[ 18 F]FET PET/MRI: An Accurate Technique for Detection of Small Functional Pituitary Tumors.

Autor:	Pruis IJ; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands., Verburg FA; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands., Balvers RK; Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands., Harteveld AA; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands., Feelders RA; Department of Medicine, Section of Endocrinology, Erasmus MC, Rotterdam, The Netherlands., Vernooij MW; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands; and., Smits M; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.; Medical Delta, Delft, The Netherlands., Neggers SJCMM; Department of Medicine, Section of Endocrinology, Erasmus MC, Rotterdam, The Netherlands., Veldhuijzen van Zanten SEM; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; s.veldhuijzenvanzanten@erasmusmc.nl.
Jazyk:	angličtina
Zdroj:	Journal of nuclear medicine : official publication, Society of Nuclear Medicine [J Nucl Med] 2024 May 01; Vol. 65 (5), pp. 688-692. Date of Electronic Publication: 2024 May 01.
DOI:	10.2967/jnumed.123.266853
Abstrakt:	Small functional pituitary tumors can cause severely disabling symptoms and early death. The gold standard diagnostic approach includes laboratory tests and MRI, with or without inferior petrosal sinus sampling (IPSS). In up to 40% of patients, however, the source of excess hormone production remains unidentified or uncertain. This excludes patients from surgical, Gamma Knife, and CyberKnife therapy and adversely affects overall cure rates. We here assess the diagnostic yield of O -(2-[ 18 F]fluoroethyl)-l-tyrosine ([ 18 F]FET) PET/MRI for detection of small functional pituitary tumors in these patients. Methods: This retrospective analysis included patients with Cushing disease (CD) but prior negative or inconclusive MRI results who underwent [ 18 F]FET PET/MRI between February 1, 2021, and December 1, 2022. PET/MR images and MR images alone were evaluated by experienced nuclear radiologists, neuroradiologists, or radiologists. Postoperative tissue analysis (when performed) was used as a reference standard to assess diagnostic metrics (i.e., sensitivity and positive predictive value). Results were also compared with previously obtained MR images, preceding IPSS, and clinical or biochemical follow-up. Results: Twenty-two patients (68% female; mean age ± SD, 48 ± 15 y; range, 24-68 y) were scanned. All patients showed a clear metabolic focus on [ 18 F]FET PET, whereas reading of the MRI alone yielded a suspected lesion in only 50%. Fifteen patients underwent surgery directed at the [ 18 F]FET-positive focus. Tissue analysis confirmed a pituitary adenoma/pituitary neuroendocrine tumor of the corticotroph cell type (TPIT lineage) in 10 of 15 and a pituicytoma in 1 of 15, rendering a sensitivity of 100% and a positive predictive value of 73%. Lateralization was more accurate with [ 18 F]FET PET/MRI than with IPSS in 33%. Twelve of 16 (75%) patients who received surgical, Gamma Knife, or CyberKnife therapy after [ 18 F]FET PET/MRI reached short-term remission. Conclusion: [ 18 F]FET PET/MRI shows a high diagnostic yield for localizing small functional pituitary tumors. This multimodal imaging technique provides a welcome improvement for diagnosis, planning of surgery, and clinical outcome in patients with Cushing disease, particularly those with repeated negative or inconclusive MRI results with or without IPSS. (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)
Databáze:	MEDLINE
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