Usefulness of ^99mTc-Tetrofosmin Scintigraphy in Different Variants of Kaposi’s Sarcoma

Abstract

We investigated ^99mTc-tetrofosmin scintigraphy in 27 patients with Kaposi’s sarcoma: 20 had classic (CK), 5 AIDS-associated (AK) and 2 transplantation-associated (TK) variants. Twenty-three patients had clinically evident cutaneous and/or mucosal lesions, 9 of them with associated sarcomatous lymphadenopathy; 2 TK patients had only lymph nodes or other extracutaneous Kaposi sites. Both planar and SPECT ^99mTc-tetrofosmin scintigraphies were performed in all cases and neck pinhole (P)-SPECT in selected patients. ^99mTc-tetrofosmin uptake was observed in 88% of patients with clinically evident cutaneous and/or extracutaneous Kaposi lesions. Scintigraphy gave additional information on cutaneous lesion extent, particularly SPECT regarding deep invasion and subclinical sites in some cases. However, scintigraphy was less sensitive in the detection of small, isolated and scattered lesions. SPECT/P-SPECT were positive in 8/8 patients with sarcomatous lymph nodes, planar imaging in 5/8, ultrasonography in 7/8, while all procedures were negative in 6 other patients with reactive or HIV infection lymph nodes. SPECT demonstrated lymphadenopathy remission in 1 TK patient after immunosuppressive therapy modification and, like planar imaging, ascertained an associated lymphoma with ⁶⁷Ga-citrate combined. ^99mTc-tetrofosmin scintigraphy, especially SPECT, can be useful both in the detection and staging of Kaposi sarcoma lesions as a complementary tool to clinical and other conventional diagnostic methods.

Kaposi sarcoma: A continuing conundrum

“…Scintigraphic procedures may be valuable in the diagnosis, staging, and differential diagnosis of KS, particularly in the latter case in differentiating KS from lymphoma and opportunistic infection. 223 …”

“…225 Radiologic techniques may also be useful, including digital subtraction angiography. 223 BA may resemble KS both clinically and histologically (Fig 14). [232][233][234] Cutaneously, typical BA is a violaceous angiomatous tumor or a nodule resembling a pyogenic granuloma.…”

99mTc‐MIBI imaging of cutaneous AIDS‐associated Kaposi's sarcoma

“…Accumulation of 99m Tc‐tetrofosmin was reported in 88% of 27 patients with cutaneous KS including five cases of AIDS‐KS. Single photon emission computed tomography (SPECT) was found to be more sensitive (82.6%, 96.4–100%) than planar imaging (69.6%, 28.6–62.5%) for clinically evident muco‐cutaneous lesions and lymphadenopathy, respectively 13 . We found similar sensitivity of 73.53% for detecting cutaneous KS in the extremities using 99m Tc‐MIBI planar imaging.…”

“…The 99m Tc‐pertechnetate scan shows uptake in both KS and pseudo‐KS lesions but no uptake in atrophie blanche 7 . There are also reports of KS lesion detection using 201 Tl‐chloride, 99m Tc‐tetrofosmin, 111 In‐DTPA‐labeled pegylated liposomes, 111 In‐DTPA‐octreotide, 18 F‐fluorodeoxyglucose, and 11 C‐methionine 8–13 . The 99m Tc‐hexakis‐2‐methoxy isobutyl isonitrile (MIBI) has been used successfully in detecting lymphoma and tumors of the brain, thyroid, parathyroid, breast, lung, bone and soft tissue 14–18 .…”

Axillary Lymph Node Status in Breast Cancer

“…Clinical applications have regarded the identification of neck metastases from differentiated thyroid carcinoma in patients previously submitted to thyroidectomy and radioiodine treatment, as the technique showing a higher per-lesion sensitivity than planar imaging and conventional SPECT with parallel-hole collimators (Spanu et al, 2004a). Pinhole-SPECT was also used in the detection of neck lymph node metastases from Kaposi's sarcoma (Spanu et al, 2003a) and in the identification of hyperfunctioning glands in both primary and secondary hyperparathyroidism, significantly increasing the sensitivity of the conventional planar parathyroid scintigraphy (Spanu et al, 2004b). In these studies we preferred to use tetrofosmin rather than sestaMIBI as the oncologic agent because of its more favorable pharmacokinetics: its faster and greater clearance from the lung and liver allows a higher target to background.…”