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Image fusion analysis of 99mTc-HYNIC-octreotide scintigraphy and CT/MRI in patients with thyroid-associated orbitopathy: the importance of the lacrimal gland

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Abstract

The aim of this study was to describe the anatomical structures that show uptake of the somatostatin analogue octreotide in patients with thyroid-associated orbitopathy (TAO). The study population comprised a series of 20 TAO patients attending the out-patient thyroid clinic and 12 patients presenting head or neck tumours. Scintigraphy was carried out with our newly developed tracer, technetium-99m labelled EDDA-HYNIC-TOC (99mTc-TOC). Morphological imaging was done with either magnetic resonance imaging or X-ray computed tomography without contrast medium. Both imaging procedures were done within an interval of 3–4 weeks. For the image fusion procedure, specific external reference markers were used for each imaging modality. The markers were screwed onto a reference frame, which was held in place via a vacuum-fixed mouthpiece. The anatomical structure showing tracer uptake that was most frequently recognised was the lacrimal gland, followed by the retronasal area, cervical lymph structures, salivary glands, the anterior insertion points of the extra-ocular muscles and discrete areas of the neck extensor muscles. The lacrimal gland and the retronasal area showed the highest and most frequent uptake of 99mTc-TOC in TAO patients, whereas such uptake did not occur in the retrobulbar space. In spite of knowledge of these results of image fusion, no changes in the involved structures could be detected on morphological imaging. It is concluded that binding of 99mTc-TOC is more frequently localised to the anterior compartment of the eye and to the neck. The previously used term "orbital" uptake should be abandoned and replaced by a descriptive term relating to the anatomically recognised structure showing tracer accumulation, i.e. the lacrimal gland. The uptake of octreotide by lymphoid and salivary glands opens a new field of investigation related to the physiology of somatostatin.

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Fig. 1A–C.
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Fig. 3A–E.

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Acknowledgements

This study was made possible by the expert contributions from Thomas Lang and Martin Knoflach, SIP Laboratory, Department of Radiology I, University of Innsbruck, who carried out the image fusion procedures. We also wish to thank the technical assistants of the Departments of Nuclear Medicine and Radiology I who were involved in the imaging procedures. Their expert technical work is deeply appreciated.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Clinic, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Hartmann Kainz, Eveline Donnemiller, Michael Gabriel, Clemens Decristoforo & Roy Moncayo

  2. Department of Radiology I, University Clinic, University of Innsbruck, Austria

    Reto Bale & Peter Kovacs

Authors
  1. Hartmann Kainz
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  2. Reto Bale
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  3. Eveline Donnemiller
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  4. Michael Gabriel
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  5. Peter Kovacs
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  6. Clemens Decristoforo
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  7. Roy Moncayo
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Corresponding author

Correspondence to Roy Moncayo.

Additional information

The individual results of the first 18 patients with thyroid-associated orbitopathy have been analysed as part of a doctoral thesis (H. Kainz, University of Innsbruck, 2002).

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Kainz, H., Bale, R., Donnemiller, E. et al. Image fusion analysis of 99mTc-HYNIC-octreotide scintigraphy and CT/MRI in patients with thyroid-associated orbitopathy: the importance of the lacrimal gland. Eur J Nucl Med Mol Imaging 30, 1155–1159 (2003). https://doi.org/10.1007/s00259-003-1207-0

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  • DOI: https://doi.org/10.1007/s00259-003-1207-0

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