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Whole body diffusion for metastatic disease assessment in neuroendocrine carcinomas: comparison with OctreoScan® in two cases.

Cossetti RJ, Bezerra RO, Gumz B, Telles A, Costa FP - World J Surg Oncol (2012)

Bottom Line: Neuroendocrine tumor (NET) patients must be adequately staged in order to improve a multidisciplinary approach and optimal management for metastatic disease.NETs significantly reduce water diffusion as compared to normal tissue.In this article we report the use of DWI in MRI and WBD in two cases of metastatic pulmonary NET staging in comparison with OctreoScan® in order to illustrate the potential advantage of DWI and WBD in staging NETs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet 91, São Paulo 01308-050, Brazil.

ABSTRACT
Neuroendocrine tumor (NET) patients must be adequately staged in order to improve a multidisciplinary approach and optimal management for metastatic disease. Currently available imaging studies include somatostatin receptor scintigraphy, like OctreoScan®, computed tomography (CT), scans and magnetic resonance imaging (MRI), which analyze vascular concentration and intravenous contrast enhancement for anatomic tumor localization. However, these techniques require high degree of expertise for interpretation and are limited by their availability, cost, reproducibility, and follow-up imaging comparisons. NETs significantly reduce water diffusion as compared to normal tissue. Diffusion-weighted imaging (DWI) in MRI has an advantageous contrast difference: the tumor is represented with high signal over a black normal surrounding background. The whole-body diffusion (WBD) technique has been suggested to be a useful test for detecting metastasis from various anatomic sites. In this article we report the use of DWI in MRI and WBD in two cases of metastatic pulmonary NET staging in comparison with OctreoScan® in order to illustrate the potential advantage of DWI and WBD in staging NETs.

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Comparison of DWI (A) and 111 In-pentetreotide scintigraphy (B) images reveal correlation between hyperintense mediastinal lymph nodes (blue arrows) and radiotracer uptake (red arrow). All the metastatic liver lesions detected by scintigraphy (yellow arrows) appeared as hyperintense nodules in the DWI (green arrows). T1-weighted image (C) shows the potential application of this method to detect bone metastasis (purple arrows).
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Figure 2: Comparison of DWI (A) and 111 In-pentetreotide scintigraphy (B) images reveal correlation between hyperintense mediastinal lymph nodes (blue arrows) and radiotracer uptake (red arrow). All the metastatic liver lesions detected by scintigraphy (yellow arrows) appeared as hyperintense nodules in the DWI (green arrows). T1-weighted image (C) shows the potential application of this method to detect bone metastasis (purple arrows).

Mentions: A 23-year-old male presented with sporadic haemoptysis over the last year. A CT scan of the thorax showed an intra-bronchial lesion with 3.0 × 2.3 cm in the right inferior lobar bronchia and a bronchoscopy confirmed a well-differentiated NET, grade 1. The tumor was a non-functioning pulmonary NET-1. He underwent a right inferior lobectomy. Pathology reported an invasive well-differentiated pulmonary neuroendocrine tumor, grade 1, measuring 2.2 cm, with predominant endobronchial growth, with less than 1 mitosis per 10 HPF. There was neither neural-vascular invasion nor necrosis. According to pathological analysis, zero of two mediastinal lymph nodes were affected (pT1b pN0). Immunohistochemistry revealed a proliferation index (Ki67) of < 1 %, with positive staining for chromogranin A, synaptophysin, cytokeratin(CK)-40, CK-48, CK-50,6 and kDa, and negative staining for TTF-1. A staging CT scan of thorax, abdomen, and pelvis demonstrated unexpected small round hypointense lesions distributed throughout the liver parenchyma, seen only on the venous phase, measuring less than 10 mm. Laboratory exams were relevant for serum chromogranin A 38 ng/mL (normal reference value: < 15 ng/mL) and urinary 5-hydroxyindoleacetic acid (5-HIAA) 5.7 mg/24 h (normal reference value: < 8.2 mg/24 h). The patient was referred for hepatic resection at our center. An abdominal MRI was performed to evaluate the hepatic lesions, revealing multiple hypervascular nodules scattered throughout the liver with washout on the delayed phase. All these hepatic lesions were detected in the DW images. WBD images revealed, in addition to the hepatic lesions, mediastinal lymph nodes with restricted diffusion confirmed in the ADC maps raising suspicion for metastatic lesions (Figure 2A). The Octreoscan® performed on the day after showed focal areas of uptake in superior mediastinal, para-tracheal, subcarinal and right pulmonar hilar lymph nodes and hepatic nodules in segments V/VIII and III (Figure 2B). The patient was submitted to a fine needle aspiration biopsy of the large hepatic lesion, which confirmed metastatic neuroendocrine carcinoma. Treatment with somatostatin analogs was initated.


