Comparison of TI-201 and Tc-99m MIBI SPECT imaging in nasopharyngeal carcinoma

Evaluation of Undifferentiated Carcinoma of Nasopharyngeal Type with Thallium-201 and Technetium-99m MIBI SPECT

OBJECTIVE: To determine the value of 201-thallium (201-Tl) and technetium-99m sestamibi (Tc-99m MIBI) single photon emission computed tomography (SPECT) for detecting primary undifferentiated carcinoma of nasopharyngeal type (UCNT), residual/recurrent tissue, and lymph node involvement.

STUDY DESIGN AND SETTING: SPECT of head and neck was prospectively performed in 46 patients with a history of UCNT (201-Tl in 24 patients, Tc-99m MIBI in 22). CT/MRI findings, clinical follow-up, and pathohistological verification served as a gold standard for calculating sensitivity, specificity, and accuracy of each scintigraphic technique. Tumor-to-background index (T/Bg) was derived when SPECT findings were positive.

RESULTS: Sensitivity of 201-Tl SPECT was 87 percent, with 78 percent specificity, 83 percent accuracy, and T/Bg of 4.05 ± 1.50. Tc-99m MIBI SPECT had 85 percent sensitivity, 78 percent specificity, 82 percent accuracy, and T/Bg of 4.45 ± 1.27.

CONCLUSION AND SIGNIFICANCE: 201-Tl SPECT and Tc-99m MIBI SPECT are useful for detecting primary UCNT, residual/recurrent disease, and lymph node involvement. This use is particularly valuable after chemoradiotherapy when CT/MRI may be ambiguous.

Comparison of201Tl-chloride SPECT with99mTc-MIBI SPECT in the depiction of malignant head and neck tumors

OBJECTIVE

Comparison of 201Tl chloride SPECT (TI-SPECT) with 99mTc-MIBI SPECT (MIBI-SPECT) in the depiction of malignant head and neck tumors was prospectively studied.

METHODS

Forty-one patients with various tumors of the head and neck were included in this prospective study. Histologically, 36 patients had squamous cell carcinomas, 3 undifferentiated carcinomas, 1 transitional cell carcinoma, and 1 MALT lymphoma. All patients underwent a simultaneous dual-isotope SPECT of the head and neck with 201Tl and 99mTc-MIBI. Dual-isotope SPECT for early (n=41) and delayed acquisition (n=21) was performed. Qualitatively, 3 observers evaluated both TI-SPECT and MIBI-SPECT individually. The interpretation criteria were graded as grade 1 (no abnormal increased uptake) to 5 (definitely increased uptake of a degree equal to or greater than that of normal salivary gland). Statistical analysis of the comparison of Tl-SPECT and MIBI-SPECT was performed. The interobserver difference was evaluated using the kappa-coefficient. Quantitatively, T/N ratio (the ratio of the counts in the tumor divided by that in the normal nuchal muscles) and retention index were compared between TI-SPECT and MIBI-SPECT.

RESULTS

On both the early and delayed images, the grades of uptake of the tumor in TI-SPECT were significantly higher than those in MIBI-SPECT by three observers. The grade of Tl-uptake of the tumor on the delayed images was 5 for all observers (kappa-coefficient=1); however, the kappa-coefficient varied from 0.39 to 0.84 in early T1-SPECT, and in early and delayed MIBI-SPECT. Statistical differences in T/N ratio were noted between early TI-SPECT (2.87 +/- 1.19) and MIBI-SPECT (2.48 +/- 1.06), and between delayed Tl-SPECT (2.11 +/- 0.70) and MIBI-SPECT (1.20 +/- 0.48). The retention index or Tl-SPECT (0.81 +/- 0.24) was significantly higher than that of MIBI-SPECT (0.52 +/- 0.15).

CONCLUSIONS

The present study qualitatively and quantitatively showed that 201Tl had higher accumulation in the tumor than 99mTc-MIBI in both early and delayed images.

