Since the identification of somatostatin receptors on lymphocytes, orbital infiltration with mononuclear cells in Graves' ophthalmopathy has provided a rationale for receptor imaging with the radiolabeled somatostatin analog Octreotide. In 40 patients with Graves' ophthalmopathy and 10 controls, 110 MBq indium-Octreotide were administered i.v., and scans were performed at 4 and 24 h after injection. An uptake ratio between the orbits and the brain was determined. In 20 ophthalmophathy patients, magnetic resonance imaging (MRI) of the orbits was performed and the T2 relaxation time was measured within the rectus muscles. Compared to controls (4 h Octreotide uptake: median 6.0 counts/pixel/MBq, orbit/brain ratio 5.6), ophthalmopathy patients showed a 2- to 3-fold increased uptake (15.8 counts/pixel/MBq vs controls p = 0.0032; ratio 12.6, vs controls p = 0.003). When considering patients with active disease only, a higher uptake was registered (16.8 counts/pixel/MBq vs controls p 0.0048, ratio 15.6 vs controls p = 0.0006). Untreated patients showed a markedly higher uptake (23 counts/pixel/MBq) compared to patients receiving steroid therapy (12.6, p = 0.001). MRI of the orbit revealed a correlation between T2 relaxation time of the eye muscles and orbital uptake of Octreotide (p < 0.001).

The objective of this study was to find additional sonomorphological criteria for determining the status of enlarged lymph nodes. By using colour-coded duplex sonography the perfusion of 63 lymph nodes in the neck was analysed. The status was confirmed either histologically or clinically (29 metastases from squamous cell carcinomas and 34 acute or chronic inflammatory nodal diseases). A quantitative evaluation of the pulsatility measured in 51 lymph nodes by computing the Pourcelot-Ratio and the Mean Pulsatility Index yielded significant differences between the two groups. By definition of a limiting value of the Pourcelot-Ratio (0.75) for the prediction of benignity, the specificity and the accuracy in screening for metastases were improved as compared to clinical examination and B-mode sonography. Additional criteria of dignity were found by qualitative evaluation of nodal perfusion patterns (presence and distribution of perfusion, partial loss of perfusion). The use of colour-coded duplex sonography in nodal disease of the neck provides an improvement of early and noninvasive diagnosis of regional metastatic involvement.