open access

Vol 21, No 1 (2018)
Reviews
Published online: 2017-10-27
Submitted: 2017-10-03
Accepted: 2017-10-20
Get Citation

The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves’ orbitopathy

László Galuska, Sándor K. Barna, József Varga, Ildikó Garai, Endre V. Nagy
DOI: 10.5603/NMR.a2018.0005
·
Pubmed: 29319139
·
Nucl. Med. Rev 2018;21(1):54-58.

open access

Vol 21, No 1 (2018)
Reviews
Published online: 2017-10-27
Submitted: 2017-10-03
Accepted: 2017-10-20

Abstract

The pathogenesis of Graves’ orbitopathy (GO) is not completely understood. Coexistent hyperfunction of the thyroid gland is frequent; however, GO may also coexist with hypo- or euthyrodism. The course of GO is largely independent of thyroid function, although elevated serum TSH is known to negatively interfere with GO course. GO is severe in 10% of the cases; sight threatening complications may also develop. A successful therapy of GO requires the assesment of both the severity and activity of orbital inflammation. Based on relevant studies and our own experiences, the possible management choices are reviewed here. For this purpose, we compare the clinical value of imaging techniques for detecting the activity of the disease. During the last 15 years, we used 99mTc-DTPA retrobulbar SPECT routinely in more than 1400 patients to facilitate the right therapeutic decision. This diagnostic utility simplified management decisions compared to previously applied alternative techniques. We recommended the routine use of 99mTc-DTPA retrobulbar SPECT for the evaluation and follow-up of GO.

Abstract

The pathogenesis of Graves’ orbitopathy (GO) is not completely understood. Coexistent hyperfunction of the thyroid gland is frequent; however, GO may also coexist with hypo- or euthyrodism. The course of GO is largely independent of thyroid function, although elevated serum TSH is known to negatively interfere with GO course. GO is severe in 10% of the cases; sight threatening complications may also develop. A successful therapy of GO requires the assesment of both the severity and activity of orbital inflammation. Based on relevant studies and our own experiences, the possible management choices are reviewed here. For this purpose, we compare the clinical value of imaging techniques for detecting the activity of the disease. During the last 15 years, we used 99mTc-DTPA retrobulbar SPECT routinely in more than 1400 patients to facilitate the right therapeutic decision. This diagnostic utility simplified management decisions compared to previously applied alternative techniques. We recommended the routine use of 99mTc-DTPA retrobulbar SPECT for the evaluation and follow-up of GO.

Get Citation

Keywords

GO, 99mTc-DTPA, hyperthyroidism

About this article
Title

The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves’ orbitopathy

Journal

Nuclear Medicine Review

Issue

Vol 21, No 1 (2018)

Pages

54-58

Published online

2017-10-27

DOI

10.5603/NMR.a2018.0005

Pubmed

29319139

Bibliographic record

Nucl. Med. Rev 2018;21(1):54-58.

