Technetium Tc 99m–Labeled Red Blood Cells in the Preoperative Diagnosis of Cavernous Hemangioma and Other Vascular Orbital Tumors

Abstract

To evaluate technetium Tc 99m (99m Tc) red blood cell scintigraphy as a diagnostic tool for orbital cavernous hemangioma and to differentiate between orbital masses on the basis of their vascularization. Methods: We performed 99m Tc red blood cell scintigraphy on 23 patients (8 female and 15 male; mean age, 47 years) affected by an orbital mass previously revealed with computed tomography (CT) and magnetic resonance imaging (MRI) and suggesting cavernous hemangioma. In our diagnosis, we considered the orbital increase delayed uptake with the typical scintigraphic pattern known as perfusion blood pool mismatch. The patients underwent biopsy or surgical treatment with transconjunctival cryosurgical extraction when possible. Results: Single-photon emission tomography (SPET) showed intense focal uptake in the orbit corresponding to radiologic findings in 11 patients who underwent surgical treatment and pathologic evaluation (9 cavernous hemangiomas, 1 hemangiopericytoma, and 1 lymphangioma). Clinical or histologic examination of the remaining 22 patients revealed the presence of 5 lymphoid pseudotumors, 2 lymphomas, 2 pleomorphic adenomas of the lacrimal gland, 1 astrocytoma, 1 ophthalmic vein thrombosis, and 1 orbital varix. Conclusions: The confirmation of the preoperative diagnosis by 99m Tc red blood cell scintigraphy shows that this technique is a reliable tool for differentiating cavernous hemangiomas from other orbital masses (sensitivity,100%; specificity,86%) when ultrasound, CT, and MRI are not diagnostic. Unfortunately, 99m Tc red blood cell scintigraphy results were positive in 1 patient with hemangiopericytoma and 1 patient with lymphangioma, which showed increased uptake in the lesion on SPET images because of the vascular nature of these tumors. Therefore, in these cases, the SPET images have to be integrated with data regarding clinical preoperative evaluation and CT scans or MRI studies. On the basis of our study, a complete diagnostic picture, CT scans or MRI studies, and scintigraphic patterns can establish the preoperative diagnosis of vascular orbital tumors such as cavernous hemangioma, adult-type lymphangioma, and hemangiopericytoma.

Diagnostic Imaging Methods and Comparative Analysis of Orbital Cavernous Hemangioma

“…Burroni et al (30) reported that the characteristics of CHMs on SPECT imaging include the absence of intake during the early blood pool phase, followed by focal intake with persistent high consistency in the late phase. Additionally, false positive results were found within one hemangiopericytoma and one lymphangioma (both vascular diseases), which is consistent with the findings by Polite et al (31); thus, more accurate CHM diagnosis is needed via combination with clinical manifestations, as well as CT and MRI manifestations. Nevertheless, the high sensitivity and specificity of SPECT imaging cannot be ignored.…”

Diagnostic Imaging Methods and Comparative Analysis of Orbital Cavernous Hemangioma

“…Burroni et al (30) reported that the characteristics of CHMs on SPECT imaging include the absence of intake during the early blood pool phase, followed by focal intake with persistent high consistency in the late phase. Additionally, false positive results were found within one hemangiopericytoma and one lymphangioma (both vascular diseases), which is consistent with the findings by Polite et al (31); thus, more accurate CHM diagnosis is needed via combination with clinical manifestations, as well as CT and MRI manifestations. Nevertheless, the high sensitivity and specificity of SPECT imaging cannot be ignored.…”

The underestimated incidence of an orbital angioleiomyoma is possibly associated with an orbital cavernous hemangioma: illustrative case

“…Tc-99m RBC SPECT, also known as RBC scintigraphy or RBC scan, has a high predictive value for diagnosing orbital cavernous hemangioma. 3,4,18 However, both cases of angioleiomyoma evaluated by RBC scan in our series showed the same findings indicative of cavernous hemangioma. Considering the histological similarities, it is possible that the cavernous type of an orbital angioleiomyoma mimics a cavernous hemangioma on MRI and RBC scans and may be misdiagnosed, especially when the diagnosis is not based on histopathological examination.…”

“…Suspecting an orbital cavernous hemangioma, which is the most common benign mass-forming lesion in the orbit, we performed technetium (Tc)-99m red blood cell (RBC) single-photon emission computed tomography (SPECT), as it is highly useful in the diagnosis of this condition. 3,4 We observed a perfusion/ blood pool mismatch with negative uptake in the perfusion phase, weak positive uptake in the early blood-pooling phase, and positive uptake in the late blood-pooling phase, which was exactly consistent with a cavernous hemangioma. Considering the location of the tumor inside the orbit and its relative anatomical orientation with the optic nerve, resection through an endoscopic endonasal approach (EEA) was planned.…”

