Retrobulbar 99mTc-diethylenetriamine-pentaacetic-acid uptake may predict the effectiveness of immunosuppressive therapy in Graves' ophthalmopathy.
BACKGROUND
In Graves' ophthalmopathy (GO), only patients with immunologically active disease respond to immunosuppressive therapy. Previous studies and theoretical considerations suggest that elevated orbital (99m)Tc-diethylenetriamine-pentaacetic-acid (DTPA) single photon emission computed tomography (SPECT) reflects inflammatory disease activity. We studied whether corticosteroid treatment causes a substantial decrease in DTPA uptake in GO, a result consistent with successful immunosuppressive treatment of GO and referred to as a favorable treatment outcome.


METHODS
One hundred fourteen orbits in 57 patients with active GO (CAS >or= 4) were entered into the study. All patients received corticosteroid treatment. Orbital DTPA uptakes were numerically quantified for the entire orbit as well as the anterior and posterior segments separately. DTPA SPECT was performed before, and 2 to 9 months after the initiation of immunosuppressive treatment. The normal range for DTPA uptake was established in 34 orbits of 17 patients who were being worked up for Raynaud's phenomenon and had no thyroid disease.


RESULTS
The mean DTPA uptake of the 114 orbits of GO patients was higher prior to corticosteroid therapy than after this treatment (11.03 +/- 4.26 MBq/cm(3) and 9.84 +/- 3.51 MBq/cm(3), respectively, p < 0.001) but a substantial decline in DTPA uptake was seen in only 39.5% of GO patients. The positive predictive value of an initial DTPA >12.28 MBq/cm(3) for a substantial decline in DTPA uptake (favorable treatment outcome) was 76%, while a negative predictive value of a pretreatment DTPA <or=12.28 MBq/cm(3) was 78%.


CONCLUSIONS
Corticosteriod treatment is associated with a decline in DTPA uptake in a fraction of GO patients. GO patients with a DTPA uptake above 12.28 MBq/cm(3) are more likely to have a favorable response to corticosteroid therapy while patients with lower values are less likely to have this potentially favorable response. An elevated DTPA uptake may identify patients who are most likely to benefit from immunosuppressive treatment.
Department of Ophthalmology, University of Debrecen Medical and Health Science Center, Debrecen, Hungary.
Bernadett
B
Ujhelyi
Annamaria
A
Erdei
Laszlo
L
Galuska
Jozsef
J
Varga
Lajos
L
Szabados
Erzsebet
E
Balazs
Miklos
M
Bodor
Bela
B
Cseke
Zsolt
Z
Karanyi
Andras
A
Leovey
Emese
E
Mezosi
Kenneth D
KD
Burman
Andras
A
Berta
Endre V
EV
Nagy
D000328:Adult; D000368:Aged; D005260:Female; D049970:Graves Ophthalmopathy / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009915:Orbit / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate; D008775:Methylprednisolone