Detection of Recurrent or Residual Nasopharyngeal Carcinomas After Radiotherapy with Technetium-99m Tetrofosmin Single Photon Emission Computed Tomography and Comparison with Computed Tomography—A Preliminary Study

The effectiveness of technetium-99m tetrofosmin (Tc-TF) single photon emission computed tomography (SPECT) of the head and neck for detecting recurrence of nasopharyngeal carcinomas (NPC) was evaluated and compared with computed tomography (CT). Both Tc-TF SPECT and CT of the head and neck were performed in 36 NPC patients 4 months after radiotherapy. All 36 then underwent histopathological examinations of nasopharyngeal biopsies. Based on the histopathological results, the sensitivity, specificity, and accuracy of visually interpreted Tc-TF SPECT images, to differentiation of recurrent NPC from benign lesions, were 64%, 96%, and 86%, respectively. The sensitivity, specificity, and accuracy of CT for detecting recurrent NPC were 73%, 88%, and 83%, respectively. The Tc-TF SPECT has a better specificity but a lower sensitivity to differentiate benign lesions and recurrent/residual NPC when compared with CT. Combined Tc-TF SPECT and CT sensitivity and specificity were 100% and 88%, respectively. There are much better either test alone. However, further studies, including a larger NPC patient population, are warranted to determine the exact role and clinical usefulness of Tc-TF SPECT to differentiate benign lesions and recurrent/residual NPC.

Nuclear medicine imaging for the assessment of primary and recurrent head and neck carcinoma using routinely available tracers

This article reviews the literature on the use of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) and thallium-201, technetium-99m sestamibi and technetium-99m tetrofosmin single-photon emission tomography (SPET) for the diagnosis and staging of primary and recurrent squamous cell carcinoma of the head and neck (SCCHN). A search of the MEDLINE and CancerLit databases covering articles entered between 1989 and February 2003 was performed. In the case of FDG PET, only full-ring PET studies that included comparison with conventional morphological imaging were considered. Due to the wide variation in methodology, a straightforward meta-analysis of FDG PET literature was impossible. Instead, indicative summary receiver-operating curves of FDG PET and morphological imaging techniques were generated and a paired comparison of the sensitivities and specificities of FDG PET and morphological imaging performed. Compared with conventional morphological imaging, FDG PET proved as sensitive and specific for the detection of primary SCCHN but more sensitive and specific for the detection of cervical lymph node involvement (CLNI) and recurrence of SCCHN. Additional studies addressing the role of FDG PET in screening for distant metastases and synchronous primary tumours are mandatory. Following negative conventional evaluations, FDG PET identifies occult primary tumours in 20-50% of patients presenting with CLNI. As regards the use of 201Tl, 99mTc-sestamibi and 99mTc-tetrofosmin, more studies are required to define whether these imaging agents could form part of the current diagnostic armamentarium in SCCHN patients. It is concluded that FDG PET either is superior to or offers added value when compared with conventional morphological imaging techniques for the purpose of diagnosis and staging of primary and recurrent SCCHN.

Detection of Recurrent Nasopharyngeal Carcinomas After Radiotherapy with Technetium-99m Tetrofosmin Single Photon Emission Computed Tomography in Patients with Indeterminate Magnetic Resonance Imaging Findings

The aim of this study is to evaluate the effectiveness of technetium-99m tetrofosmin (Tc-99m TF) single photon emission computed tomography (SPECT) of head and neck for detecting suspected recurrence of nasopharyngeal carcinomas (NPCs) when magnetic resonance imaging (MRI) findings are indeterminate. MRI was performed 4 months after radiotherapy and 26 NPC patients with indeterminate MRI findings were included. MRI, Tc-99m TF SPECT, and biopsy were performed within 1 week. The final results were based on histopathologic findings and clinical follow-up for at least 6 months. For detecting recurrent NPC in indeterminate MRI findings, the sensitivity, specificity, and accuracy of Tc-99m TF SPECT were 92.3%, 100.0%, and 96.2%, respectively. Based on this result, we can suggest Tc-99m TF SPECT is effective to detect recurrent NPC when MRI findings are indeterminate. However, further studies including a larger NPC patient population are warranted to determine the exact role and clinical usefulness of Tc-99m TF SPECT to differentiate benign lesions and recurrent NPC when MRI findings are indeterminate.

Using thallium-201 SPECT to detect recurrent or residual nasopharyngeal carcinoma after radiotherapy in patients with indeterminate CT findings

BACKGROUND

The aim of this study is to evaluate the usefulness of thallium-201 (Tl-201) single-photon emission CT (SPECT) to detect recurrent or residual nasopharyngeal carcinomas (NPC) when CT findings are indeterminate.

METHODS

After radiotherapy, 30 NPC patients with indeterminate CT findings were included. CT, Tl-201, and biopsy were performed at least 4 months after radiotherapy and within 1 week of each other. The final results were based on histopathologic findings and clinical follow-up after at least 6 months.

RESULTS

The rates for sensitivity, specificity, and accuracy of Tl-201 SPECT in detecting recurrent or residual NPC when there were indeterminate CT findings, were 86.7%, 93.3%, and 90.0%, respectively.

CONCLUSIONS

These results suggest that Tl-201 SPECT is effective in detecting recurrent or residual NPC when CT findings are indeterminate.

Detection of recurrent nasopharyngeal carcinomas with technetium-99m methoxyisobutylisonitrile single photon emission computed tomography in patients with indeterminate magnetic resonance imaging findings after radiotherapy

The aim of this study was to evaluate the effectiveness of technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) single photon emission computed tomography (SPECT) for detecting recurrent nasopharyngeal carcinomas (NPCs) when magnetic resonance imaging (MRI) findings are indeterminate. Twenty-eight NPC patients who had received radiotherapy and had indeterminate MRI findings were included in the study. We performed MRI, Tc-99m MIBI SPECT, and biopsy at least 4 months after radiotherapy and within 1 week. The final results were based on histopathologic findings and clinical follow-up after 6 or more months. For detecting recurrent NPC in indeterminate MRI findings, the sensitivity, specificity, and accuracy of Tc-99m MIBI SPECT were 85.7%, 92.9%, and 89.3%, respectively. Our findings suggest that Tc-99m MIBI SPECT may be an effective tool for detecting recurrent NPC when MRI findings are indeterminate.

Detection of recurrent nasopharyngeal carcinomas with thallium-201 single-photon emission computed tomography in patients with indeterminate magnetic resonance imaging findings after radiotherapy

BACKGROUND

The aim of this study was to evaluate the usefulness of thallium-201 (Tl-201) single-photon emission CT (SPECT) to detect recurrent nasopharyngeal carcinomas (NPC) when MRI findings are indeterminate.

METHODS

After radiotherapy, 26 NPC patients with indeterminate MRI findings were included in this study. MRI, Tl-201, and biopsy were performed at least 4 months after radiotherapy and within 1 week. The final results were based on histopathologic findings and clinical follow-up after at least 6 months.

RESULTS

For detecting recurrent NPC in indeterminate MRI findings, the sensitivity, specificity, and accuracy of Tl-201 SPECT were 92.3%, 92.3%, and 92.3%, respectively.

CONCLUSIONS

On the basis of this result, Tl-201 SPECT seems to be effective in detecting recurrent NPC when MRI findings are indeterminate.

Detection of recurrent or persistent nasopharyngeal carcinomas after radiotherapy with technetium-99m methoxyisobutylisonitrile single photon emission computed tomography and computed tomography: comparison with 18-fluoro-2-deoxyglucose positron emission tomography

BACKGROUND

The diagnostic accuracy of technetium-99m methoxyisobutylisonitrile (Tc-MIBI) single photon emission computed tomography (SPECT) and computed tomography (CT) of the head and neck for differentiating recurrent or residual nasopharyngeal carcinomas (NPC) from benign lesions after radiotherapy was compared with positron emission tomography (PET) with 18-fluoro-2-deoxyglucose (FDG).

METHODS

Thirty six NPC patients underwent head and neck CT, Tc-MIBI SPECT, and FDG-PET four months after radiotherapy to differentiate recurrent or residual NPC from benign lesions. Histopathologic examinations of nasopharyngeal biopsies were performed for all 36 patients. No patients had multiple foci of NPC.

RESULTS

Based on biopsy results, the sensitivity, specificity, and accuracy of CT for differentiating recurrent or residual NPC from benign lesions were 73%, 88%, and 83%, respectively. The sensitivity, specificity, and accuracy of Tc-MIBI SPECT were 73%, 96%, and 89%, respectively. The sensitivity, specificity, and accuracy of FDG-PET were 100%, 96%, and 97%, respectively. Combination CT and Tc-MIBI SPECT for 28 NPC patients with congruent results showed the same sensitivity, specificity, and accuracy of 100%, 96%, and 96%, respectively, as FDG-PET for differentiating recurrent or residual NPC from benign lesions. In eight patients with incongruent results between CT and Tc-MIBI SPECT, FDG-PET correctly differentiated two benign lesions and six recurrent or residual NPCs.

CONCLUSIONS

In detecting recurrent or residual NPC, FDG-PET is the best tool. However, combined use of CT and Tc-MIBI SPECT can result in the same accuracy as FDG-PET.

