Utility of [.sup.18]F-AlF-NOTA-Octreotide PET/CT in the Localization of Tumor-Induced Osteomalacia

Context: Tumor-induced osteomalacia (TIO) is a paraneoplastic disorder, usually caused by benign mesenchymal tumors that produce high levels of fibroblast growth factor 23. The only curative therapy is resection of the causative tumors. Objective: This research was conducted to evaluate the efficacy...

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Published in:The journal of clinical endocrinology and metabolism 2021-10, Vol.106 (10), p.e4202
Main Authors: Long, Tingting, Hou, Jiale, Yang, Nengan, Zhou, Ming, Li, Yulai, Li, Jian, Tang, Yongxiang, Chen, Dengming, Hu, Shuo
Format: Article
Language:English
Subjects:
Aluminum compounds
Electrical equipment and supplies industry
Fibroblast growth factors
Medical research
Medicine, Experimental
PET imaging
Phosphates
Stem cells
Tumors
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Summary:Context: Tumor-induced osteomalacia (TIO) is a paraneoplastic disorder, usually caused by benign mesenchymal tumors that produce high levels of fibroblast growth factor 23. The only curative therapy is resection of the causative tumors. Objective: This research was conducted to evaluate the efficacy of [.sup.18]F-AlF-NOTA-octreotide ([.sup.18]F-OC) positron emission tomography/computed tomography (PET/CT) in detecting TIO and its impact on patient management. Methods: Retrospective analysis was conducted of 17 patients with hypophosphatemic osteomalacia suspected to be TIO. A [.sup.18]F-OC PET/CT study was performed in all 17 patients to localize the tumor and [.sup.68]Ga-DOTATATE PET/CT was performed in 4 out of 17 patients; both studies were performed within 1 week of each other. Both studies were interpreted blindly without the knowledge of other imaging findings. The image findings were compared with the results of histopathological examinations and clinical follow-ups. Results: The [.sup.18]F-OC PET/CT scans were positive in 14 patients. Furthermore, 4 of 14 patients were scanned with both [.sup.18]F-OC and [.sup.68]Ga-DOTATATE PET/CT. Both studies were able to localize the tumor in all 4 patients. In total, 14 patients had surgery to remove the lesions. Postsurgical pathological examination confirmed causative tumors in these patients, whose symptoms diminished promptly. Serum phosphate levels normalized, confirming the diagnosis of TIO. [.sup.18]F-OC PET/CT sensitivity, specificity, and accuracy were 87.5%, 100%, and 88.2% respectively. [.sup.18]F-OC PET/CT findings affected patient management in 88.2% of cases. Conclusion: [.sup.18]F-OC PET/CT scan is useful in the detection of tumors causing TIO. Further studies with larger patient populations are needed to validate the result. Key Words: [.sup.18]F-AlF-NOTA-octreotide, [.sup.18]F-OC PET/CT, tumor-induced osteomalacia, TIO, [.sup.68]Ga-DOTATATE PET/CT, hypophosphatemia
ISSN:0021-972X
DOI:10.1210/clinem/dgab258