Clinical use of [¹⁸F]fluoro-ethyl-L-tyrosine PET co-registered with MRI for localizing prolactinoma remnants.

IF 3.3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM Pituitary Pub Date : 2024-10-01 Epub Date: 2024-07-23 DOI:10.1007/s11102-024-01430-y

Victoria R van Trigt, Leontine E H Bakker, Huangling Lu, Iris C M Pelsma, Marco J T Verstegen, Wouter R van Furth, Lenka M Pereira Arias-Bouda, Nienke R Biermasz

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Abstract

Purpose: To assess the utility of [¹⁸F]fluoroethyl-L-tyrosine PET co-registered with magnetic resonance imaging ([¹⁸F]FET-PET/MRI^CR) in patients with difficult-to-localize prolactinoma to inform clinical decision-making and (surgical) treatment planning.

Methods: Retrospective cohort study of 17 consecutive patients with prolactinoma undergoing [¹⁸F]FET-PET/MRI^CR between October 2020 and September 2022 for either (1) additional information in case of difficult-to-visualize remnants after prior transsphenoidal surgery (TSS), or pharmacological treatment, or (2) radiological diagnosis in absence of a (clear) adenoma on diagnostic/post-treatment conventional MRI.

Results: [¹⁸F]FET-PET/MRI^CR identified a lesion in 14/17 patients, yet failed to identify active lesions in 2 patients with negative conventional MRI despite prolactin > 7.5 times upper limit of normal. [¹⁸F]FET-PET/MRI^CR results were inconclusive in 1 patient due to diffuse tracer uptake 10 weeks post-surgery. [¹⁸F]FET-PET/MRI^CR was completely concordant with a suspected lesion on conventional MRI in 10/17 patients, and partially concordant in 3/17 patients. New foci were identified in 4/17 patients. The [¹⁸F]FET-PET/MRI^CR conclusions influenced clinical shared decision-making in 15/17 patients, of whom 7 patients underwent TSS and 8 refrained from TSS. One patient underwent TSS despite negative [¹⁸F]FET-PET/MRI^CR, and one patient underwent additional imaging. Intraoperative findings corresponded with [¹⁸F]FET-PET/MRI^CR in 5/8 patients, and immunohistochemistry was positive in 5/8 patients. The treatment goal was achieved in 7/8 patients, and remission was achieved in 5/7 patients in whom total resection was considered feasible.

Conclusion: [¹⁸F]FET-PET/MRI^CR can be of added value in the preoperative decision-making process for selected patients with difficult-to-localize prolactinoma (remnants), or patients lacking a substrate on conventional MRI.

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临床上使用[18F]氟-乙基-L-酪氨酸 PET 与核磁共振成像共同定位催乳素瘤残余。

目的：评估[18F]氟乙基-L-酪氨酸 PET 与磁共振成像（[18F]FET-PET/MRICR）在难以定位的泌乳素瘤患者中的应用，为临床决策和（手术）治疗计划提供信息：对2020年10月至2022年9月期间接受[18F]FET-PET/MRICR检查的17例连续性泌乳素瘤患者进行回顾性队列研究，目的是：(1)为之前经蝶窦手术（TSS）或药物治疗后难以观察到残留物的患者提供额外信息；或(2)为诊断性/治疗后常规磁共振成像检查未发现（清晰）腺瘤的患者提供放射学诊断：结果：[18F]FET-PET/MRICR在14/17例患者中发现了病灶，但在2例常规磁共振成像阴性的患者中，尽管催乳素超过正常值上限的7.5倍，却未能发现活动性病灶。一名患者在术后 10 周出现弥漫性示踪剂摄取，[18F]FET-PET/MRICR 结果无法确定。10/17例患者的[18F]FET-PET/MRICR与常规磁共振成像的疑似病灶完全吻合，3/17例患者部分吻合。在 4/17 例患者中发现了新病灶。[18F]FET-PET/MRICR的结论影响了15/17例患者的临床共同决策，其中7例患者接受了TSS检查，8例患者未接受TSS检查。一名患者在[18F]FET-PET/MRICR阴性的情况下接受了TSS，一名患者接受了额外的成像检查。5/8例患者的术中发现与[18F]FET-PET/MRICR相符，5/8例患者的免疫组化呈阳性。7/8例患者达到了治疗目标，5/7例患者的病情得到缓解，这些患者的全切除术被认为是可行的：结论：[18F]FET-PET/MRICR 可为选定的难以定位的催乳素瘤（残余）患者或常规磁共振成像缺乏底物的患者的术前决策过程提供附加价值。

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来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.

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