Zollinger-Ellison syndrome other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]

Overview

Endoscopic ultrasound and somatostatin receptor scintigraphy (SRS) (octreotide scan) may be helpful in the diagnosis of Zollinger-Ellison syndrome caused by gastrinoma.

Other Imaging Findings

Other imaging studies that may be helpful in the diagnosis of Zollinger-Ellison syndrome include:

• Somatostatin receptor scintigraphy (SRS) (octreotide scan)
• Somatostatin receptor scintigraphy (SRS) using 111In-pentetreotide with single photon emission tomography (SPECT) scanning allows total body localization study simultaneously at one time, thus allowing detection of liver and distant metastases and it is more sensitive in both localizing the primary gastrinoma and identifying patients with liver metastases than conventional methods such as CT, MRI, US.

Gallery

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  Figure A
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  Figure B

• Figure - A: Somatostatin receptor scintigraphy with pathological radiotracer uptake in the lesser curvature of the stomach.
• Figure - E. Somatostatin receptor scintigraphy revealing pathological radiotracer uptake in the second and third portions of the duodenum at 4 and 24 hours after administration of the radiotracer.

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  Figure 1
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  Figure 2

• Figure 1: An In-111 pentetreotide octreotide scan showed an avid focus at the epigastrium (open arrow), besides physiologic uptake in the kidneys and the spleen.
• Figure 2: Pentetreotide imaging plus abdomen scintigrams. The patient was asked to drink a mouthful of water with Tc-99m pertechnetate added. Dual-isotope planar images were acquired simultaneously, centering on the In-111 photopeaks and on the Tc-99m photopeak.

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  A
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  B
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  C
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  D

• Figures A-D: A 37-year-old male with MEN 1. The patient was injected with 6.4 mCi In-111 octreotide, and images were acquired in the anterior and posterior projections at 4 hours (A) and 24 hours (B). SPECT images were also obtained at 24 hours (C, axial, and D, coronal). Findings are consistent with metastatic somatostatin-receptor-positive malignancy involving the lymph nodes either in the peripancreatic or porta hepatis region.