Abstract
To evaluate the potential value of somatostatin receptor scintigraphy (SRS) using 111In-DTPA (diethylenetriaminepenta acetic acid)-D-Phe1-octreotide (111In-pentetreotide) in patients with recurring or persisting symptoms of myasthenia gravis (MG), 14 consecutive cases with such supplemental receptor imaging during neurological routine follow-up were retrospectively evaluated in this study. All 14 patients underwent SRS in addition to chest computed tomography (CT). Mean follow-up after imaging was 34 months. Eight patients had previous thymectomy, and three patients were referred to surgery after scintigraphy and chest CT. SRS was positive in one of the 14 patients with local recurrence of thymoma and pleural invasion, and negative in the remaining 13 patients. CT was positive for thymoma in three patients, inconclusive in four patients and negative in seven patients. In conclusion, while SRS may be able to detect thymoma lesions including metastases, it seems of limited value in patients with inconspicuous CT findings. Our initial experience fails to point out a benefit of SRS in the management of persisting or recurring MG (with regard to detection of thymic disorders) compared to CT. Whether SRS is useful for differentiating thymoma from non-neoplastic thymic disease may be investigated by larger series. A predominant proportion of patients with unsatisfactory treatment response, however, continue to suffer an unfavourable clinical course despite absent evidence for thymic pathology.
Similar content being viewed by others
References
Liu W, Liu G, Fan Z, Gai X (2003) Myasthenia gravis in pediatric and elderly patients. Chin Med J (Engl) 116:1578–1581
Pirronti T, Rinald P, Batocchi AP et al (2002) Thymic lesions and myasthenia gravis: diagnosis based on mediastinal imaging and pathological findings. Acta Radiol 43:380
Lastoria S, Vergara E, Palmieri G et al (1998) In vivo detection of malignant thymic masses by indium-111-DTPA-D-Phe1-octreotide scintigraphy. J Nucl Med 39:634–639
Lastoria S, Palmieri G, Muto P, Lombardi G (1999) Functional imaging of thyroid disorders. Ann Med 31[Suppl 2]:63–69
Dohi-Iijima N, Sekijima Y, Nakamura A et al (2004) Retrospective analyses of clinical features and therapeutic outcomes in thymectomized patients with myasthenia gravis at Shinshu University. Intern Med 43:189–193
Romi F, Gilhus NE, Aarli JA (2004) Thymectomy and muscle antibodies in myasthenia gravis. Tidsskr Nor Laegeforen 124:629–631
Guillermo GR, Tellez-Zenteno JF, Weder-Cisneros N et al (2004) Response of thymectomy: clinical and pathological characteristics among seronegative and seropositive myasthenia gravis patients. Acta Neurol Scand 109:217–221
El-Medany Y, Hajjar W, Essa M et al (2003) Predictors of outcome for myasthenia gravis after thymectomy. Asian Cardiovasc Thorac Ann 11:323–327
Singh RS, Behera SK, Saji R, Dhaliwal RS (2003) Thymectomy for myasthenia gravis: 12-year experience. Asian Cardiovasc Thorac Ann 11:299–303
Okumura M, Ohta M, Takeuchi Y et al (2003) The immunologic role of thymectomy in the treatment of myasthenia gravis: implication of thymus-associated B-lymphocyte subset in reduction of the anti-acetylcholine receptor antibody titer. J Thorac Cardiovasc Surg 126:1922–1928
Wolfe GI, Kaminski HJ, Jaretzki A III et al (2003) Development of a thymectomy trial in nonthymomatous myasthenia gravis patients receiving immunosuppressive therapy. Ann N Y Acad Sci 998:473–480
Nicolaou S, Muller NL, Li DK, Oger JJ (1996) Thymus in myasthenia gravis: comparison of CT and pathologic findings and clinical outcome after thymectomy. Radiology 201:471–474
Camera L, Brunetti A, Romano M et al (1999) Morphological imaging of thymic disorders. Ann Med 31[Suppl 2]:57–62
Lamberts SWJ, Krenning EP, Reubi JC (1991) The role of somatostatin and its analogues in the diagnosis and treatment of tumors. Endocrinol Rev 12:450–482
Krenning EP, Kwekkeboom DJ, Bakker WH et al (1993) Somatostatin receptor scintigraphy with [111In-DTPA-D-Phe1]-and [123I-Tyr3]-octreotide: the Rotterdam experience with over 1000 patients. Eur J Nucl Med 20:716–731
Marienhagen J, Schalke B, Aebert H et al (1999) Somatostatin receptor scintigraphy in thymoma imaging method and clinical application. Pathol Res Pract 195:575–581
Reubi JC, Waser B, Horisberger U et al (1993) In vitro autoradiographic and in vivo scintigraphic localization of somatostatin receptors in human lymphatic tissue. Blood 82:2143–2151
Lin K, Nguyen BD, Ettinger DS, Chin BB (1999) Somatostatin receptor scintigraphy and somatostatin therapy in the evaluation and treatment of malignant thymoma. Clin Nucl Med 24:24–28
Palmieri G, Montella L, Martignetti A et al (2002) Somatostatin analogs and prednisone in advanced refractory thymic tumors. Cancer 94:1414–1420
Loehrer PJ Sr, Wang W, Johnson DH, Ettinger DS (2004) Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an eastern cooperative oncology group phase II trial. J Clin Oncol 22:293–299
Higuchi T, Taki J, Kinuya S et al (2001) Thymic lesions in patients with myasthenia gravis: characterization with thallium-201 scintigraphy. Radiology 221:201–206
Yasukawa Y, Yoshikawa H, Iwasa K et al (2004) Comparative study of pre-operative thymic imaging and pathology in patients with myasthenia gravis. J Clin Neurosci 11:610–613
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gao, Z.R., Kornblum, C., Flacke, S. et al. Somatostatin receptor scintigraphy in the follow-up of myasthenia gravis. Neurol Sci 28, 175–180 (2007). https://doi.org/10.1007/s10072-007-0816-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-007-0816-y