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Value of Peptide Receptor Scintigraphy Using ¹²³I-Vasoactive Intestinal Peptide and ¹¹¹In-DTPA-D-Phe1-Octreotide in 194 Carcinoid Patients: Vienna University Experience, 1993 to 1998

From the Departments of Internal Medicine I, Nuclear Medicine, Internal Medicine III, Internal Medicine IV, Surgery, and Radiology, University of Vienna, and Research Center Seibersdorf, Vienna, Austria.

Address reprint requests to Irene Virgolini, MD, Department of Nuclear Medicine, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; email irene.virgolini{at}akh-wien.ac.at

PURPOSE: To report our experience with both ¹²³I-vasoactive intestinal peptide (VIP) and ¹¹¹In-DTPA-D-Phe¹-octreotide for imaging to identify primary and metastatic tumor sites in carcinoid patients.

PATIENTS AND METHODS: One hundred ninety-four patients with a verified or clinically suspected diagnosis of a carcinoid tumor were injected with ¹¹¹In-DTPA-D-Phe¹-OCT for imaging purposes, while 133 patients underwent scanning with both ¹²³I-VIP and ¹¹¹In-DTPA-D-Phe¹-OCT in random order. Imaging results were compared with computed tomography scans, results of conventional ultrasound, endosonography, and endoscopy, and results of surgical exploration in case of inconclusive conventional imaging.

RESULTS: Primary or recurrent carcinoid tumors could be visualized with ¹¹¹In-DTPA-D-Phe¹-OCT in 95 (91%) of 104 patients; metastatic sites were identified in 110 (95%) of 116 patients. In 11 (51%) of 21 patients with suggestive symptoms but without identified lesions by conventional imaging, focal tracer uptake located the carcinoid tumor. In addition, metastatic disease was demonstrated in three patients after resection. In a direct comparison in the 133 patients who underwent both imaging modalities, ¹¹¹In-DTPA-D-Phe¹-OCT was found to be superior to ¹²³I-VIP, with 35 (93%) of 38 versus 32 (82%) of 38 scans being positive in primary or recurrent tumors, 58 (90%) of 65 versus 53 (82%) of 65 being positive in patients with metastatic sites, and seven (44%) of 16 versus four (25%) of 16 being positive in patients with symptoms but otherwise negative work-ups. Overall, additional lesions not seen on conventional imaging were imaged in 43 (41%) of 158 versus 25 (25%) of 103 scans with ¹¹¹In-DTPA-D-Phe¹-OCT and ¹²³I-VIP, respectively.

CONCLUSION: Both peptide tracers have a high sensitivity for localizing tumor sites in patients with ascertained or suspected carcinoid tumors, with ¹¹¹In-DTPA-D-Phe¹-OCT scintigraphy being more sensitive than ¹²³I-VIP receptor scanning. Both, however, had a higher diagnostic yield than conventional imaging, as verified by surgical intervention or long-term follow-up. The combination of both peptide receptor scans does not seem to further enhance diagnostic information.

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