Temporal Volume Change of Cavernous Sinus Cavernous Hemangiomas after Gamma Knife Surgery

“…6 7 This study showed progressive and persistent tracer accumulation of labeled RBCs in the lesion, establishing RBC scan as an effective method for the diagnosis of CSCH. 6 7 …”

Diagnostic Imaging Methods and Comparative Analysis of Orbital Cavernous Hemangioma

“…Burroni et al (30) reported that the characteristics of CHMs on SPECT imaging include the absence of intake during the early blood pool phase, followed by focal intake with persistent high consistency in the late phase. Additionally, false positive results were found within one hemangiopericytoma and one lymphangioma (both vascular diseases), which is consistent with the findings by Polite et al (31); thus, more accurate CHM diagnosis is needed via combination with clinical manifestations, as well as CT and MRI manifestations. Nevertheless, the high sensitivity and specificity of SPECT imaging cannot be ignored.…”

The underestimated incidence of an orbital angioleiomyoma is possibly associated with an orbital cavernous hemangioma: illustrative case

“…Tc-99m RBC SPECT, also known as RBC scintigraphy or RBC scan, has a high predictive value for diagnosing orbital cavernous hemangioma. 3,4,18 However, both cases of angioleiomyoma evaluated by RBC scan in our series showed the same findings indicative of cavernous hemangioma. Considering the histological similarities, it is possible that the cavernous type of an orbital angioleiomyoma mimics a cavernous hemangioma on MRI and RBC scans and may be misdiagnosed, especially when the diagnosis is not based on histopathological examination.…”

“…Suspecting an orbital cavernous hemangioma, which is the most common benign mass-forming lesion in the orbit, we performed technetium (Tc)-99m red blood cell (RBC) single-photon emission computed tomography (SPECT), as it is highly useful in the diagnosis of this condition. 3,4 We observed a perfusion/ blood pool mismatch with negative uptake in the perfusion phase, weak positive uptake in the early blood-pooling phase, and positive uptake in the late blood-pooling phase, which was exactly consistent with a cavernous hemangioma. Considering the location of the tumor inside the orbit and its relative anatomical orientation with the optic nerve, resection through an endoscopic endonasal approach (EEA) was planned.…”

Temporal Volume Change of Cavernous Sinus Cavernous Hemangiomas after Gamma Knife Surgery

“…6 7 This study showed progressive and persistent tracer accumulation of labeled RBCs in the lesion, establishing RBC scan as an effective method for the diagnosis of CSCH. 6 7 …”

Diagnostic Imaging Methods and Comparative Analysis of Orbital Cavernous Hemangioma

“…Burroni et al (30) reported that the characteristics of CHMs on SPECT imaging include the absence of intake during the early blood pool phase, followed by focal intake with persistent high consistency in the late phase. Additionally, false positive results were found within one hemangiopericytoma and one lymphangioma (both vascular diseases), which is consistent with the findings by Polite et al (31); thus, more accurate CHM diagnosis is needed via combination with clinical manifestations, as well as CT and MRI manifestations. Nevertheless, the high sensitivity and specificity of SPECT imaging cannot be ignored.…”

The underestimated incidence of an orbital angioleiomyoma is possibly associated with an orbital cavernous hemangioma: illustrative case

“…Tc-99m RBC SPECT, also known as RBC scintigraphy or RBC scan, has a high predictive value for diagnosing orbital cavernous hemangioma. 3,4,18 However, both cases of angioleiomyoma evaluated by RBC scan in our series showed the same findings indicative of cavernous hemangioma. Considering the histological similarities, it is possible that the cavernous type of an orbital angioleiomyoma mimics a cavernous hemangioma on MRI and RBC scans and may be misdiagnosed, especially when the diagnosis is not based on histopathological examination.…”

“…Suspecting an orbital cavernous hemangioma, which is the most common benign mass-forming lesion in the orbit, we performed technetium (Tc)-99m red blood cell (RBC) single-photon emission computed tomography (SPECT), as it is highly useful in the diagnosis of this condition. 3,4 We observed a perfusion/ blood pool mismatch with negative uptake in the perfusion phase, weak positive uptake in the early blood-pooling phase, and positive uptake in the late blood-pooling phase, which was exactly consistent with a cavernous hemangioma. Considering the location of the tumor inside the orbit and its relative anatomical orientation with the optic nerve, resection through an endoscopic endonasal approach (EEA) was planned.…”

Temporal Volume Change of Cavernous Sinus Cavernous Hemangiomas after Gamma Knife Surgery

“…6 7 This study showed progressive and persistent tracer accumulation of labeled RBCs in the lesion, establishing RBC scan as an effective method for the diagnosis of CSCH. 6 7 …”