. 13
35 Metz CE. Basic principles of ROC analysis. Sem Nucl Med 1978; 8: 283-98.
36 Metz CE. ROC methodology in radiological imaging. Invest Radiol 1986; 21: 720-33.
37 Metz CE. Statistical analysis of ROC data in evaluating diagnostic performance. In: Multiple regression analysis: applications in the health sciences. Myers HD. ed. New York: American Institute of Physics; 1986: 365-84.
38 Metz CE. Some practical issues of experimental design and data analysis in radiological ROC studies. Invest Radiol 1989; 24: 234-45.
39 Metz CE, Kronman HB. Statistical significance tests for binormal ROC curves. J Math Psych 1980; 22: 218-43.
40 Metz CE, Wang P-L, Kronman HB. A new approach for testing the significance of differences between ROC curves measured from correlated data. In: Information processing in medical imaging. Deconninck F. ed. The Hague: Nijhoff; 1984: 432-45.
41 Müller SP, Guth-Tougelidis B, Creutzig H. Imaging of malignant tumors with Tc-99m-MIBI SPECT. J Nucl Med 1987; 28: 562.
42 Müller SP, Guth-Tougelidis B, Piotrowski B, Farahati J, Reiners C. Tl-201 scintigraphy in the follow-up of eosinophilic thyroid carcinoma. J Nucl Med 1990; 31: 767.
43 Müller SP, Piotrowski B, Guth-Tougelidis B, Reiners C. Tc-99m MIBI and Tl-201 uptake in thyroid carcinoma. J Nucl Med 1988; 29: 854.
44 Müller SP, Reiners C, Paas M. et al. Tc-99m MIBI and Tl-201 uptake in bronchial carcinoma. J Nucl Med 1989; 30: 845.
45 OTuama LA, Treves TS, Larar JN. et al. Thallium-201 vs. Technetium-99m-MIBI SPECT in evaluation of childhood brain tumors: A within-subject comparison. J Nucl Med 1993; 34: 1045-51.
46 Piwnica-Worms D, Kronauge JF, Chiu ML. Uptake and retention of hexakis(2-meth-oxyisobutylisonitrile) Technetium (I) in cultured chick myocardial cells: mitochondrial and plasma membrane potential-dependence. Circulation 1990; 82: 1826-38.
47 Pohost GM, Alpert NM, Ingwall JS. Thallium redistribution: Mechanisms and clinical utility. Sem Nucl Med 1980; 10: 70-93.
48 Ramanna L, Waxman A, Braunstein G. Thallium-201 scintigraphy in differentiated thyroid cancer: comparison with radioiodi-ne scintigraphy and serum thyroglobulin determinations. J Nucl Med 1991; 32 (Suppl. 03) 441-6.
49 Roseli H, Jacobsson H, Larson SA, Lundell G. Retrospective evaluation of single photon emission computed tomography of the liver. Eur J Nucl Med 1987; 13: 234-8.
50 Sehweil AM, McKillop JH, Milroy R, Ab-del-Dayem HM, Omar YT. Mechanism of Tl-201 uptake in tumors. Eur J Nucl Med 1989; 15: 376-9.
51 Sehweil AM, McKillop JH, Milroy R. et al. 201T1 scintigraphy in the staging of lung cancer, breast cancer and lymphoma. Nucl Med Comm 1990; 11 (Suppl. 04) 263-9.
52 Stanley KE. Prognostic factors for survival in patients with inoperable lung cancer. J Nat Cancer Inst 1980; 65: 25-32.
53 Swets JA, Pickett RM. Evaluation of diagnostic systems: Methods from signal detection theory. New York: Academic Press; 1982
54 Tonami N, Shuke N, Yokoyama K. et al. Thallium-201 single photon emission computed tomography in the evaluation of suspected lung cancer. J Nucl Med 1989; 30 (Suppl. 06) 997-1004.
55 Waxman AD, Goldsmith MS, Greif PM. et al. Differentiation of tumor vs. sarcoidosis using Tl-201 in patients with hilar and mediastinal adenopathy. J Nucl Med 1987; 28: 561.
56 Wickens TD. Maximum-likelihood estimation of a multivariate Gaussian rating model with excluded data. J Math Psych 1992; 36: 213-34.