title: Octreotide exerts only acute, but no sustained, effects on MRI enhancement of liver metastases in carcinoid syndrome.
abstract: We have investigated the acute and sustained hemodynamic effects of octreotide on hepatic metastases of midgut carcinoids using contrast-enhanced dynamic magnetic resonance imaging (MRI). Seven patients with the carcinoid syndrome and metastasized midgut carcinoid tumors underwent functional dynamic multi-phase gadolinium-enhanced MRI of selected liver metastases at baseline and 60 min after the subcutaneous (s.c.) administration of 100 microg octreotide, and also after 3 months with three times daily (t.i.d.) 100 microg octreotide s.c. Baseline MRIs showed the typical aspect of carcinoid liver metastases with a very bright signal on the T2-weighted sequences and intense enhancement in the arterial phase after injection of gadolinium-diethylenetriaminepentaacetate. MRIs 60 min after the s.c. administration of 100 microg octreotide showed a 34.9 +/- 6.2% (mean +/- SD) reduction in relative enhancement in the selected liver metastases as compared to baseline. In 2 patients, however, there was no (significant) reduction in the relative enhancement in the selected liver metastases 60 min after the s.c. administration of 100 microg octreotide as compared to baseline. Only in 2 patients did the MRIs at 3 months show a decrease in relative enhancement in one of the selected liver metastases. At 3 months, with 100 microg octreotide s.c. t.i.d., there was no correlation between the change in relative enhancement on MRI and the change in 24-hour 5-HIAA excretion. There is thus only an acute effect of octreotide on the perfusion of liver metastases. This study further shows that contrast-enhanced dynamic MRI can be a very useful tool for studying hemodynamic effects of medical therapies on liver metastases in patients with metastatic midgut carcinoids.
authors.affiliation: Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Menno T
authors.initials: MT
authors.lastname: Zomerhuis
authors.forename: Shahid M
authors.initials: SM
authors.lastname: Hussain
authors.forename: Richard A
authors.initials: RA
authors.lastname: Feelders
authors.forename: Aart-Jan
authors.initials: AJ
authors.lastname: van der Lely
authors.forename: Wouter W
authors.initials: WW
authors.lastname: de Herder
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000494:pharmacology*; D002276:Carcinoid Tumor / Q000098:blood supply / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007089:Image Enhancement; D008113:Liver Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000188:drug therapy* / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000494:pharmacology*; D012039:Regional Blood Flow / Q000187:drug effects; D013152:Splanchnic Circulation / Q000187:drug effects*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide