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Meta-iodobenzylguanidine (MIBG) is an analogue of noradrenalin which concentrates in adrenergic vesicles. Studies performed with an iodine131 radiolabelled form (1311MIBG) have shown that it can be used as an imaging agent for the adrenal medulla (Fischer et al., 1984) and its neoplasms (phaeochromocytoma and neuroblastoma) (Hoefnagel et al., 1987; Kimmig et al., 1984). 1311-MIBG has also been shown to localise in paraganglioma, another tumour arising from the sympathetic nervous system (Pease & Polak, 1978), and in medullary carcinoma of the thyroid (Shapiro et al., 1985). These tumours show a common APUD (amine precursor uptake and decarboxylation) mechanism (Sisson et al., 1981). Carcinoid tumours also possess a number of APUD properties, including in particular neurosecretory (dense core) granules and the ability to produce a variety of biogenic amines. Preliminary studies have suggested that carcinoid tumours may also take up '311-MIBG (Sisson et al., 1984; Smit et al., 1984). If carcinoid tumours were shown to take up this radiopharmaceutical with sufficient concentration then it might be possible to achieve therapeutic doses of 131I-MIBG, a technique successfully employed with malignant phaeochromocytoma (Sone et al., 1985). We describe a study to investigate further the uptake of 1311-MIBG for diagnostic imaging in II patients with confirmed metastatic carcinoid tumours. Eleven patients known to have metastatic carcinoid tumours were studied. In 5 patients secondary deposits were histologically confirmed as carcinoid. The remaining 6 patients had metastatic tumours diagnosed by CT scanning or ultrasound and elevated urinary 5 hydroxyindoleacetic acid (5HIAA) levels, the original primary tumour had been diagnosed histologically. Ten of the II patients had abdominal CT scan or ultrasound to document metastases. An NMR scan was performed in one patient (10). Bone scans were only performed in patients with bone pain. Patient details are shown in Table I. The patients received 0.3ml of Lugol's iodine 3 times a day for 3 days prior to and 3 days after administration of 131I-MIBG to prevent thyroid uptake of the radioiodine. 131I-MIBG (20-40mBq) was injected intravenously. Imaging was performed at 24 and 48h following injection for all patients, and at 72h in 6 patients, using a Siemen's ZLC75 Gamma camera. A medium energy collimator was used with the peak set at 350KeV and a window of 15%. Images were acquired over 600 seconds. Planar anterior and posterior views of the chest and abdomen were taken with selective views of clinically involved areas.

The use of 131I-MIBG in the imaging of metastatic carcinoid tumours