Medicine:Octreotide scan

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Octreotide scan
Medical diagnostics
Octreoscan.jpg
111In-pentetreotide scintigraphy of a 41-year-old man with ectopic Cushing's syndrome caused by a neuroendocrine carcinoma of the mesentery. Radiotracer accumulation in the left thyroid in 10/2003 (arrow). The mesenterial neuroendocrine tumor became clearly visible in 4/2005 (arrow).
Synonymsocreoscan
ICD-9-CM92.18
OPS-301 code3-70c

An octreotide scan is a type of SPECT scintigraphy used to find carcinoid, pancreatic neuroendocrine tumors, and to localize sarcoidosis. It is also called somatostatin receptor scintigraphy (SRS). Octreotide, a drug similar to somatostatin, is radiolabeled with indium-111,[1] and is injected into a vein and travels through the bloodstream. The radioactive octreotide attaches to tumor cells that have receptors for somatostatin (i.e. gastrinoma, glucagonoma, etc.). A gamma camera detects the radioactive octreotide, and makes pictures showing where the tumor cells are in the body, typically by a SPECT technique. A technetium-99m based radiopharmaceutical kit is also available.[2][3]

Octreotide scanning is reported to have a sensitivity between 75% and 100% for detecting pancreatic neuroendocrine tumors.[4]

Instead of gamma-emitting 111In, certain octreotide derivatives such as edotreotide (DOTATOC) or DOTATATE are able to be linked by chelation to positron-emitting isotopes such as gallium-68 and copper-64 which in turn can be evaluated with more precise (compared with SPECT) scanning techniques such as PET-CT. Thus, the octreotide scan is now being replaced in most centers with gallium-68 DOTATATE and copper-64 DOTATATE scans. Somatostatin receptor imaging can now be performed with positron emission tomography (PET) which offers higher resolution and more rapid imaging.[5]

Indications

An octreotide scan may be used to locate suspected primary neuroendocrine tumours (NET) or for follow-up or staging after treatment.[6][7][8]

Where indicated, octreotide scanning for NET tumors is being increasingly replaced by gallium-68 DOTA and copper-64 DOTATATE scans.[9]

Procedure

Indium-111

Indium In-111 pentetreotide
Indium In 111 pentetreotide - OctreoScan.svg
Clinical data
Trade namesOctreoscan
Other namesMP-1727
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Intravenous
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The indium-111 pentetreotide radiopharmaceutical is prepared from a kit in a radiopharmacy. Pentetreotide is a DTPA conjugate of octreotide.[6][11]

Approximately 200 megabecquerels (MBq) of indium-111 is injected intravenously. Imaging takes place 24 hours after injection, but may also be carried out at 4 and 48 hours.[7][12]

Technetium-99m

The 99mTc product is supplied as a kit with two vials, one containing the chelating agent ethylenediaminediacetic acid (EDDA) and the other the HYNIC-Tyr3-octreotide chelator and somatostatin analog.[13] Approximately 400-700 MBq may be administered, with imaging at 2, 4, and occasionally 24 hours post administration.[14] 99mTc based octreotide imaging shows slightly higher sensitivity than 111In.[2][15]

References

  1. medicinenet.com > Carcinoid Syndrome (cont.) By Dennis Lee and Jay Marks. Retrieved Mars 2011
  2. 2.0 2.1 Briganti, Vittorio; Cuccurullo, Vincenzo; Berti, Valentina; Di Stasio, Giuseppe D.; Linguanti, Flavia; Mungai, Francesco; Mansi, Luigi (30 November 2020). "99mTc-EDDA/HYNIC-TOC is a New Opportunity in Neuroendocrine Tumors of the Lung (and in other Malignant and Benign Pulmonary Diseases)". Current Radiopharmaceuticals 13 (3): 166–176. doi:10.2174/1874471013666191230143610. PMID 31886756. 
  3. Scherübl, H.; Raue, F.; Frank-Raue, K. (November 2019). "Neuroendokrine Tumoren: Klassifikation, Klinik und Bildgebung" (in de). Der Radiologe 59 (11): 952–960. doi:10.1007/s00117-019-0574-x. PMID 27479887. 
  4. "Somatostatin receptor imaging". Seminars in Nuclear Medicine 32 (2): 84–91. April 2002. doi:10.1053/snuc.2002.31022. PMID 11965603. 
  5. Hofman, M.S.; Kong, G.; Neels, O.C.; Eu, P.; Hong, E.; Hicks, R.J. (2012). "High management impact of Ga-68 DOTATATE (GaTate) PET/CT for imaging neuroendocrine and other somatostatin expressing tumours". Journal of Medical Imaging and Radiation Oncology 56 (1): 40–47. doi:10.1111/j.1754-9485.2011.02327.x. PMID 22339744. 
  6. 6.0 6.1 "ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: somatostatin receptor imaging with (111)In-pentetreotide". Neuroendocrinology 90 (2): 184–189. 2009. doi:10.1159/000225946. PMID 19713709. 
  7. 7.0 7.1 "111In-pentetreotide scintigraphy: procedure guidelines for tumour imaging". European Journal of Nuclear Medicine and Molecular Imaging 37 (7): 1441–1448. July 2010. doi:10.1007/s00259-010-1473-6. PMID 20461371. 
  8. (in en) Fundamentals of Nuclear Pharmacy. Springer. 2010. p. 145. ISBN 9781441958600. https://books.google.com/books?id=bEXqI4ACk-AC&pg=PA145. 
  9. "Management of Small Bowel Neuroendocrine Tumors". Journal of Oncology Practice 14 (8): 471–482. 2018. doi:10.1200/JOP.18.00135. PMID 30096273. 
  10. "Octreoscan- indium in -111 pentetreotide kit". https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=93d8f3b2-1216-41dc-a63d-0e812b33891d. 
  11. "In 111 pentetreotide" (in en). National Cancer Institute. 2011-02-02. https://www.cancer.gov/publications/dictionaries/cancer-drug?cdrid=43127. 
  12. "The SNM practice guideline for somatostatin receptor scintigraphy 2.0". Journal of Nuclear Medicine Technology 39 (4): 317–324. December 2011. doi:10.2967/jnmt.111.098277. PMID 22068564. 
  13. "TEKTROTYD". http://www.rotop-pharmaka.de/en/our-products/99m-tc-kits/tektrotyd/. 
  14. Garai, Ildikó; Barna, Sandor; Nagy, Gabor; Forgacs, Attila (2016). "Limitations and pitfalls of 99mTc-EDDA/HYNIC-TOC (Tektrotyd) scintigraphy". Nuclear Medicine Review 19 (2): 93–98. doi:10.5603/NMR.2016.0019. PMID 27479887. 
  15. "TEKTROTYD Public Assessment Report (PAR)". Heads of Medicines Agencies. 6 May 2020. https://mri.cts-mrp.eu/Human/Product/Details/45950. 

External links

 This article incorporates public domain material from the U.S. National Cancer Institute document "Dictionary of Cancer Terms".