Case report: drug interference with MIBG uptake in a patient with metastatic paraganglioma.
Metaiodobenzylguanidine (MIBG) labelled with iodine-131 ((131)I) has become a well established therapeutic tool for inoperable metastastic tumours of paraganglioma. There are different pharmacological substances known to interfere with MIBG-uptake which may result in a false negative MIBG scan. We present the case of a 26-year-old male polytoxicomanic patient with metastatic paraganglioma, who underwent MIBG therapy. During earlier therapies, MIBG uptake in the metastatic lesions was very high. A post-therapeutic whole-body scan subsequent to recent (131)I-MIBG therapy failed to detect the vast majority of metastatic lesions-except for two. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) showed metastases with a similar distribution to the initial MIBG scan. The possible reasons for the discrepancy in the findings of the MIBG scans and the (18)F-FDG-PET scan are discussed with special emphasis on drug intake prior to MIBG administration, increased MIBG turn-over and unknown drug mixture interference with MIBG uptake.
Zaplatnikov
K
K
Department of Nuclear Medicine, Hospital of the J.W. Goethe-University, Frankfurt/Main, Germany.
Menzel
C
C
Döbert
N
N
Hamscho
N
N
Kranert
W T
WT
Gotthard
M
M
Behr
T M
TM
Grünwald
F
F
D019797:3-Iodobenzylguanidine / Q000627:therapeutic use; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D004347:Drug Interactions; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D010235:Paraganglioma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000150:complications*; D014055:Tomography, Emission-Computed / Q000379:methods
D000970:Antineoplastic Agents; D007457:Iodine Radioisotopes; D009294:Narcotics; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D019797:3-Iodobenzylguanidine; D008691:Methadone