Comparison of iodine-123 epidepride and iodine-123 IBZM for dopamine D2 receptor imaging in clinically non-functioning pituitary macroadenomas and macroprolactinomas

We compared pituitary iodine-123 epide- pride single-photon emission tomography (SPET) and 123I-IBZM SPET for the in vivo imaging of dopamine D2 receptors in 15 patients with clinically non-functioning pituitary adenomas. Four patients with dopamine agonist-sensitive macroprolactinomas were studied as positive controls. The uptake of radioactivity in the pituitary was established using a visual scoring system and an uptake index calculated by dividing the average count rates in the pituitary area by the average count rates in the cerebellum. All four macroprolactinomas showed specific binding of 123I-epidepride, but only one showed specific binding of 123I-IBZM. Specific binding of 123I-epidepride was demonstrated in 9 of the 15 clinically non-functioning pituitary adenomas (60%), but specific binding of 123I-IBZM was shown in only 6 of these 15 cases (40%). The uptake of 123I-epidepride in the pituitary region was consistently higher than that of 123I-IBZM. None of the patients who showed absence of uptake of 123I-epidepride in the pituitary area showed uptake of 123I-IBZM in this area. In conclusion: 123I-epidepride SPET is superior to 123I-IBZM SPET for the visualization of dopamine receptor-positive pituitary adenomas. Therefore, 123I-epidepride should replace 123I-IBZM for future D2 receptor SPET studies of pituitary adenomas. 123I-epidepride SPET potentially might serve to predict the response of clinically non-functioning pituitary adenomas to dopamine agonist therapy. (orig.)