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SPECIAL FEATURE
Year : 2018  |  Volume : 7  |  Issue : 4  |  Page : 189-191

99mTc-hydrazinonicotinyl-Tyr3-octreotide single-photon emission computed tomography–computed tomography in detection of functional neuroendocrine tumour in patient presenting with Zollinger–Ellison syndrome


1 Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Surgery, NRI Medical College, Mangalagiri, Andhra Pradesh, India

Date of Web Publication13-Jun-2019

Correspondence Address:
Manthri Ranadheer
Assistant Professor, Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCSR.JCSR_22_19

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How to cite this article:
Ranadheer M, Mehabunnisa S K, Reddy A D, Hemalatha D S, Kalawat T C. 99mTc-hydrazinonicotinyl-Tyr3-octreotide single-photon emission computed tomography–computed tomography in detection of functional neuroendocrine tumour in patient presenting with Zollinger–Ellison syndrome. J Clin Sci Res 2018;7:189-91

How to cite this URL:
Ranadheer M, Mehabunnisa S K, Reddy A D, Hemalatha D S, Kalawat T C. 99mTc-hydrazinonicotinyl-Tyr3-octreotide single-photon emission computed tomography–computed tomography in detection of functional neuroendocrine tumour in patient presenting with Zollinger–Ellison syndrome. J Clin Sci Res [serial online] 2018 [cited 2019 Sep 19];7:189-91. Available from: http://www.jcsr.co.in/text.asp?2018/7/4/189/260222



A 20-year-old male presented with recurrent black-coloured stools, anaemia and abdominal pain in good performance status with no co-morbidities. Upper gastrointestinal endoscopy was suggestive of multiple ulcers in the duodenum up to D3, hypertrophied gastric folds. Biopsy from ulcer revealed superficial chronic non-specific duodenitis. Serum gastrin was 3917 pg/mL. The patient was referred for 99mTc-hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC) scintigraphy for localisation. Scan findings revealed intense radiotracer intense focal tracer concentration inferior to the left lobe of the liver. Single-photon emission computed tomography (SPECT)-computed tomography (CT) revealed soft-tissue density lesion measuring 4.3 cm × 6.2 cm, inferior to the left lobe of the liver probably arising from the head of the pancreas or duodenum. The lesion was maintaining fat planes with stomach and liver [Figure 1] and [Figure 2]. The intensity of somatostatin receptor expression suggests well-differentiated benign neuroendocrine tumour. The patient underwent surgical resection of tumour. Post-operative histopathological examination was suggestive of a pancreatic neuroendocrine tumour with Grade II morphology. After resection, the serum gastrin had fallen to 78 ng/mL.
Figure 1: Anterior and posterior planar images of 99mTc-hydrazinonicotinyl-Tyr3-octreotide scintigraphy showing increased tracer accumulation in the region between the liver and stomach. Physiological distribution in the liver, spleen, kidneys and bladder can be seen

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Figure 2: Axial computed tomography (a) and fused positron emission tomography/computed tomography (b) images showing increased radiotracer uptake in the soft-tissue density lesion arising from the head of the pancreas

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Gastrinomas are postulated to originate from stem cells of the ventral pancreatic bud, as a result of aberration of neuroendocrine cells during normal embryonic rotation of the ventral pancreas.[1] Various imaging modalities can be used for the diagnosis of Zollinger–Ellison syndrome (ZES). These include endoscopic ultrasonography, CT, magnetic resonance imaging, somatostatin receptor expression with 111 Indiethylene triamine penta acetic (DTPA) octreotide (Octreoscan), 68Ga labelled 1, 4, 7,10-tetraazacyclo-dodecane-N, N', N″, N‴-tetra acetic acid (DOTA) tyrosine 3 octreortate (TATE) or 68Ga DOTA-1-NaI3-octreotide (NOC) and 99mTcHYNIC-TOC.[2]

Somatostatin receptor scintigraphy (SSR) is the most sensitive imaging modality for gastrinomas in patients with ZES.[3] SSR using Octreoscan is an established diagnostic modality in the imaging of different somatostatin receptor-expressing tumours. However, the physical characteristics of 111 In are not optimal for gamma camera imaging. Overexpression of cell surface Somatostatin receptors in well-differentiated neuroendocrine tumours can be exploited for imaging and therapy with radiolabeled somatostatin analogues. Radiolabelled somatostatin analogue has three parts; somatostatin analogue (Octreotide), chelator (DOTA, DTPA) and radionuclide (111 In, 99mTc and 68Ga for diagnosis;177 Lu and 90 Y for therapy). Optimal method for the diagnosis of gastroenteropancreatic neuroendocrine tumours is SSR positron emission tomography (PET)-CT with 68GaDOTATATE or DOTANOC. Certainly, a 68 Ge/ 68Ga generator is very expensive. Although PET-CT has higher spatial resolution, SSR SPECT-CT can be used for initial evaluation in places where PET-CT is not available. Hence, the availability of 99mTc-labelled SSR analogues allows a wide use of SSR with good imaging quality. 99mTc-HYNIC-TOC has favourable imaging characteristics in the detection of SSR-positive tumours due to specific and high receptor affinity, good biodistribution, faster renal excretion, lower radiation exposure, high imaging quality and relatively easy availability.[4] In the current era of multimodality imaging, SPECT-CT plays an important role in localising small lesions. SSR imaging is also useful in the evaluation of other neuroendocrine tumours, oncogenic osteomalacia, medullary carcinoma thyroid, thyroglobulin-elevated negative iodine scan of differentiated thyroid cancer and pituitary adenomas.

99mTc-HYNIC-TOC scintigraphy is highly useful for localisation of functional neuroendocrine tumour-like gastrinomas and can be used as initial modality to localise in patients presenting with syndromes of pancreatic hormone excess.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Passaro E Jr., Howard TJ, Sawicki MP, Watt PC, Stabile BE. The origin of sporadic gastrinomas within the gastrinoma triangle: A theory. Arch Surg 1998;133:13-6.  Back to cited text no. 1
    
2.
Kartalis N, Mucelli RM, Sundin A. Recent developments in imaging of pancreatic neuroendocrine tumors. Ann Gastroenterol 2015;28:193-202.  Back to cited text no. 2
    
3.
Alexander HR, Fraker DL, Norton JA, Bartlett DL, Tio L, Benjamin SB, et al. Prospective study of somatostatin receptor scintigraphy and its effect on operative outcome in patients with Zollinger-Ellison syndrome. Ann Surg 1998;228:228-38.  Back to cited text no. 3
    
4.
Liepe K, Becker A. 99mTc-hynic-TOC imaging in the diagnostic of neuroendocrine tumors. World J Nucl Med 2018;17:151-6.  Back to cited text no. 4
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