Value of Somatostatin Receptor Scintigraphy with 99mTc-HYNIC-TOC in Patients with Primary Sjögren Syndrome

Luz Kelly Anzola; Josè Nelson Rivera; Rudi A Dierckx; Chiara Lauri; Stefano Valabrega; Filippo Galli; Sergio Moreno Lopez; Andor W J M Glaudemans; Alberto Signore

doi:10.3390/jcm8060763

Value of Somatostatin Receptor Scintigraphy with ^99mTc-HYNIC-TOC in Patients with Primary Sjögren Syndrome

J Clin Med. 2019 May 30;8(6):763. doi: 10.3390/jcm8060763.

Authors

Luz Kelly Anzola^{1

2

3}, Josè Nelson Rivera⁴, Rudi A Dierckx⁵, Chiara Lauri^{6

7}, Stefano Valabrega⁸, Filippo Galli⁹, Sergio Moreno Lopez¹⁰, Andor W J M Glaudemans¹¹, Alberto Signore^{12

13}

Affiliations

¹ Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University, 00161 Rome, Italy. lkanzola@gmail.com.
² Nuclear Medicine Unit, Clinica Colsanitas, 11021 Bogotà, Colombia. lkanzola@gmail.com.
³ Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands. lkanzola@gmail.com.
⁴ Internal Medicine Unit, Clinica Colsanitas, 11021 Bogotà, Colombia. jonerimo@yahoo.com.
⁵ Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands. r.a.dierckx@umcg.nl.
⁶ Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University, 00161 Rome, Italy. chialau84@hotmail.it.
⁷ Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands. chialau84@hotmail.it.
⁸ Surgery Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University, 00161 Rome, Italy. stefano.valbrega@uniroma.it.
⁹ Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University, 00161 Rome, Italy. filippo.galli@hotmail.com.
¹⁰ Epidemiology Department, National University of Colombia, 11021 Bogotà, Colombia. smmorenol@unal.edu.co.
¹¹ Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands. a.w.j.m.glaudemans@umcg.nl.
¹² Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University, 00161 Rome, Italy. alberto.signore@uniroma1.it.
¹³ Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands. alberto.signore@uniroma1.it.

Abstract

Objectives: Primary Sjögren syndrome (SS) is diagnosed based on the American European Consensus Group (AECG) criteria, but lacks specificity, not only in the involvement of salivary glands, but also in extra-glandular involvement. Whole-body somatostatin receptor scintigraphy with ^99mTc-HYNIC-TOC scintigraphy could overcome these limitations. The aims of this study were to evaluate salivary gland uptake of ^99mTc-HYNIC-TOC in untreated patients with de-novo diagnosis of SS as compared to control subjects and as compared to conventional sialoscintigraphy with ^99mTcO₄^-. We also aimed to evaluate the involvement of joints.

Methods: ^99mTc-HYNIC-TOC was used with SS patients and uptake in joints and salivary glands was analyzed semi-quantitatively. Patients also underwent ^99mTcO₄ sialoscintigraphy. The control group that we analyzed consisted of 30 patients with neuroendocrine tumors.

Results: Fifty-two females and 10 males fully met the AECG criteria for SS, and were included. A target background ratio (TBR) >1.18 in submandibular glands correctly classified 93% of the patients with SS in comparison to 27% for ^99mTcO₄ sialoscintigraphy. The area under the curve (ROC) analysis for TBR in submandibular glands was 0.95. In joints there was a huge variety in uptake. The median TBR was significantly higher in salivary glands in patients with SS compared to controls.

Conclusions: ^99mTc-HYNIC-TOC scintigraphy identified active inflammatory processes not only in the salivary glands, but, unexpectedly, also in many joints in patients with primary SS, contrary to popular belief. This technique provides an objective parameter to evaluate the inflammation burden in salivary glands and joints and could be used to evaluate response to treatment.

Keywords: 99mTc-HYNIC-TOC; Sjögren syndrome; inflammation; salivary glands; somatostatin receptor scintigraphy.