Nuclear medicine in the detection and management of pancreatic islet-cell tumours.
Over the last decade somatostatin receptor scintigraphy using various derivatives of long-acting somatostatin analogues has gained its place in the management of pancreatic islet-cell tumours. Scintigraphy is based on the high-affinity binding of such somatostatin analogues to receptors over-expressed by these tumour types. Following the introduction of (111)In-DTPA-D-Phe(1)-octreotide, clinical studies with radiolabelled DOTA-Tyr(3)-octreotide and DOTA-Tyr(3)-octreotate derivatives have shown considerable improvement of imaging results with increased tumour uptake. One of the newer developments, (68)Ga-labelled DOTA-Tyr(3)-octreotide, has shown promising results in patients with pancreatic islet-cell tumours, based on the high-affinity binding to the somatostatin receptor subtype 2 in combination with positron emission tomography (PET) technology. Other peptides--such as ligands for the gastrin/CCK2 receptors or vasoactive intestinal peptide (VIP)--have also been studied for imaging pancreatic cell tumours. Whereas small-sized gastrinoma, somatostatinoma, glucagonoma, carcinoid and VIPoma are frequently detected by somatostatin receptor scintigraphy, insulinoma may escape detection due to reduced receptor expression. Following peptide receptor scintigraphy, a change in patient management is reported in up to 30% of patients. When labelled with (90)Y or (177)Lu, some somatostatin analogues have been applied to patients in advanced stages of the disease. Despite positive response data in 50% of patients, long-term results and survival rates are lacking.
Virgolini
Irene
I
Clinical Department of Nuclear Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. irene.virgolini@uibk.ac.at
Traub-Weidinger
Tatjana
T
Decristoforo
Clemens
C
D007516:Adenoma, Islet Cell / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007515:Islets of Langerhans / Q000000981:diagnostic imaging*; D008297:Male; D009683:Nuclear Medicine / Q000379:methods; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D013004:Somatostatin / Q000031:analogs & derivatives
D019275:Radiopharmaceuticals; D013004:Somatostatin