A Pilot Study Evaluating 99mTc-anti-TNF-alpha Scintigraphy in Graves’ Ophtalmopathy Patients with Different Clinical Activity Score

 

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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.

• References

• 1 Bahn RS. Graves’ ophthalmopathy. N Engl J Med 2010; 362: 726-738
  Google Scholar
• 2 Bartalena L, Baldeschi L, Dickinson A, Eckstein A, Kendall-Taylor P, Marcocci C, Mourits M, Perros P, Boboridis K, Boschi A, Currò N, Daumerie C, Kahaly GJ, Krassas GE, Lane CM, Lazarus JH, Marinò M, Nardi M, Neoh C, Orgiazzi J, Pearce S, Pinchera A, Pitz S, Salvi M, Sivelli P, Stahl M, von Arx G, Wiersinga WM. Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol 2008; 158: 273-285
  CrossrefPubMedGoogle Scholar
• 3 Eckstein AK, Johnson KT, Thanos M, Esser J, Ludgate M. Current insights into the pathogenesis of Graves’ orbitopathy. Horm Metab Res 2009; 41: 456-464
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Moncayo R, Dessl A, Judmaier W. Octreoscan and magnetic resonance imaging of endocrine orbitopathy. Eur J Nucl Med 1994; 21: 754
  PubMedGoogle Scholar
• 5 Galuska L, Loevey A, Szucs-Farkas Z, Garai I, Szabo J, Varga J, Nagy EV. SPECT using 99m Tc-DTPA for the assessment of disease activity in Graves’ ophthalmopathy: a comparison with the results from MRI. Nucl Med Commun 2002; 23: 1211-1216
  CrossrefPubMedGoogle Scholar
• 6 Durak H, Söylev M, Durak I, Değirmenci B, Capa Kaya G, Uysal B. Tc-99m polyclonal human immunoglobulin G imaging in Graves’ ophthalmopathy. Clin Nucl Med 2000; 25: 704-707
  CrossrefPubMedGoogle Scholar
• 7 Colao A, Lastoria S, Ferone D, Pivonello R, Macchia PE, Vassallo P, Bonavolonta G, Muto P, Lombardi G, Fenzi G. Orbital scintigraphy with [111 In-diethyenetriamine pentaacetic acid-D-phe1]-octreotide predicts the clinical response to corticosteroid therapy in patients with Graves’ ophthalmopathy. J Clin Endocrinol Metab 1998; 83: 3790-3794
  CrossrefPubMedGoogle Scholar
• 8 Kahaly G, Diaz M, Hahn K, Beyer J, Bockisch A. Indium-111-pentreotide scintigraphy in Graves’ Ophthalmopathy. J Nucl Med 1995; 36: 550-554
  PubMedGoogle Scholar
• 9 Roimicher L, Lopes FP, de Souza SA, Mendes LF, Domingues RC, da Fonseca LM, Gutfilen B. (99m)Tc-anti-TNF-α scintigraphy in RA: a comparison pilot study with MRI and clinical examination. Rheumatology (Oxford) 2011; 50: 2044-2050
  CrossrefPubMedGoogle Scholar
• 10 Lopes FP, de Azevedo MN, Marchiori E, da Fonseca LM, de Souza SA, Gutfilen B. Use of 99mTc-anti-CD3 scintigraphy in the differential diagnosis of rheumatic diseases. Rheumatology 2010; 49: 933-939
  CrossrefPubMedGoogle Scholar
• 11 Martins FP, Gutfilen B, de Souza SA, de Azevedo MN, Cardoso LR, Fraga R, da Fonseca LM. Monitoring rheumatoid arthritis synovitis with 99mTc-anti-CD3. Br J Radiol 2008; 81: 25-29
  PubMedGoogle Scholar
• 12 Lopes FP, de Souza SA, dos Santos Teixeira de PF, Rebelo Pinho dos ES, da Fonseca LM, Vaisman M, Gutfilen B. 99mTc-Anti-TNF-α scintigraphy: a new perspective within different methods in the diagnostic approach of active Graves ophthalmopathy. Clin Nucl Med 2012; 37: 1097-1101
  CrossrefPubMedGoogle Scholar
• 13 Paridaens D, van den Bosch WA, Van der Loos TL, Krenning EP, Van Hagen PM. The effect of etanercept on Graves’ ophthalmopathy: a pilot study. Eye 2005; 19: 1286-1289
  CrossrefPubMedGoogle Scholar
• 14 American Diabetes Association . Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2012; 35: S64-S71
  CrossrefPubMedGoogle Scholar
• 15 Neary N, Nieman L. Adrenal insufficiency: etiology, diagnosis and treatment. Curr Opin Endocrinol Diabetes Obes 2010; 17: 217-223
  CrossrefPubMedGoogle Scholar