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Somatostatin Receptor Scintigraphy: Its Sensitivity Compared with That of Other Imaging Methods in Detecting Primary and Metastatic Gastrinomas: A Prospective Study

Fathia Gibril, MD; James C. Reynolds, MD; John L. Doppman, MD; Clara C. Chen, MD; David J. Venzon, PhD; Basel Termanini, MD; H. Christian Weber, MD; Charmaine A. Stewart, MD; and Robert T. Jensen, MD
[+] Article and Author Information

From the National Institutes of Health, Bethesda, Maryland. Requests for Reprints: Robert T. Jensen, National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases/Digestive Diseases Branch, Building 10, Room 9C-103, 10 Center Drive, MSC 1804, Bethesda, MD 20892-1804. Current Author Addresses: Drs. Gibril, Termanini, Weber, Stewart, and Jensen: National Institute of Health/National Institute of Diabetes and Digestive and Kidney Diseases/Digestive Diseases Branch, Building 10, Room 9C-103, 10 Center Drive, MSC 1804, Bethesda, MD 20892-1804.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;125(1):26-34. doi:10.7326/0003-4819-125-1-199607010-00005
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Objective: To compare the sensitivity of somatostatin receptor scintigraphy done using [111In-DTPA-DPhe1]octreotide with that of other imaging methods in the localization of gastrinomas in patients with the Zollinger-Ellison syndrome.

Design: Prospective study.

Setting: Referral-based clinical research center.

Patients: 80 consecutive patients with the Zollinger-Ellison syndrome.

Interventions: Conventional tumor localization studies (ultrasonography, computed tomography [CT], magnetic resonance imaging [MRI], selective angiography, and bone scanning) and somatostatin receptor scintigraphy done using [111In-DTPA-DPhe1]octreotide with single-photon emission CT imaging at 4 and 24 hours. Patients with possible liver metastases had biopsies done for confirmation, and 15 patients had exploratory laparotomies done to assess primary tumor localization.

Results: Extrahepatic gastrinomas or liver metastases were identified by ultrasonography in 19% of patients, by CT in 38% of patients, by MRI in 45% of patients, by angiography in 40% of patients, and by somatostatin receptor scintigraphy in 70% of patients. Somatostatin receptor scintigraphy was as sensitive as the other tests combined (59%), and when the results of all other tests were added to the somatostatin receptor scintigraphy results, tumors were localized in 75% of patients. Among patients with a possible primary tumor, the results of ultrasonography were positive in 9%, the results of CT were positive in 31%, the results of MRI were positive in 30%, the results of angiography were positive in 28%, and the results of somatostatin receptor scintigraphy were positive in 58%. Somatostatin receptor scintigraphy was as sensitive as all of the other imaging studies combined; when the results of scintigraphy were added to the results of the other studies, possible primary tumors were identified in 68% of patients. In 24 patients who had histologically proven metastatic liver disease, sensitivities for the detection of any metastatic liver lesions were 46% for ultrasonography, 42% for CT, 71% for MRI, 62% for angiography, and 92% for somatostatin receptor scintigraphy. Somatostatin receptor scintigraphy was significantly better than all of the conventional imaging methods in the identification of gastrinomas later found at surgery (P = 0.004), but it still missed 20% of gastrinomas.

Conclusions: Somatostatin receptor scintigraphy is the single most sensitive method for imaging either primary or metastatic liver lesions in patients with the Zollinger-Ellison syndrome. Because of its sensitivity, simplicity, and cost-effectiveness, it should be the first imaging method used in these patients. For patients with negative results on somatostatin receptor scintigraphy, guidelines about the use of other imaging studies are proposed.

Figures

Grahic Jump Location
Figure 1. Results are expressed as the percentage of the 80 patients in whom a tumor was located extrahepatic or metastatic to the liver. Each patient was counted only once. All patients but one (who did not have selective angiography because recent liver transplantation resulted in contraindication) had all of the studies done. Angio equals angiography; CT equals computed tomography; MRI equals magnetic resonance imaging; SRS equals somatostatin receptor scintigraphy; US equals ultrasonography. *** < 0.001 for the method compared with somatostatin receptor scintigraphy alone.
Results of tumor localization studies for the identification of hepatic or extrahepatic gastrinoma in patients with the Zollinger-Ellison syndrome.P
Grahic Jump Location
Grahic Jump Location
Figure 2. Results are expressed as the percentage of the 80 patients in whom any extrahepatic tumor was localized. Each patient was counted only once. Angio equals angiography; CT equals computed tomography; MRI equals magnetic resonance imaging; SRS equals somatostatin receptor scintigraphy; US equals ultrasonography. *** < 0.001 for the method compared with somatostatin receptor scintigraphy alone.
Results of tumor localization studies for identification of an extrahepatic tumor in patients with the Zollinger-Ellison syndrome.P
Grahic Jump Location
Grahic Jump Location
Figure 3. Negative magnetic resonance imaging STIR (short-time inversion-inversion recovery) result. Negative computed tomography scan. Somatostatin receptor scintigraphy image showing a gastrinoma in the pancreatic head-duodenal area. At surgery, a 0.4-cm duodenal wall gastrinoma was removed.
Localization of a duodenal gastrinoma by somatostatin receptor scintigraphy alone. Top.Middle.Bottom.
Grahic Jump Location
Grahic Jump Location
Figure 4. Results are expressed as the percentage of the 24 patients with proven metastatic liver disease in whom metastasis was identified. Each patient was counted only once. Angio equals angiography; CT equals computed tomography; MRI equals magnetic resonance imaging; SRS equals somatostatin receptor scintigraphy; US equals ultrasonography. *P equals 0.016, **P equals 0.001, and *** < 0.001 for the method compared with somatostatin receptor scintigraphy alone.
Results of tumor localization studies for the identification of liver metastases in patients with proven metastatic gastrinomas to the liver.P
Grahic Jump Location
Grahic Jump Location
Figure 5. Magnetic resonance imaging (MRI) STIR (short-time inversion-inversion recovery) showing metastasis in the right lobe of the liver only ( ). Somatostatin receptor scintigraphy (SRS) image showing metastases in both the right and left liver lobes ( ). This patient was treated with interferon.
Localization of liver metastases by somatostatin receptor scintigraphy alone in a patient with the Zollinger-Ellison syndrome. Top.arrowBottom.arrows
Grahic Jump Location

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