Original article Somatostatin receptor scintigraphy to predict the clinical evolution and therapeutic response of thyroid-associated ophthalmopathy Marie Nocaudie 1 , Alban Bailliez 1 , Emmanuel Itti 1 , Catherine Bauters 2 , Jean-Louis Wemeau 2 , Xavier Marchandise 1 1 Service Central de Médecine Nucléaire et Imagerie Fonctionnelle, Centre Hospitalier Régional et Universitaire de Lille, France 2 Clinique d’Endocrinologie, Centre Hospitalier Régional et Universitaire de Lille, France &misc:Received 17 November 1998 and in revised form 13 January 1998 &p.1:Abstract. Management of thyroid-associated ophthal- mopathy remains a topic of controversy. Immunosup- pressive treatments have to be applied at peak disease activity and before criteria of severity develop. Expres- sion of somatostatin receptors on activated lymphocytes allows scintigraphic imaging with indium-111 pentetreo- tide. We conducted a prospective study with 17 patients who presented severe ophthalmopathy (11 Graves’ dis- ease, four Hashimoto’s thyroiditis, two isolated in ap- pearance: Means’ syndrome). Each patient underwent hormonal (free T 3 and TSH) and immunological (TBII) assessment, an orbital computed tomography scan or magnetic resonance imaging, a visual functional exami- nation and 111 In-pentetreotide orbital scintigraphy before undergoing treatment by steroids and/or radiotherapy, in- dependently of scintigraphic results. At 4 and 24 h after the intravenous injection of 111 MBq of 111 In-pentetreo- tide, planar imaging centred on the head and neck (ante- rior and both lateral views) was carried out. Retrobulbar uptake was assessed by visual semi-quantitative analysis (score given by two independent trained observers) and by quantitative analyses (regions of interest, orbit/brain uptake indices). Patients were ophthalmologically fol- lowed up for 6 months and then classified as improved or not. Visual semi-quantitative analysis of 4-h/24-h pla- nar images was correlated with the ophthalmological evolution (χ 2 test, P<0.01). All ten patients in whom scintigraphy was considered positive were clinically im- proved at 6 months, and of the seven patients in whom scintigraphy was negative, six were not improved. Nev- ertheless, objective quantitative analysis did not succeed in confirming these results. We conclude that 111 In-pent- etreotide scintigraphy requires further developments, in- cluding quantitative single-photon emission tomographic acquisition, if its role as a guide to therapeutic strategy in thyroid-associated ophthalmopathy is to be confirmed. &kwd:Key words: Graves’ ophthalmopathy – Somatostatin ana- logues – Radionuclide imaging – Evolution – Therapeu- tic response Eur J Nucl Med (1999) 26:511–517 Introduction The appropriate therapeutic regimen for thyroid-associ- ated ophthalmopathy remains controversial because the physiopathological mechanisms involved are still not completely known [1, 2]. Ophthalmic signs are, howev- er, present in 40% of cases of Graves’ disease [3]. They can occur on their own (Means’ syndrome) or can be as- sociated with Graves’ disease or chronic Hashimoto’s thyroiditis. The thickening of the oculomotor muscles and increased retro-orbital fat are histologically related to oedematous and lymphocyte infiltration (with glycos- aminoglycans deposition) and later fibrous infiltration, of auto-immune origin [1]. A 64-kDa protein antigen, occurring in both the ocular muscles and the thyroid, is the most likely cause [4]. Ophthalmopathy is severe in about 20% of cases [5]. The criteria for assessing the severity of orbital disease are above all clinical: the intensity of protrusion (as measured with an exophthalmometer) is responsible for corneal and conjunctival complications, visual problems such as loss of acuity and decreased colour perception are related to the compression of the optic nerve, and fi- nally oculomotor dysfunction is responsible for diplopia. In 2%–4% of cases the exophthalmia is malignant. Se- vere disease requires appropriate treatment, generally in the form of systemic corticosteroid therapy possibly as- sociated with local radiotherapy, but other immunosup- pressive treatment may also be indicated. To be effec- tive, the treatment must be started early, during the ac- tive phase of the disease and before criteria of severity develop [1]. European Journal of Nuclear Medicine Vol. 26, No. 5, May 1999 – © Springer-Verlag 1999 Correspondence to: M. Nocaudie, Service Central de Médecine Nucléaire et Imagerie Fonctionnelle, Centre Hospitalier Régional et Universitaire de Lille, Hôpital Roger Salengro, F-59037 Lille cedex, France&/fn-block: