111In-octreotide imaging in patients with long-standing Gravesʼ ophthalmopathy

Bohuslavizki, K. H.; Oberwöhrmann, S.; Brenner, Winfried; Eberhardt, Jens; Mönig, H.; Clausen, M.; Sippel, C.; Wolf, Holly J.; Epe, Bernd; Henze, Eberhard

doi:10.1097/00006231-199511000-00006

Cited by 19 publications

(6 citation statements)

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“…It is also possible that a transient, time-related expression of the IL2R occurs and that expression of IL2R might only be observed in the early phases of exophthalmos. This has already been reported for 111 In-octreotide, which showed accumulation in the retroorbital space of patients with exophthalmos only during the early phases of the disease [17,18]. Finally, a sensitivity problem cannot be ruled out due to the limited amount of radioactivity (about 100 MBq) injected in our patients.…”

Section: Discussionsupporting

confidence: 57%

99mTc-interleukin-2 scintigraphy in normal subjects and in patients with autoimmune thyroid diseases: a feasibility study

Chianelli

Mather

Grossman

et al. 2008

Eur J Nucl Med Mol Imaging

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Purpose Radiolabelled interleukin-2 is a radiopharmaceutical used for the study of chronic inflammatory processes. 123 I-labelled interleukin-2 has successfully been used in a large number of patients affected by several immunemediated diseases. 123I, however, is expensive and not readily available. We have, therefore, developed a method for labelling interleukin-2 with 99m Tc to high specific activity based on the use of an N 3 S bifunctional chelating agent. In this paper, we describe the results obtained with 99m Tc-interleukin-2 in a series of eight normal subjects and of 12 patients with autoimmune thyroid diseases. Methods Biodistribution, pharmacokinetics, haematological and systemic toxicity, radiation absorbed dose and in vivo targeting were studied.Results Results showed rapid plasma clearance of 99m Tcinterleukin-2 with retention mainly in the kidneys. Biodistribution and kinetics were similar to that observed for 123 I-interleukin-2. No acute systemic toxicity was found; a small decrease in peripheral blood lymphocytes was observed in the first hours only in patients, but it was mild and transient. Tc-interleukin-2 accumulated, to varying extents, in the thyroid of all patients affected by autoimmune thyroid diseases but not in the thyroid of normal subjects. The effective dose equivalent of a diagnostic activity of 99m Tc-interleukin-2 (185 MBq) was 1.35 mSv. No correlation was observed between thyroid autoantibodies and uptake of 99m Tc-interleukin-2. Conclusions The use of 99m Tc-interleukin-2 is safe and simple; the favourable dosimetry and biodistribution and the rapid clearance make it potentially useful for the study of chronic inflammatory diseases such as autoimmune thyroid disease.

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Section: Discussionsupporting

confidence: 57%

99mTc-interleukin-2 scintigraphy in normal subjects and in patients with autoimmune thyroid diseases: a feasibility study

Chianelli

Mather

Grossman

et al. 2008

Eur J Nucl Med Mol Imaging

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“…While some (89,90) but not all studies (91)(92)(93) found a higher uptake of the tracer in patients with more severe forms of ophthalmopathy, all studies indicated a relationship between the octreoscan positivity and the activity of the disease: the orbital octreotide accumulation was higher in patients with active ophthalmopathy than in those with inactive eye disease (90,91), implying also that GO patients with positive octreoscans might have a successful outcome of medical therapy. In this regard, a positive predictive value of 90 -92% has been reported (94,95).…”

Section: A Whom To Treat?mentioning

confidence: 98%

Management of Graves' Ophthalmopathy: Reality and Perspectives

Bartalena¹

2000

Endocrine Reviews

299

351

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Graves' ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In mild cases, local therapeutic measures (artificial tears and ointments, sunglasses, nocturnal taping of the eyes, prisms) can control symptoms and signs. In severe forms of the disease (3-5%), aggressive measures are required. If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment. If the disease is severe but inactive, orbital decompression is preferred. Novel treatments such as somatostatin analogs or intravenous immunoglobulins are under evaluation. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease. Correction of both hyper-and hypothyroidism is crucial for the ophthalmopathy. Antithyroid drugs and thyroidectomy do not influence the course of the ophthalmopathy, whereas radioiodine treatment may cause the progression of preexisting ophthalmopathy, especially in smokers. The exacerbation, however, is prevented by glucocorticoids. In addition, thyroid ablation may prove beneficial for the ophthalmopathy in view of the pathogenetic model relating eye disease to autoimmune reactions directed against antigens shared by the thyroid and the orbit.

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“…Wide differences exist between various studies regarding the administered dose of radionuclide, the time interval after injection for determining the orbital uptake, the selection of orbital slices for quantification of the orbital uptake, and the method of correction for background radioactivity (19)(20)(21). The earlier studies used rather large doses of pentetreotide and preferred to measure orbital uptake 24 h postinjection (2,12,14,21), while later studies administered a low dose and measured orbital uptake only 2 h postinjection arguing that the low dose decreases the radiation burden and the cost of the examination (15,22).…”

mentioning

confidence: 99%

“…The earlier studies used rather large doses of pentetreotide and preferred to measure orbital uptake 24 h postinjection (2,12,14,21), while later studies administered a low dose and measured orbital uptake only 2 h postinjection arguing that the low dose decreases the radiation burden and the cost of the examination (15,22). Nevertheless, a low dose might cause problems in count statistics and at 2 h postinjection, 12% of the dose is still in the blood pool causing high background uptake.…”

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confidence: 99%

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The role of octreoscan in thyroid eye disease

Krassas¹,

Kahaly²

1999

European Journal of Endocrinology

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Until recently there was no imaging technique available which could demonstrate pathological changes in orbital tissues and could be regarded as a reliable measure of inflammation in thyroid eye disease (TED). Pentetreotide (a synthetic derivative of somatostatin) labelled with 111In has been used to localize tumours which possess surface or membrane receptors for somatostatin in vivo using a gamma camera (1). This technique visualizes somatostatin receptors in endocrine-related tumours in vivo and predicts the inhibitory effect of the somatostatin analogue octreotide on hormone secretion by the tumours (1). By applying 111In-DTPA-d-Phe octreotide scintigraphy (octreoscan), accumulation of the radionuclide was also detected in both the thyroid and orbit of patients with Graves' disease (2-4). If peak activity in the orbit 5h after injection of radiolabelled octreotide is set at 100%, a decrease to 40+/-4% is found at 24h, significantly different from the decrease in blood pool radioactivity, which is 15+/-4% at 24h. Accumulation of the radionuclide is most probably due to the presence in the orbital tissue of activated lymphocytes bearing somatostatin receptors (5). Alternative explanations are binding to receptors on other cell types (e.g. myoblasts, fibroblasts or endothelial cells) or local blood pooling due to venous stasis by the autoimmune orbital inflammation.

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111In-octreotide imaging in patients with long-standing Gravesʼ ophthalmopathy

Cited by 19 publications

References 0 publications

99mTc-interleukin-2 scintigraphy in normal subjects and in patients with autoimmune thyroid diseases: a feasibility study

99mTc-interleukin-2 scintigraphy in normal subjects and in patients with autoimmune thyroid diseases: a feasibility study

Management of Graves' Ophthalmopathy: Reality and Perspectives

The role of octreoscan in thyroid eye disease

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