[Usefulness of 201T1 gammagraphy in the diagnosis of carcinoma of the larynx]

For the evaluation of a patient with a laryngeal tumor we need the clinical exam and other exams as the CT scan or MRI. Those studies have a sensitivity of less than 80%. For that reason in the last years there has been a development of new techniques trying to increase the accuracy. The 201Tl SPECT is one of them although it was developed for cardiological purposes. We present our experience in 46 patients with laryngeal tumor in whom we did a 201Tl SPECT as part of the extension study. The sensitivity of the study was 81.6% in the diagnosis of the primary tumor and 46.1% for the neck adenopathies. The 201Tl SPECT can be a good method for the evaluation and detection of recurrences in patients with pharyngo-laryngeal tumor.

Comparing 18-fluoro-2-deoxyglucose positron emission tomography with a combination of technetium 99m tetrofosmin single photon emission computed tomography and computed tomography to detect recurrent or persistent nasopharyngeal carcinomas after radiotherapy

BACKGROUND

The diagnostic accuracy of combined computed tomography (CT) and technetium 99m tetrofosmin (Tc-TF) single photon emission computed tomography (SPECT) of head and neck to differentiate recurrent or residual nasopharyngeal carcinomas (NPCs) from benign lesions after radiotherapy was evaluated and compared with positron emission tomography (PET) with 18-fluoro-2-deoxyglucose (FDG).

METHODS

Four months after radiotherapy, 36 patients with NPC underwent Tc-TF SPECT and CT of head and neck to differentiate recurrent or residual NPC from benign lesions. Histopathologic examinations were performed on nasopharyngeal biopsies of all 36 patients.

RESULTS

Based on the biopsy results, the sensitivity, specificity, and accuracy of Tc-TF SPECT were 64%, 96%, and 86%, respectively, for differentiation of recurrent or persistent NPC from benign lesions. For CT and FDG-PET, the sensitivity, specificity, and accuracy were 73%, 88%, and 83% and 100%, 96%, 97%, respectively. For the 27 patients with NPC whose Tc-TF SPECT and CT results were congruent, the combination of Tc-TF SPECT and CT had the same sensitivity, specificity, and accuracy (100%, 96%, and 96%) as FDG-PET. For the nine patients with NPC with incongruent Tc-TF SPECT and CT results, FDG-PET correctly differentiated two benign lesions from seven recurrent/residual NPCs.

CONCLUSIONS

Although, FDG-PET is the best tool for detecting recurrent or residual NPC, combined congruent Tc-TF SPECT and CT results achieved the same accuracy as FDG-PET. Therefore, we concluded that FDG-PET could be considered only when Tc-TF SPECT and CT give incongruent results.

Detection of nasopharyngeal carcinoma with head and neck Tc-99m tetrofosmin SPECT imaging

Tc-99m tetrofosmin SPECT imaging of the head and neck was performed on 10 patients with nasopharyngeal carcinoma (NPC) and 10 controls. There was no abnormal nasopharyngeal uptake of tetrofosmin in the 10 controls. In the patients with NPC, 3/10 (30%) of the cases had no abnormal uptake and 7/10 (70%) had increased nasopharyngeal uptake. Considering our preliminary study, we find that Tc-99m tetrofosmin SPECT of the head and neck may be helpful in the detection of NPC. However, further study with a larger number of patients is needed to ascertain the value of Tc-99m tetrofosmin SPECT in such cases.

Imaging of nasopharyngeal carcinoma with Tc-99m MIBI

PURPOSE

Differentiation of recurrent nasopharyngeal carcinoma (NPC) from radiation fibrosis using conventional diagnostic methods can be difficult. The authors prospectively studied patients with NPC to determine the efficacy of Tc-99m MIBI scintigraphy in detecting the primary, residual, and recurrent tumors.

MATERIALS AND METHODS

The authors performed Tc-99m MIBI SPECT studies of the head and neck and whole-body scans on 21 healthy adult volunteers and 43 patients with NPC before (n = 26) or after (n = 17) radiotherapy. The images were qualitatively assessed by comparing the nasopharyngeal uptake to scalp radioactivity. MIBI uptake index was calculated as a ratio of mean counts per pixel in the normal nasopharynx or tumor to mean counts per pixel in the scalp.

RESULTS

There was significantly higher uptake of Tc-99m MIBI by NPC than normal nasopharynx and radiation fibrosis (P < .05). The authors determined the optimum cutoff MIBI uptake index value of 1.3 with a sensitivity of 97%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 96%, and an accuracy of 98% for diagnosing NPC.

CONCLUSION

This study suggests that Tc-99m MIBI SPECT is useful for detecting primary NPC and for differentiating residual or recurrent tumor from radiation fibrosis. The authors propose the cutoff MIBI uptake index value of 1.3 for diagnosing NPC.