Technetium Tc 99m–Labeled Red Blood Cells in the Preoperative Diagnosis of Cavernous Hemangioma and Other Vascular Orbital Tumors

Abstract

To evaluate technetium Tc 99m (99m Tc) red blood cell scintigraphy as a diagnostic tool for orbital cavernous hemangioma and to differentiate between orbital masses on the basis of their vascularization. Methods: We performed 99m Tc red blood cell scintigraphy on 23 patients (8 female and 15 male; mean age, 47 years) affected by an orbital mass previously revealed with computed tomography (CT) and magnetic resonance imaging (MRI) and suggesting cavernous hemangioma. In our diagnosis, we considered the orbital increase delayed uptake with the typical scintigraphic pattern known as perfusion blood pool mismatch. The patients underwent biopsy or surgical treatment with transconjunctival cryosurgical extraction when possible. Results: Single-photon emission tomography (SPET) showed intense focal uptake in the orbit corresponding to radiologic findings in 11 patients who underwent surgical treatment and pathologic evaluation (9 cavernous hemangiomas, 1 hemangiopericytoma, and 1 lymphangioma). Clinical or histologic examination of the remaining 22 patients revealed the presence of 5 lymphoid pseudotumors, 2 lymphomas, 2 pleomorphic adenomas of the lacrimal gland, 1 astrocytoma, 1 ophthalmic vein thrombosis, and 1 orbital varix. Conclusions: The confirmation of the preoperative diagnosis by 99m Tc red blood cell scintigraphy shows that this technique is a reliable tool for differentiating cavernous hemangiomas from other orbital masses (sensitivity,100%; specificity,86%) when ultrasound, CT, and MRI are not diagnostic. Unfortunately, 99m Tc red blood cell scintigraphy results were positive in 1 patient with hemangiopericytoma and 1 patient with lymphangioma, which showed increased uptake in the lesion on SPET images because of the vascular nature of these tumors. Therefore, in these cases, the SPET images have to be integrated with data regarding clinical preoperative evaluation and CT scans or MRI studies. On the basis of our study, a complete diagnostic picture, CT scans or MRI studies, and scintigraphic patterns can establish the preoperative diagnosis of vascular orbital tumors such as cavernous hemangioma, adult-type lymphangioma, and hemangiopericytoma.

A Case of Intraorbital Hemangioma Diagnosed with Tc 99m Labeled Erythrocyte Scintigraphy and Magnetic Resonance Imaging

“…The scintigraphic pattern of the hemangioma which is hypoactive in the vascular phase and hyperactive in the late phase, is previously well established (8,9,10). In some studies, this typical appearance of these tumors was used for the differentiation from malignant tumors and confirmed with histopathology (5). According to previous reports, Tc 99m labeled erythrocyte imaging could differentiate hemangioma from malignant tumors (5,8,9,10).…”

“…In some studies, this typical appearance of these tumors was used for the differentiation from malignant tumors and confirmed with histopathology (5). According to previous reports, Tc 99m labeled erythrocyte imaging could differentiate hemangioma from malignant tumors (5,8,9,10). This characteristic of Tc 99m labeled erythrocyte scintigraphy might help to decide the choice of treatment, i.e.…”

“…Scintigraphic imaging of orbital tumors is a rare approach during the diagnostic course. However, in some previously reported cases, Tc 99m labeled erythrocyte imaging was used and the diagnosis was confirmed with histopathological results (5). Differentiation of the hemangioma from vascular malignant tumors might be difficult by MRI for some cases but MRI can identify the lesion borders, nature and relationship with the adjacent soft tissue structures.…”

Giant cavernoma of the orbit: clinical and surgical considerations

“…Scintigraphy with technetium Tc 99m (99mTc) labeled red blood cell, is a useful tool in the differential diagnosis of cavernous hemangioma from other orbital masses 11,12 .…”

Modern radionuclide methods in diagnosing orbital masses

“…исследователи получили ги-перфиксацию меченых эритроцитов в опухоли только у пациентов с сосудистыми новообразова-ниями: кавернозной гемангиомой, гемангиопери-цитомой и лимфангиомой. В остальных случаях (лимфома, астроцитома, псевдотумор, плеоморф-ная аденома) были получены негативные резуль-таты [10,21,26 Тс. Были выявлены и обоснованы сцинтигра-фические дифференциально-диагностические критерии доброкачественных и злокачествен-ных опухолей орбиты, определены показания к применению различных РФП [3,4].…”