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Year : 2019  |  Volume : 34  |  Issue : 1  |  Page : 74-75  

Technetium-99m labeled tropane derivative: Uptake in a pituitary macroadenoma


1 Department of Nuclear Medicine and Positron Emission Tomography, All India Institute of Medical Sciences, New Delhi, India
2 Department of Neurology, CN Centre, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication17-Jan-2019

Correspondence Address:
Dr. Madhavi Tripathi
Department of Nuclear Medicine and Positron Emission Tomography, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_113_18

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   Abstract 


We present a case of suspected idiopathic Parkinson's disease in whom extrastriatal accumulation of Technetium-99m labeled tropane derivatives in a pituitary macroadenoma interfered with image quality and interpretation. Subsequent F-18 fluoro-dihydroxyphenylalanine positron emission tomography/computed tomography was useful to demonstrate the absence of presynaptic dopaminergic dysfunction.

Keywords: Fluoro-dihydroxyphenylalanine, Parkinson disease, pituitary macroadenoma, single-photon emission computed tomography/computed tomography, technetium-99m labeled tropane derivatives


How to cite this article:
Angamuthu M, Tripathi M, Goyal H, Parida G, Goyal V, Damle N, Bal C. Technetium-99m labeled tropane derivative: Uptake in a pituitary macroadenoma. Indian J Nucl Med 2019;34:74-5

How to cite this URL:
Angamuthu M, Tripathi M, Goyal H, Parida G, Goyal V, Damle N, Bal C. Technetium-99m labeled tropane derivative: Uptake in a pituitary macroadenoma. Indian J Nucl Med [serial online] 2019 [cited 2019 Apr 20];34:74-5. Available from: http://www.ijnm.in/text.asp?2019/34/1/74/250352



A 55-year-old male presented with difficulty in walking, tremors of bilateral upper limbs, scanning speech, and urinary incontinence, for the past 2 years. He was a known case of pituitary macroadenoma (PM) and was referred to our department for dopamine transporter single-photon emission computed tomography (DAT SPECT) with the clinical suspicion of Parkinson's disease. Technetium-99m labeled tropane derivative (Tc-99m TRODAT) (20 mCi) was injected intravenously and SPECT/CT was done 4 h later. Evaluation of the cine image [Figure 1]a revealed intense focal tracer accumulation which corresponded to PM on the fused axial SPECT/CT images [Figure 1]b, and on magnetic resonance imaging [Figure 1]c. As a result of this intense uptake in the macroadenoma, tracer binding in the basal ganglia was suboptimal and while the left basal ganglia showed normal binding, the right side was interpreted as normal only after a careful review of the transaxial images [Figure 1]d. To further confirm the absence of presynaptic dopaminergic dysfunction, we performed a F-18 fluoro-dihydroxyphenylalanine (FDOPA) positron emission tomography/computed tomography (PET/CT) which revealed normal tracer uptake in both basal ganglia [Figure 1]e. No accumulation of FDOPA was noted in the PM [Figure 1]f. The symptoms of the patient were subsequently attributed to the presence of cerebellar atrophy.
Figure 1: (a) Cine single-photon emission computed tomography image showing focal tracer accumulation, (b) corresponding to the pituitary macroadenoma on single-photon emission computed tomography/computed tomography, (c) pituitary macroadenoma as seen on magnetic resonance imaging, (d) labeled tropane derivatives single-photon emission computed tomography transaxial image showing normal uptake in the left basal ganglia and equivocal right basal ganglia uptake, (e) F-18 fluoro-dihydroxyphenylalanine positron emission tomography transaxial image showing normal uptake in both basal ganglia and, (f) F-18 fluoro-dihydroxyphenylalanine positron emission tomography image at sella level showing no uptake in the pituitary macroadenoma

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Tc-99m TRODAT ([2-[2-[3- (4-chlorophenyl)-8-methyl-8-azabicyclo [3, 2, 1]oct-2-yl] methyl](2-mercaptoethyl) -amino] ethyl] amino] ethanethiolato (3-)-N2, N2', S2, S2']oxo-[1R-(exo-exo)]) binds to the DAT and is used for the evaluation of presynaptic dopaminergic function in  Parkinsonism More Details.[1],[2],[3],[4] The extrastriatal uptake of TRODAT has been reported in PM, primary brain tumors, brain metastases, meningioma, osteoid tumor of clivus, intracranial tuberculoma, and subdural hematoma.[5],[6],[7],[8],[9],[10],[11],[12],[13] The possibility of extrastriatal accumulation of TRODAT interfering with image interpretation as in our case should be kept in mind, while planning TRODAT SPECT and alternative modalities like FDOPA PET with superior image quality and resolution should be resorted to at the outset. F-18 FDOPA is an analog of DOPA and serves as substrate for aromatic amino acid decarboxylase that converts dopa to dopamine. It can be used as an alternative for Tc-99m TRODAT,[14] especially when the symptom duration of Parkinson's is not too short.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Tripathi M, Arora G, Das CJ, Grover T, Gupta R, Bal C, et al. Incidental detection of intracranial tuberculomas on (99m) Tc-TRODAT-1 SPECT/CT. Clin Nucl Med 2015;40:e321-2.  Back to cited text no. 12
    
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Hsieh TC, Kao CH, Wu YC, Wang CH, Yen KY, Sun SS. Findings of subdural hematoma on tc-99m-TRODAT-1 SPECT. Clin Nucl Med 2009;34:245-6.  Back to cited text no. 13
    
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Huang WS, Chiang YH, Lin JC, Chou YH, Cheng CY, Liu RS, et al. Crossover study of (99m)Tc-TRODAT-1 SPECT and (18)F-FDOPA PET in Parkinson's disease patients. J Nucl Med 2003;44:999-1005.  Back to cited text no. 14
    


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