The role of Tc-99m (V) DMSA scintigraphy in the diagnosis and follow-up of lung cancer lesions

• Published in: Annals of nuclear medicine 2007-07, Vol.21 (5), p.275-283
• Main Authors: Ergün, Eser L, Kara, Pelin O, Gedik, Gonca K, Kars, Ayşe, Türker, Alev, Caner, Biray
• Format: Article
• Language: English
• Subjects: Aged; Bone and Bones - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Small Cell - diagnosis; Carcinoma, Small Cell - diagnostic imaging; Carcinoma, Small Cell - pathology; Female; Humans; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Male; Medical imaging; Middle Aged; Neoplasm Metastasis; Patients; Radiation therapy; Radionuclide Imaging - methods; Radiopharmaceuticals - pharmacology; Technetium Tc 99m Dimercaptosuccinic Acid - chemistry; Technetium Tc 99m Dimercaptosuccinic Acid - pharmacology; Tomography, Emission-Computed, Single-Photon - methods; Whole Body Imaging
• ISSN: 0914-7187; 1864-6433
• DOI: 10.1007/s12149-007-0017-z

To define the role of Tc-99m (V) dimercaptosuccinic acid (DMSA) scanning in the detection of lung cancer (LC) and its metastases, and monitoring the response of LC lesions (LCL) to chemo/radiotherapy (TH). Tc-99m (V) DMSA whole-body scans, planar thorax views, and thorax Single-photon emission computed tomography (SPECT) images were obtained both 30 min (early) and 5 h (late) after Tc-99m (V) DMSA administration in 12 small/nonsmall cell LC patients (11 men, 1 woman; mean age 59 years). Five patients also had bone scans. The same scintigraphic protocol was performed in 7 of 12 patients, 3 weeks after first-line TH. TH response was evaluated visually in all LCL and semiquantitatively in primary tumors (PT) of six patients, by comparing the tumor uptake ratios (TUR) of pre-TH and post-TH Tc-99m (V) DMSA SPECT [TUR = mean counts of region of interests (ROI) in PT/mean counts in contralateral ROI]. In seven patients, a 6-month survival was determined. Tc-99m (V) DMSA accumulated in 34 LCL (11 PT, 19 bone metastases, 1 suprarenal mass, 1 axillary node, 2 supraclavicular nodes). A total of 11 patients displayed Tc-99m (V) DMSA uptake in LCL and one patient did not show uptake. In six patients, SPECT imaging showed deeply located PT in the lung parenchyma better than planar views. In five patients, both planar and SPECT views revealed peripherally located PT in the lungs. Early scans showed 18 LCL and late scans displayed all the LCL. Nine bone metastases on pre-TH Tc-99m (V) DMSA scans revealed matched areas of increased Tc-99m methylene diphosphonate (MDP) uptake on bone scans; six bone metastases were additionally detected on Tc-99m (V) DMSA scans when compared with bone scans, and four bone metastases on Tc-99m (V) DMSA scans could not be compared with bone scans because bone scan was not performed. In one patient, Tc-99m (V) DMSA scans became positive for bone metastases on post-TH later than the bone scans for some of the bone metastases. Neither planar nor SPECT imaging showed mediastinal lesions defined on thorax CT in nine patients. On TH monitoring, 17 LCL showed diminished Tc-99m (V) DMSA uptake, one disappeared, four were unchanged, three displayed increased uptake, and five new lesions were established. Of the six patients, TUR in PT increased in two (one survived), decreased in one (exitus), was unchanged in two (two exitus) on post-TH scans, and PT totally disappeared in one (survived) patient. Tc-99m (V) DMSA scans are useful in detecting LCL, exc