Korean J Radiol.  2013 Oct;14(5):841-844. 10.3348/kjr.2013.14.5.841.

An Incidentally Found Inflamed Uterine Myoma Causing Low Abdominal Pain, Using Tc-99m-Tektrotyd Single Photon Emission Computed Tomography-CT Hybrid Imaging

• Zandieh S
• Schutz M
• Bernt R
• Zwerina J
• Haller J

• KMID: 1711444
• DOI: http://doi.org/10.3348/kjr.2013.14.5.841

Abstract

We report the case of a 50-year-old woman presented with a history of right hemicolectomy due to an ileocecal neuroendocrine tumor and left breast metastasis. Owing to a slightly elevated chromogranin A-level and lower abdominal pain, single photon emission computed tomography-computer tomography (SPECT-CT) was performed. There were no signs of recurrence on the SPECT-CT scan, but the patient was incidentally found to have an inflamed intramural myoma. We believe that the slightly elevated chromogranin A-level was caused by the hypertension that the patient presented. In the clinical context, this is a report of an inflamed uterine myoma seen as a false positive result detected by TC-99m-Tc-EDDA/HYNIC-Tyr3-Octreotide (Tektrotyd) SPECT-CT hybrid imaging.

Keyword

Tektrotyd; SPECT-CT; Uterine myoma

MeSH Terms

Abdominal Pain/etiology/*radionuclide imaging
Edetic Acid/*analogs & derivatives/diagnostic use
Female
Humans
*Incidental Findings
Leiomyoma/complications/*radionuclide imaging
Middle Aged
Organotechnetium Compounds/*diagnostic use
Radiopharmaceuticals/diagnostic use
Tomography, Emission-Computed, Single-Photon/*methods
Uterine Neoplasms/complications/*radionuclide imaging
Edetic Acid
Organotechnetium Compounds
Radiopharmaceuticals

Figure

• 

  Fig. 1 SPECT (A), SPECT-CT (B, C), CT enteroclysis (D), intravaginal sonography of an inflammatory myoma. A. Coronal image of SPECT scan performed 24 hours after administration of 569 MBq Tc-99m-Tektrotyd to evaluate possible NET demonstrated physiological uptake (liver, spleen, kidney, and bladder) and intense, ring-shaped uptake on left side of pelvis (long arrow). Short arrow in upper left abdomen shows physiological uptake by spleen. B, C. Fusion image of low-dose CT scan (coronal and sagittal images) performed in pelvic region, showing an uptake in anterior wall of uterus, consistent with intramural myoma. Study's findings show that Tektrotyd uptake is not specific for neuroendocrine tumors because somatostatin receptors (predominantly somatostatin receptor subtypes sst2 and sst5) are also over-expressed in different inflammatory cells, leading to visualization of sites of active inflammation and in endothelium. NET = neuroendocrine tumor, SPECT = single photon emission computed tomography D. There was no sign of recurrence on CT enteroclysis examination. Intramural myoma is illustrated in anterior wall of uterus (arrow). E. Transvaginal ultrasound shows intramural myoma in uterus (arrow).

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