3. Moertel CG. An odyssey in the land ofsmall tumors. iC/in Onco/ l987;5:1503—l522. 20. Kressel HY. Strategies for magnetic resonance imaging of focal liver disease. Radio/ 4. Vinik Al, McLeod MK, Fig LM, et aI. Clinical features, diagnosis and localization of C/inNorthAm l988;26:607—617. carcinoid tumors and their management. Gastroentero/ C/in North Am l989;l8:865— 21 . Li K, Glazer GM, Quint LE, et al. Distinction of hepatic cavernous hemangioma from 896. hepatic metastases with MR imaging. Radio/ogy, I988;169:409—415. 5. Kvols LK, MoertelCG, O'Connel Mi, SchuttAJ, RubinJ, HahnRO. Treatmentof the 22. Bomanji J, Levison DA, Zuzarte J, Britton KE. Imaging of carcinoid tumors with malignant carcinoid syndrome: evaluation of a long-acting somatostatin analogue. ‘23l-metaiodobenzylguanidine.J Nuci Med I987;28: 1907—I910. N Eng/iMed 1986:315:663—666. 23. Hoefnagel CA, den Hartog Jager FCA, Taal BG, Abeling NGGM, Engelsman EE. The 6. Kvols LK, Reubi JC. Metastaticcarcinoid tumors and the malignant carcinoid role of ‘311-MIBGin the diagnosis and therapy of carcinoids. Eur J Nuci Med syndrome. Acta Onco/ 1993:32:197—201. 1987;13:187—191. 7. Feldman JM, Blinder RA, Lucas KJ, Coleman RE. Iodine-I31 metaiodobenzylguani 24. Hoefnagel CA. Metaiodobenzyl-guanidine and somatostatin in oncology: role in the dine scintigraphy ofcarcinoid tumors. J Nuc/ Med l986;27:1691—I696. management of neural crest tumors. Eur J Nuc/ Med 19942l :561—581. 8. Hanson MW, Feldman JM, Blinder RA, Moore JO, Coleman RE. Carcinoids tumors: iodine-131 MIBG scintigraphy. Radiology I989;172:699—703. 25. LambertsSWJ, KrenningEP,ReubiJC.The role ofsomatostatin and its analogsin the 9. Lamberts SWJ, Bakker WH, Reubi JC, et al. Somatostatin receptors imaging in the diagnosis and treatment of tumors. Endocrino/ Rev 1991;21:450—482. localization of endocrine tumors. N Eng/ J Med 1990;323:1246—1249. 26. Bonanji J, Ur E, Mather 5, et al. A scintigraphic comparison of iodine-123- 10. Kvols LK, Brown ML, O'Connor MK, et aI. Evaluation ofa radiolabeled somatostatin metaiodobenzylguanidine and an iodine-labeled somatostatin analogue (tyr-3-oct analog (‘231-oetreotide)in the detection and localization of carcinoid and islet cells reotide) in metastatic carcinoids tumors. J Nuci Med 1992;33:l 121—1124. tumors. Radiology 1993;49:1583—I591. 27. Krenning EP, Bakker WH, Kooij PPM, et al. Somatostatin receptor scintigraphy with I I. Bakker WH, Albert R, Bruns C, et al. lndium-Ill-DTPA-D-Ph&-octreotide, a indium-l I I-DTPA-D-phel-octreotide in man: metabolism, dosimetry and comparison potential radiopharmaceutical for imaging of somatostatin receptor-positive tumors: with iodine-123-tyr-3-octreotide.J Nuc/ Med l992;33:652—658. synthesis, radiolabeling and in vitro validation. L@feSd 1991;49:1583—159I. 28. Schillaci 0, Scopinaro F, Di Macio L, et al. Detection ofmalignant endocrine tumors 12. Bakker WH, Krenning EP, Reubi JC, et al. In vivo application of [‘‘‘ln-DTPA-D with ‘‘‘In-octreoscanand SPECT [abstract]. J Nuc/ Bio/ Med I994;38:341—342. Phe']-octreotide for detection of somatostatin receptor-positive tumors in rats. L@feSci 29. Pauwels 5, Leners 5, Fiasse R. Jamar F. Localization of gastroenteropancreatic 1991;49:1593—I601. neuroendocrine tumors with ‘‘‘indium-pentetreotide scintigraphy. Semin Onco/ 1994; 13. Kwekkeboom DS, Krenning EP, Bakker WH, Oei HJ, Kooij PPM, Lamberts SWJ. 21(suppl l3):15—20. Somatostatin analogue scintigraphy in carcinoid tumors. Eur J Nuc/ Med I993;20: 30. Jamar F, Fiasse R, Leners N, Pauwels 5. Somatostatin receptor imaging with 283—292. indium-l 11-pentetreotide in gastroenteropancreatic neuroendocrine tumors: safety, 14. Carnaille B, Nocadudie M, Pattou F, et al. Scintiscans and carcinoid tumors. Surgery efficacy and impact on patient management. J Nuc/ Med 1995;36:542—549. 1994;l 16:1 I 18—1122. 31. Krenning EP, Kwekkeboom DJ, Bakker WH, et al. Somatostatin receptor scintigraphy IS. Simpson 5, Vinik Al, Harangos PJ, Lloyd RV. Immunohistochemical localization of with [‘‘‘in-DTPA-D-Phe']- and [‘23I.tyr@]-octreotide:the Rotterdam experience with neuron-specific enolase in gastroenteropancreatic neuroendocrine tumors. Correlation more than 1000 patients. Eur J Nuc/ Med 1993;20:7I6—731. with tissue and serum level of neuron-specific enolase. Cancer 1984;54: 1364—1369. 32. Pellizzari CA, Chen GTY, Spelbring DR. Weichselbaum RR, Chen CT. Accurate 16. Nash SU, Said JW. Gastroenteropancreatic neuroendocrine tumors: a histochemical and immunohistochemical study of epithelial (keratin proteins, carcinoembryonic three-dimensional registration of CT, PET, and/or MR images of the brain. J Comput antigen) and neuroendocrine (neuron-specific enolase, bombesin and chomogranin) AssistTomogr 1989;13:20—26. markers in foregut, midgut, and hindgut tumors. Am J Clin Patho/ l986;86:415—422. 