title: A pilot study evaluating 99mTc-anti-TNF-alpha scintigraphy in graves' ophtalmopathy patients with different clinical activity score.
abstract: The present study describes the preliminary results of the use of 99mTc-anti-TNF-α scintigraphy as a new diagnostic approach to evaluate patients presenting with Graves' ophthalmopathy (GO). Patients (n=25) presenting at different inflammatory stages of GO and 10 healthy volunteers underwent 99mTc-anti-TNF-α scintigraphy. Images were obtained 15 min after the intravenous injection of 370 MBq (10 mCi) 99mTc-anti-TNF-α. Planar images were obtained in a 256×256 matrix (each lasting 5 min) and single photon emission computed tomography (SPECT) scan lasting 13 min. Regions of interest (ROI) were drawn on the orbit and cerebral hemispheres. The uptake of 99m Tc-anti-TNF-α in these regions was compared and positive scintigraphy established when the ROI was >2.5. In addition, uptake for each positive exam was scored as either slight (2.6-5.1), moderate (5.2-7.6), or high (>7.6). In this pilot study, 69 orbits were evaluated (1 patient had only 1 eye), and 27 had a positive CAS (≥3/7). Scintigraphies were positive in 38 orbits. Comparing the results of the exams with CAS, a high sensitivity and negative predictive values were determined for scintigraphy (96.3% and 96.7%, respectively). However, the specificity and the positive predictive values were 71.4% and 68.4%, respectively, with an accuracy of 81.2%. The exclusion of examinations that were slightly positive from the analysis resulted in an improvement in test accuracy (95.5%). The preliminary results suggest that 99mTc-anti-TNF-α scintigraphy is a promising procedure for the evaluation of active orbital inflammation in GO.
authors.affiliation: Departamento de Radiologia e Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: E dos S
authors.initials: Edos S
authors.lastname: Rebelo Pinto
authors.forename: F P P L
authors.initials: FP
authors.lastname: Lopes
authors.forename: S A L
authors.initials: SA
authors.lastname: de Souza
authors.forename: L M B
authors.initials: LM
authors.lastname: da Fonseca
authors.forename: M
authors.initials: M
authors.lastname: Vaisman
authors.forename: B
authors.initials: B
authors.lastname: Gutfilen
authors.forename: P de F
authors.initials: Pde F
authors.lastname: dos Santos Teixeira
mesh_terms: D000328:Adult; D000906:Antibodies; D005123:Eye / Q000000981:diagnostic imaging / Q000473:pathology; D049970:Graves Ophthalmopathy / Q000000981:diagnostic imaging*; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging; D008875:Middle Aged; D009915:Orbit / Q000000981:diagnostic imaging; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012107:Research Design; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013667:Technetium; D015899:Tomography, Emission-Computed, Single-Photon; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*
chemical_list: D000906:Antibodies; D014409:Tumor Necrosis Factor-alpha; D013667:Technetium