SPECT/CT with radiolabeled somatostatin analogues in the evaluation of systemic granulomatous infections

Monteiro, Paulo Henrique Silva; Souza, Thiago Ferreira de; Moretti, Maria Luíza; Resende, Mariângela Ribeiro; Mengatti, Jair; Lima, Mariana da Cunha Lopes de; Santos, Allan O.; Ramos, Celso Darío

doi:10.1590/0100-3984.2016.0076

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…Our study shows that PET scanning using a somatostatin analogue radioligand can detect pulmonary lesions in patients with active TB. This finding is consistent with a recent case report showing intense DOTANOC uptake in a single mesenteric tuberculous lesion 24 , and several previous nuclear imaging studies using 99mTc- and 111In-labelled somatostatin analogs, that have shown increased uptake in pathological lesions in TB and other granulomatous diseases 20 , 25 – 27 . However, although we demonstrated that DOTANOC images TB lung disease, there does not appear to be any particular advantage over the standard ligand: the few discrepancies we observed in lesions visualised with the two ligands generally favoured FDG, and lesion uptake was, on average, more than two-fold higher with FDG for individual lesions and for total lung lesions.…”

Section: Discussionsupporting

confidence: 93%

Comparison of 68Ga-DOTANOC with 18F-FDG using PET/MRI imaging in patients with pulmonary tuberculosis

Naftalin

Leek

Hallinan

et al. 2020

Sci Rep

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We compared the somatostatin analog radioligand, DOTANOC, with FDG, to determine whether there was increased detection of active or sub-clinical lesions in pulmonary tuberculosis (TB) with DOTANOC. Three groups were recruited: (1) active pulmonary TB; (2) IGRA-positive household TB contacts; (3) pneumonia (non-TB). DOTANOC PET/MRI followed by FDG PET/MRI was performed in active TB and pneumonia groups. TB contacts underwent FDG PET/MRI, then DOTANOC PET/MRI if abnormalities were detected. Quantitative and qualitative analyses were performed for total lung and individual lesions. Eight active TB participants, three TB contacts and three pneumonia patients had paired PET/MRI scans. In the active TB group, median SUVmax [FDG] for parenchymal lesions was 7.69 (range 3.00-15.88); median SUVmax [DOTANOC] was 2.59 (1.48-6.40). Regions of tracer uptake were fairly similar for both radioligands, albeit more diffusely distributed in the FDG scans. In TB contacts, two PET/MRIs had parenchymal lesions detected with FDG (SUVmax 5.50 and 1.82), with corresponding DOTANOC uptake < 1. FDG and DOTANOC uptake was similar in pneumonia patients (SUVmax [FDG] 4.17-6.18; SUVmax [DOTANOC] 2.92-4.78). DOTANOC can detect pulmonary TB lesions, but FDG is more sensitive for both active and sub-clinical lesions. FDG remains the preferred ligand for clinical studies, although DOTANOC may provide additional value for pathogenesis studies. Tuberculosis (TB) disease affects 10 million people worldwide every year, and is the leading cause of death from an infectious disease 1. New TB biomarkers are required for a variety of applications, including detection of subclinical disease for early intervention to prevent disease progression; detection of new active TB cases; and for monitoring of treatment response in clinical practice or in clinical trials of new TB therapies. Positron emission tomography (PET) imaging in combination with structural imaging may have value as a biomarker for detecting subclinical TB disease, active disease where the diagnosis is problematical, and an outcome measure in clinical trials 2-7. The standard PET ligand, [18F]fluoro-2-deoxy-2-d-glucose (FDG), accumulates in cells with high levels of glucose metabolism, and is a non-specific marker of inflammation. There may be additional value in using alternatives to FDG, if these have higher sensitivity or specificity for TB-infected cells 8. Somatostatin analog PET radiotracers are useful in evaluating neuro-endocrine tumours 9-11 and other cancers' cells 12-15 that have upregulated cell surface somatostatin receptors (SSTRs). These receptors are also overexpressed on activated macrophages 16,17 , which are a key cell population infected by TB, residing within granulomas 18,19. Over-expression of somatostatin receptors in granulomas within lymph nodes of TB patients have been visualised using in vitro autoradiography 20 , and SSTR-positive cells have been detected using immunohistochemistry analysis in granulomas from multiple granulomatous conditions 21,22 including pulmon...

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Section: Discussionsupporting

confidence: 93%

Comparison of 68Ga-DOTANOC with 18F-FDG using PET/MRI imaging in patients with pulmonary tuberculosis

Naftalin

Leek

Hallinan

et al. 2020

Sci Rep

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“…Our results also showed that the specificity of SRI (50%) is quite low as two cases of the infection group showed positive finding on 99m Tc-HYNIC-TOC SPECT/CT, which were misdiagnosed as the culprit tumors of ECS and were then surgically resected. Inflammatory disease demonstrating increased tracer uptake on SRI is not uncommon in the literature because somatostatin receptor is known to be expressed on activated macrophages in inflammatory process (22,23). These findings suggested that SRI may not effectively discriminate tumor-like infectious lesions from ACTH-secreting lung tumors.…”

Section: Discussionmentioning

confidence: 99%

Use of 18F-FDG PET/CT to Differentiate Ectopic Adrenocorticotropic Hormone-Secreting Lung Tumors From Tumor-Like Pulmonary Infections in Patients With Ectopic Cushing Syndrome

Hou

Jiang

et al. 2021

Front. Oncol.

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BackgroundEctopic adrenocorticotropic hormone (ACTH)-secreting lung tumors represent the most common cause of ectopic Cushing syndrome (ECS). Pulmonary opportunistic infections are associated with ECS. The present study aimed to evaluate the usefulness of 18F-FDG PET/CT for differentiating ectopic ACTH-secreting lung tumors from tumor-like pulmonary infections in patients with ECS.MethodsWe retrospectively reviewed the imaging data of 24 patients with ECS who were suspected to have ACTH-secreting lung tumors and underwent 18F-FDG PET/CT between 2008 and 2019. Eleven patients with lung tumors and 4 with pulmonary infections also had additional somatostatin receptor imaging (99mTc-HYNIC-TOC SPECT/CT or 68Ga-DOTATATE PET/CT).ResultsIn total, 18 patients had lung tumors and six had pulmonary infections. The primary source of ECS remained occult in the six patients with pulmonary infections. The maximum standardized uptake value (SUVmax) for pulmonary infections was significantly higher than that for tumors (P = 0.008). Receiver operating characteristic analysis revealed that a cut-off SUVmax of 4.95 helped in differentiating ACTH-secreting lung tumors from infections with 75% sensitivity and 94.4% specificity. For the 11 patients with ACTH-lung tumors, somatostatin receptor imaging (SRI) was positive in 6; while for the 4 with pulmonary infections, SRI was positive in 2. The sensitivity and specificity of somatostatin receptor imaging (SRI) for detecting ACTH-secreting lung tumor was 54.5% and 50%.ConclusionsOur findings suggest that pulmonary infections exhibit significantly higher FDG uptake than ACTH-secreting lung tumors in 18F-FDG PET/CT. An SUVmax cut-off value of 4.95 may be useful for differentiating the two conditions. Our results also suggested that SRI may not be an effective tool for differentiating the two conditions given the relatively low specificity.

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“…DOTATATE PET scan in patients in the USA has shown to have a specificity of 90% for NET 13. However, activated macrophages have been shown to have strong expression of membrane somatostatin receptors,14 and scans with radiolabeled somatostatin analogues are currently being evaluated as a diagnostic technique in patients with infectious granulomatous disease (including TB, leishmaniasis and aspergillosis) in the developing world 15…”

Section: Discussionmentioning

confidence: 99%

Disseminated tuberculosis masquerading as a neuroendocrine tumour

Garcia¹,

Yamshon

2018

BMJ Case Reports

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We describe the case of a 61-year-old man from the Dominican Republic admitted with diarrhoea, fevers and weight loss who was found to have lab studies and imaging (including radiolabeled somatostatin positron emission tomography/CT scan) initially consistent with a metastatic neuroendocrine tumour. However, after weeks of workup and multiple inconclusive biopsies, he was diagnosed with disseminated extrapulmonary tuberculosis. Here we examine the data for neuroendocrine tumour and tuberculosis labs and imaging to delineate where these studies overlap. We also analyse the biases and pitfalls in this case that led to a protracted diagnosis.

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SPECT/CT with radiolabeled somatostatin analogues in the evaluation of systemic granulomatous infections

Cited by 7 publications

References 12 publications

Comparison of 68Ga-DOTANOC with 18F-FDG using PET/MRI imaging in patients with pulmonary tuberculosis

Comparison of 68Ga-DOTANOC with 18F-FDG using PET/MRI imaging in patients with pulmonary tuberculosis

Use of 18F-FDG PET/CT to Differentiate Ectopic Adrenocorticotropic Hormone-Secreting Lung Tumors From Tumor-Like Pulmonary Infections in Patients With Ectopic Cushing Syndrome

Disseminated tuberculosis masquerading as a neuroendocrine tumour

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