<p>Background: The aim of this study was to assess the feasibility and diagnostic accuracy of an optimized <sup>111</sup>Indium-diethylenetriamine-penta-acetic-acid single-photon-emission computed tomography (CT) (<sup>111</sup>In-DTPA SPECT-CT) examination in patients with suspected intrathecal drug delivery (ITDD) failure.  <br/></p><p>Materials and Methods: Retrospective analysis of routinely collected observational data from a case series of patients in the setting of the academic Center for Pain Medicine, Departments of Radiology and Nuclear Medicine and Neurosurgery. Twenty-seven patients participated between January 2014 and January 2019. Thirty-six optimized examinations including standardized pump flow rate with additional SPECT-CT imaging and a stepwise standardized analysis were performed. A 10 mL mixture of medication and 20 MBq 111In-DTPA was injected into the pump reservoir. Planar and SPECT-CT images were acquired at 24, 48, and 72 hours (h) after injection and at 96 hours and/or seven days, if needed. All images were reassessed by the first two authors using an optimized procedure.  <br/></p><p>Results and Conclusions: Twenty-two abnormalities were identified in 21 examinations, with these abnormalities consisting of leakage (n = 7), spinal catheter obstruction (n = 7), and cerebrospinal fluid flow obstruction (n = 8). Interventions (n = 19) confirmed the cause of ITDD failure. A false-positive finding at follow-up (n = 1) and a false-negative finding (n = 1) were encountered. Sensitivity was 95% (20/21) and the specificity 93% (14/15). A significant difference (p &lt; 0.001) was found between the accuracy of the conventical and the optimized analysis. The optimized <sup>111</sup>In-DTPA SPECT-CT examination is a powerful diagnostic tool for detecting the cause of ITDD failure.</p>

doi.org/10.1111/ner.13275, hdl.handle.net/1765/137188
Erasmus MC: University Medical Center Rotterdam

EM (Elmar) Delhaas, D.M.E. (Danielle) van Assema, A.C. Vos - Froberg, Ben G.J.C. Zwezerijnen, B.S. Harhangi, S.P.G. (Sander) Frankema, … A. (Aad) van der Lugt. (2021). Isotopic Scintigraphy in Intrathecal Drug Delivery Failure: A Single-Institution Case Series. Neuromodulation, 24(7), 1190–1198. doi:10.1111/ner.13275