Keywords

GO
99mTc-DTPA
hyperthyroidism

Authors

László Galuska
Sándor K. Barna
József Varga
Ildikó Garai
Endre V. Nagy

References (24)
  1. Marcocci C, Bartalena L, Bogazzi F, et al. Studies on the occurrence of ophthalmopathy in Graves' disease. Acta Endocrinol (Copenh). 1989; 120(4): 473–478.
  2. Heufelder AE. Pathogenesis of Graves' ophthalmopathy: recent controversies and progress. Eur J Endocrinol. 1995; 132(5): 532–541.
  3. RUNDLE FF. Management of exophthalmos and related ocular changes in Graves' disease. Metabolism. 1957; 6(1): 36–48.
  4. Mourits MP, Prummel MF, Wiersinga WM, et al. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clin Endocrinol (Oxf). 1997; 47(1): 9–14.
  5. Nagy EV, Toth J, Kaldi I, et al. Graves' ophthalmopathy: eye muscle involvement in patients with diplopia. Eur J Endocrinol. 2000; 142(6): 591–597.
  6. Wiersinga WM, Kahaly GJ. Graves’ orbitopathy A Multidisciplinary Approach Karger, Amsterdam 2007: Amsterdam.
  7. Mark A, Prummel M, Wilmar M, et al. Medical management of Graves’ orbitopathy . Thyroid. 1995; 5: 231–234.
  8. Bartley GB, Gorman CA, Fatourechi V, et al. Diagnostic criteria for Graves' ophthalmopathy. Am J Ophthalmol. 1995; 119(6): 792–795.
  9. Szucs-Farkas Z, Toth J, Balazs E, et al. Using morphologic parameters of extraocular muscles for diagnosis and follow-up of Graves' ophthalmopathy: diameters, areas, or volumes? AJR Am J Roentgenol. 2002; 179(4): 1005–1010.
  10. Szucs-Farkas Z, Toth J, Kollar J, et al. Volume changes in intra- and extraorbital compartments in patients with Graves' ophthalmopathy: effect of smoking. Thyroid. 2005; 15(2): 146–151.
  11. Gerding MN, van der Zant FM, van Royen EA, et al. Octreotide-scintigraphy is a disease-activity parameter in Graves' ophthalmopathy. Clin Endocrinol (Oxf). 1999; 50(3): 373–379.
  12. Krassas GE, Doumas A, Kaltsas T, et al. Somatostatin receptor scintigraphy before and after treatment with somatostatin analogues in patients with thyroid eye disease. Thyroid. 1999; 9(1): 47–52.
  13. Burggasser G, Hurtl I, Hauff W, et al. Orbital scintigraphy with the somatostatin receptor tracer 99mTc-P829 in patients with Graves' disease. J Nucl Med. 2003; 44(10): 1547–1555.
  14. Durak H, Söylev M, Durak I, et al. Tc-99m polyclonal human immunoglobulin G imaging in Graves' ophthalmopathy. Clin Nucl Med. 2000; 25(9): 704–707.
  15. Galuska L, Leovey A, Szucs-Farkas Z, et al. SPECT using 99mTc-DTPA for the assessment of disease activity in Graves' ophthalmopathy: a comparison with the results from MRI. Nucl Med Commun. 2002; 23(12): 1211–1216.
  16. Galuska L, Varga J, Szucs Farkas Z, et al. Active retrobulbar inflammation in Graves' ophthalmopathy visualized by Tc-99m DTPA SPECT. Clin Nucl Med. 2003; 28(6): 515–516.
  17. Galuska L, Leovey A, Szucs-Farkas Z, et al. Imaging of disease activity in Graves' orbitopathy with different methods: comparison of (99m)Tc-DTPA and (99m)Tc-depreotide single photon emission tomography, magnetic resonance imaging and clinical activity scores. Nucl Med Commun. 2005; 26(5): 407–414.
  18. Iyer S, Bahn R. Immunopathogenesis of Graves' ophthalmopathy: the role of the TSH receptor. Best Pract Res Clin Endocrinol Metab. 2012; 26(3): 281–289.
  19. Szabados L, Nagy EV, Ujhelyi B, et al. Retrobulbar 99mTc-diethylenetriamine-pentaacetic-acid uptake may predict the effectiveness of immunosuppressive therapy in Graves' ophthalmopathy. Thyroid. 2009; 19(4): 375–380.
  20. Cooper IF, Siadaty MS. Quantitative Concepts' associated with '99m Technetium Diethylenetriaminepentaacetic Acid. Top Publications. BioMedLib Review. 2014; 11(9).
  21. Galuska L, Varga J, Szücs-Farkas Z, et al. Differences in SPET analysis of thyroid-associated orbitopathy. Eur J Nucl Med Mol Imaging. 2004; 31(5): 793–795.
  22. Szabados L, Nagy EV, Ujhelyi B, et al. The impact of 99mTc-DTPA orbital SPECT in patient selection for external radiation therapy in Graves' ophthalmopathy. Nucl Med Commun. 2013; 34(2): 108–112.
  23. Hauser W, Atkins HL, Nelson KG, et al. Technetium-99m DTPA: a new radiopharmaceutical for brain and kidney scanning. Radiology. 1970; 94(3): 679–684.
  24. Alevizaki-Harhalaki M, Alevizaki C, Georgiou E, et al. Increased Tc-99m DTPA uptake in active Graves' ophthalmopathy and pretibial myxoedema. J Nucl Med. 1983; 24(2): 174–176.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl