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. 2014 Spring;2(1):30-41.

Clinical utility of indigenously formulated single-vial lyophilized HYNIC-TOC kit in evaluating Gastro-entero Pancreatic neuro endocrine tumours

Ajit S Shinto  1 , K Kamaleshwaran  1 , K Vyshak  1 , Natarajan Sudhakar  1 , Sharmila Banerjee  2 , Aruna Korde  2 , Grace Samuel  2 , Madhav Mallia  2
Affiliations

Clinical utility of indigenously formulated single-vial lyophilized HYNIC-TOC kit in evaluating Gastro-entero Pancreatic neuro endocrine tumours

Ajit S Shinto et al. Asia Ocean J Nucl Med Biol. 2014 Spring.

Abstract

Objectives: The objective of this study was to evaluate the performance and utility of (99m)Tc HYNIC-TOC planar scintigraphy and SPECT/CT in the diagnosis, staging and management of gastroenteropancreatic neuroendocrine tumors (GPNETs).

Methods: 22 patients (median age, 46 years) with histologically proven gastro- entero- pancreatic NETs underwent (99m)Tc HYNIC-TOC whole body scintigraphy and regional SPECT/CT as indicated. Scanning was performed after injection of 370-550 MBq (10-15 mCi) of (99m)Tc HYNIC-TOC intravenously. Images were evaluated by two experienced nuclear medicine physicians both qualitatively as well as semi quantitatively (tumor to background and tumor to normal liver ratios on SPECT -CT images). Results of SPECT/CT were compared with the results of conventional imaging. Histopathology results and follow-up somatostatin receptor scintigraphy with (99m)Tc HYNIC TOC or conventional imaging with biochemical markers were considered to be the reference standards.

Results: (99m)Tc HYNIC TOC showed sensitivity and specificity of 87.5% and 85.7%, respectively, for primary tumor and 100% and 86% for metastases. It was better than conventional imaging modalities for the detection of both primary tumor (P<0.001) and metastases (P<0.0001). It changed the management strategy in 6 patients (31.8%) and supported management decisions in 8 patients (36.3%).

Conclusion: (99m)Tc HYNIC TOC SPECT/CT appears to be a highly sensitive and specific modality for the detection and staging of GPNETs. It is better than conventional imaging for the evaluation of GPNETs and can have a significant impact on patient management and planning further therapeutic options.

Keywords: HYNIC TOC; Neuroendocrine tumor; SPECT CT.

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Figures

Figure 1
Figure 1
a) Whole body anterior and posterior Tc-99m-HYNIC-TOC images showing primary pancreatic neuroendocrine tumour. b) SPECT, CT and fused SPECT/CT slices localized uptake to the pancreatic tumour
Figure 2
Figure 2
Transaxial SPECT, CT and fused SPECT/CT as well as coronal image shows uptake in the duodenum and liver lesions.
Figure 3
Figure 3
(a) Whole body anterior and posterior Tc-99m-HYNIC-TOC images showing multiple liver metastasis. (b) SPECT, CT and SPECT/CT localized uptake to the liver lesions.
Figure 4
Figure 4
(a)Whole body Tc-99m-HYNIC-TOC images showing two focal uptake, one in the right thigh and other just below bladder. Also photopenic area noted in the liver lesion suggestive of necrosis.(b) Transaxial SPECT, CT and SPECT/CT showing uptake in the neck of right femur and left pubis.
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