Repository logo
 

18F-fluoro-ethyl-tyrosine PET co-registered with MRI in patients with persisting acromegaly.

Published version
Peer-reviewed

Repository DOI


Change log

Authors

Bakker, Leontine EH 
Verstegen, Marco JT 
Manole, Diandra C 
Lu, Huangling 
Decramer, Thomas JM 

Abstract

OBJECTIVE: To report our experience with 18F-fluoro-ethyl-tyrosine (FET) positron emission tomography-computed tomography (PET-CT) co-registered with magnetic resonance imaging (MRI) (FET-PET/MRICR) in the care trajectory for persistent acromegaly. DESIGN: Prospective case series. PATIENTS: Ten patients with insufficiently controlled acromegaly referred to our team to evaluate surgical options. MEASUREMENTS: FET-PET/MRICR was used to support decision-making if MRI alone and multidisciplinary team evaluation did not provide sufficient clarity to proceed to surgery. RESULTS: FET-PET/MRICR showed suspicious (para)sellar tracer uptake in all patients. In five patients FET-PET/MRICR was fully concordant with conventional MRI, and in one patient partially concordant. FET-PET/MRICR identified suggestive new foci in four other patients. Surgical re-exploration was performed in nine patients (aimed at total resection (6), debulking (2), diagnosis (1)), and one patient underwent radiation therapy. In 7 of 9 (78%) operated patients FET-PET/MRICR findings were confirmed intraoperatively, and in six (67%) also histologically. IGF-1 decreased significantly in eight patients (89%). All patients showed clinical improvement. Complete biochemical remission was achieved in three patients (50% of procedures in which total resection was anticipated feasible). Biochemistry improved in five and was unchanged in one patient. No permanent complications occurred. At six months, optimal outcome (preoperative intended goal achieved without permanent complications) was achieved in six (67%) patients and an intermediate outcome (goal not achieved, but no complications) in the other three patients. CONCLUSIONS: In patients with persisting acromegaly without a clear surgical target on MRI, FET-PET/MRICR is a new tracer to provide additional information to aid decision-making by the multidisciplinary pituitary team.

Description

Publication status: Published

Keywords

18F‐fluoro‐ethyl‐tyrosine, acromegaly, functional imaging, multidisciplinary team, positron emission tomography, surgical decision making, transsphenoidal surgery

Journal Title

Clin Endocrinol (Oxf)

Conference Name

Journal ISSN

0300-0664
1365-2265

Volume Title

Publisher

Wiley
Sponsorship
Mark Gurnell is supported by the NIHR Cambridge Biomedical Research Centre (NIHR203312*)