Whole body diffusion for metastatic disease assessment in neuroendocrine carcinomas: comparison with OctreoScan® in two cases.

Cossetti RJ, Bezerra RO, Gumz B, Telles A, Costa FP - World J Surg Oncol (2012)

Comparison of DWI (A) and 111 In-pentetreotide scintigraphy (B) images reveal correlation between hyperintense mediastinal lymph nodes (blue arrows) and radiotracer uptake (red arrow). All the metastatic liver lesions detected by scintigraphy (yellow arrows) appeared as hyperintense nodules in the DWI (green arrows). T1-weighted image (C) shows the potential application of this method to detect bone metastasis (purple arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472201&req=5

Figure 2: Comparison of DWI (A) and 111 In-pentetreotide scintigraphy (B) images reveal correlation between hyperintense mediastinal lymph nodes (blue arrows) and radiotracer uptake (red arrow). All the metastatic liver lesions detected by scintigraphy (yellow arrows) appeared as hyperintense nodules in the DWI (green arrows). T1-weighted image (C) shows the potential application of this method to detect bone metastasis (purple arrows).
Mentions: A 23-year-old male presented with sporadic haemoptysis over the last year. A CT scan of the thorax showed an intra-bronchial lesion with 3.0 × 2.3 cm in the right inferior lobar bronchia and a bronchoscopy confirmed a well-differentiated NET, grade 1. The tumor was a non-functioning pulmonary NET-1. He underwent a right inferior lobectomy. Pathology reported an invasive well-differentiated pulmonary neuroendocrine tumor, grade 1, measuring 2.2 cm, with predominant endobronchial growth, with less than 1 mitosis per 10 HPF. There was neither neural-vascular invasion nor necrosis. According to pathological analysis, zero of two mediastinal lymph nodes were affected (pT1b pN0). Immunohistochemistry revealed a proliferation index (Ki67) of < 1 %, with positive staining for chromogranin A, synaptophysin, cytokeratin(CK)-40, CK-48, CK-50,6 and kDa, and negative staining for TTF-1. A staging CT scan of thorax, abdomen, and pelvis demonstrated unexpected small round hypointense lesions distributed throughout the liver parenchyma, seen only on the venous phase, measuring less than 10 mm. Laboratory exams were relevant for serum chromogranin A 38 ng/mL (normal reference value: < 15 ng/mL) and urinary 5-hydroxyindoleacetic acid (5-HIAA) 5.7 mg/24 h (normal reference value: < 8.2 mg/24 h). The patient was referred for hepatic resection at our center. An abdominal MRI was performed to evaluate the hepatic lesions, revealing multiple hypervascular nodules scattered throughout the liver with washout on the delayed phase. All these hepatic lesions were detected in the DW images. WBD images revealed, in addition to the hepatic lesions, mediastinal lymph nodes with restricted diffusion confirmed in the ADC maps raising suspicion for metastatic lesions (Figure 2A). The Octreoscan® performed on the day after showed focal areas of uptake in superior mediastinal, para-tracheal, subcarinal and right pulmonar hilar lymph nodes and hepatic nodules in segments V/VIII and III (Figure 2B). The patient was submitted to a fine needle aspiration biopsy of the large hepatic lesion, which confirmed metastatic neuroendocrine carcinoma. Treatment with somatostatin analogs was initated.

Bottom Line: Neuroendocrine tumor (NET) patients must be adequately staged in order to improve a multidisciplinary approach and optimal management for metastatic disease.NETs significantly reduce water diffusion as compared to normal tissue.In this article we report the use of DWI in MRI and WBD in two cases of metastatic pulmonary NET staging in comparison with OctreoScan® in order to illustrate the potential advantage of DWI and WBD in staging NETs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet 91, São Paulo 01308-050, Brazil.

ABSTRACT
Neuroendocrine tumor (NET) patients must be adequately staged in order to improve a multidisciplinary approach and optimal management for metastatic disease. Currently available imaging studies include somatostatin receptor scintigraphy, like OctreoScan®, computed tomography (CT), scans and magnetic resonance imaging (MRI), which analyze vascular concentration and intravenous contrast enhancement for anatomic tumor localization. However, these techniques require high degree of expertise for interpretation and are limited by their availability, cost, reproducibility, and follow-up imaging comparisons. NETs significantly reduce water diffusion as compared to normal tissue. Diffusion-weighted imaging (DWI) in MRI has an advantageous contrast difference: the tumor is represented with high signal over a black normal surrounding background. The whole-body diffusion (WBD) technique has been suggested to be a useful test for detecting metastasis from various anatomic sites. In this article we report the use of DWI in MRI and WBD in two cases of metastatic pulmonary NET staging in comparison with OctreoScan® in order to illustrate the potential advantage of DWI and WBD in staging NETs.

Show MeSH
Related in: MedlinePlus