Olympia Koulouri1, Narayanan Kandasamy1, Andrew C Hoole2, Daniel Gillett3, Sarah Heard3, Andrew S Powlson1, Dominic G O'Donovan4, Anand K Annamalai1, Helen L Simpson1, Scott A Akker5, Simon J B Aylwin6, Antonia Brooke7, Harit Buch8, Miles J Levy9, Niamh Martin10, Damian Morris11, Craig Parkinson11, James R Tysome12, Tom Santarius13, Neil Donnelly12, John Buscombe3, Istvan Boros14, Rob Smith14, Franklin Aigbirhio14, Nagui M Antoun15, Neil G Burnet16, Heok Cheow3, Richard J Mannion13, John D Pickard17, Mark Gurnell18. 1. Metabolic Research LaboratoriesWellcome Trust-MRC Institute of Metabolic Science. 2. Department of Medical Physics. 3. Department of Nuclear Medicine. 4. Department of Pathology. 5. Department of EndocrinologySt Bartholomew's Hospital, London, UK. 6. Department of EndocrinologyKing's College Hospital, London, UK. 7. Macleod Diabetes and Endocrine CentreRoyal Devon and Exeter Hospital, Exeter, UK. 8. Department of Diabetes and EndocrinologyNew Cross Hospital, Wolverhampton, UK. 9. Department of EndocrinologyLeicester Royal Infirmary, Leicester, UK. 10. Department of EndocrinologyImperial College Healthcare NHS Trust, London, UK. 11. Diabetes and Endocrine CentreIpswich Hospital, Ipswich, UK. 12. Department of Otolaryngology. 13. Department of Neurosurgery. 14. Wolfson Brain Imaging CentreUniversity of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK. 15. Department of Neuroradiology. 16. Department of Oncology. 17. Department of Neurosurgery Wolfson Brain Imaging CentreUniversity of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK. 18. Metabolic Research LaboratoriesWellcome Trust-MRC Institute of Metabolic Science mg299@medschl.cam.ac.uk.
Abstract
OBJECTIVE: To determine if functional imaging using 11C-methionine positron emission tomography co-registered with 3D gradient echo MRI (Met-PET/MRI), can identify sites of residual active tumour in treated acromegaly, and discriminate these from post-treatment change, to allow further targeted treatment. DESIGN/ METHODS: Twenty-six patients with persistent acromegaly after previous treatment, in whom MRI appearances were considered indeterminate, were referred to our centre for further evaluation over a 4.5-year period. Met-PET/MRI was performed in each case, and findings were used to decide regarding adjunctive therapy. Four patients with clinical and biochemical remission after transsphenoidal surgery (TSS), but in whom residual tumour was suspected on post-operative MRI, were also studied. RESULTS: Met-PET/MRI demonstrated tracer uptake only within the normal gland in the four patients who had achieved complete remission after primary surgery. In contrast, in 26 patients with active acromegaly, Met-PET/MRI localised sites of abnormal tracer uptake in all but one case. Based on these findings, fourteen subjects underwent endoscopic TSS, leading to a marked improvement in (n = 7), or complete resolution of (n = 7), residual acromegaly. One patient received stereotactic radiosurgery and two patients with cavernous sinus invasion were treated with image-guided fractionated radiotherapy, with good disease control. Three subjects await further intervention. Five patients chose to receive adjunctive medical therapy. Only one patient developed additional pituitary deficits after Met-PET/MRI-guided TSS. CONCLUSIONS: In patients with persistent acromegaly after primary therapy, Met-PET/MRI can help identify the site(s) of residual pituitary adenoma when MRI appearances are inconclusive and direct further targeted intervention (surgery or radiotherapy).
OBJECTIVE: To determine if functional imaging using 11C-methionine positron emission tomography co-registered with 3D gradient echo MRI (Met-PET/MRI), can identify sites of residual active tumour in treated acromegaly, and discriminate these from post-treatment change, to allow further targeted treatment. DESIGN/ METHODS: Twenty-six patients with persistent acromegaly after previous treatment, in whom MRI appearances were considered indeterminate, were referred to our centre for further evaluation over a 4.5-year period. Met-PET/MRI was performed in each case, and findings were used to decide regarding adjunctive therapy. Four patients with clinical and biochemical remission after transsphenoidal surgery (TSS), but in whom residual tumour was suspected on post-operative MRI, were also studied. RESULTS:Met-PET/MRI demonstrated tracer uptake only within the normal gland in the four patients who had achieved complete remission after primary surgery. In contrast, in 26 patients with active acromegaly, Met-PET/MRI localised sites of abnormal tracer uptake in all but one case. Based on these findings, fourteen subjects underwent endoscopic TSS, leading to a marked improvement in (n = 7), or complete resolution of (n = 7), residual acromegaly. One patient received stereotactic radiosurgery and two patients with cavernous sinus invasion were treated with image-guided fractionated radiotherapy, with good disease control. Three subjects await further intervention. Five patients chose to receive adjunctive medical therapy. Only one patient developed additional pituitary deficits after Met-PET/MRI-guided TSS. CONCLUSIONS: In patients with persistent acromegaly after primary therapy, Met-PET/MRI can help identify the site(s) of residual pituitary adenoma when MRI appearances are inconclusive and direct further targeted intervention (surgery or radiotherapy).
Authors: W A Bashari; M van der Meulen; J MacFarlane; D Gillett; R Senanayake; L Serban; A S Powlson; A M Brooke; D J Scoffings; J Jones; D G O'Donovan; J Tysome; T Santarius; N Donnelly; I Boros; F Aigbirhio; S Jefferies; H K Cheow; I A Mendichovszky; A G Kolias; R Mannion; O Koulouri; M Gurnell Journal: Pituitary Date: 2022-05-24 Impact factor: 3.599
Authors: Leontine E H Bakker; Marco J T Verstegen; Wouter R van Furth; Lenka M Pereira Arias Bouda; Eidrees Ghariq; Berit M Verbist; Pieter J Schutte; Waiel A Bashari; Mark C Kruit; Alberto M Pereira; Mark Gurnell; Nienke R Biermasz Journal: Pituitary Date: 2022-05-26 Impact factor: 3.599