33. Kessler ML, Pitluck 5, Petti P. Castro JR. Integration of multimodality imaging data I7. Zimmer T, Ziegler K, Bader M, et al. Localization of neuroendocrine tumors of the for radiotherapy treatment planning. mt J Radiat Oncol Bio/ Phys I991 ;2 1:I653—1667. upper gastrointestinal tract. Gut I994;35:47I—475. 34. Scott AM, Macapinlac HA, Divgi CR, et al. Clinical validation ofSPECT and CT/MRI 18. Picus D, Glazer HS, Levitt RG, Husband JE. Computed tomography of abdominal image registration in radiolabeled monoclonal antibody studies of colorectal carci carcinoid tumors. AiR 1984;I43:581—584. noma. J Nuc/ Med I994;35: 1976—1984. 19. McCarthy SM, Stark DD, Moss AA, Goldberg HI. Computed tomography of 35. Scott AM, MacapinlacH, Zhang JJ,Ctal. Clinical applicationsof fusion imaging in malignant carcinoid disease. J Comput Assist Tomogr 1984;8:846—850. oncology. Nuci Med Biol 1994;21:775—784. Bone Scintigraphy Evaluated in Diagnosing and Staging Langerhans‘Cell Histiocyto sis and Related Disorders Douglas M. Howarth, Brian P. Mullan, Gregory A. Wiseman, Doris E. Wenger, Lee A. Forstrom and William L. Dunn Department ofNuclear Medicine and Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota sensitMty, 52% specificity). Radiationdosimetry to adult reproduc An analysis of patients with proven Langerhans' cell histiocytosis tive organs was less favorable for radiographic skeletal survey (LCH)was undertaken with the aim of evaluating the role of bone compared to bone scintigraphy. Conclusion: Our results support scintigraphy in the diagnosis and staging of LCH. MethOdS Radio the use of radiographicskeletal survey inthe initialdiagnosis of LCH. graphic skeletal surveys and whole-body bone scintigraphy study Bone scintigraphy may have a role in monitoring a patient's progress results were reviewed for all patients treated at the Mayo Clinic in in which the initialscintigrarnand radiographicsurvey show good Rochester, Minnesota during 1965—1994 with histologic proven correlation. LCH.,@Jlavailable studies were then reported in a randomized and blinded fashion. Results: Of the 73 patients with the histologic Key Words bone scintigraphy; Langerhans'cell histiocytosis diagnosis, 56 (76%) had a definite lesion reported on radiographs J NucI Med 1996;37:1456-1460 and subsequent biopsy-proven bone involvement. For this popula tion, the sensitivity and specificity of radiographic survey were 100% and 61%, respectively, compared to 91% and 55% for bone ‘LediversegroupofdiseasesassociatedwithLangerhans'cell scintigraphy. Solitary bone lesions were reported on 21 radiographic proliferation encompass a disparate group of clinical presenta surveys and 24 bone scintigrams. For solitary lesions, radiograph tions, clinical courses and responses to treatment. They all sensitivity and specificity were 95% and 73%, respectivaly, corn display, however, abnormal proliferation of histiocytes, the cell pared to 88% and 77% for bone scintigraphy. Bone scintig/aphy class to which the Langerhans' cell belongs. Only recently has receiver operating characteristic curves showed the region of great the classification and nomenclature of these diseases been eat diagnostic accuracy to be skull, facial bones and mandible (88% standardized. The recommended term, Langerhans' cell histio cytosis (LCH) represents diseases that were previously known Received May 22, 1995; revision accepted Dec. 13, 1995. as eosinophilic granuloma, histiocytosis X, Langerhans' cell For correspondence or reprints contact Douglas M. Howarth, MD, Department of Nuclear Med@ine, John Hunter Hospital Locked Bag No. 1, Newcastle Mail Centre, granulomatosis and classified into unifocal or multifocal sub Newcastle, 2310 NSW, Austraka. types (1 ). Syndromes such as Hand-Schuller-Christian disease 1456 THEJOURNALOFNUCLEARMEDICINE‘Vol. 37 ‘No. 9 . September 1996 and the Letterer-Siwe disease are included in this spectrum, but react with OK6/Leu6 antibody and the cytoplasmic protein S 100 each disease also exhibits their own unique clinical character detected by immunoperoxidase staining methods were sought in istics. cases where further confirmatory diagnostic evidence was required. Skeletal radiology is generally regarded as the most accurate The patient follow-up period ranged from I mo to 24 yr and 4 mo means of detecting bone lesions due to LCH (2). Bone (mean = 7 yr—3mo). Prolonged remission was defined as no new scintigraphy has also been advocated as having a role in the lesions after 5 yr and radiologic improvement of bone lesions. diagnosis and staging of LCH but as yet has not been thor Radiation dosimetry for whole-body radiograph