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Clinical use of [18F]fluoro-ethyl-L-tyrosine PET co-registered with MRI for localizing prolactinoma remnants
Purpose To assess the utility of [ 18 F]fluoroethyl-L-tyrosine PET co-registered with magnetic resonance imaging ([ 18 F]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...
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Published in: | Pituitary 2024-10, Vol.27 (5), p.614-624 |
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Main Authors: | , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites |
Online Access: | Get full text |
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Summary: | Purpose
To assess the utility of [
18
F]fluoroethyl-L-tyrosine PET co-registered with magnetic resonance imaging ([
18
F]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 [
18
F]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
[
18
F]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. [
18
F]FET-PET/MRI
CR
results were inconclusive in 1 patient due to diffuse tracer uptake 10 weeks post-surgery. [
18
F]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 [
18
F]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 [
18
F]FET-PET/MRI
CR
, and one patient underwent additional imaging. Intraoperative findings corresponded with [
18
F]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
[
18
F]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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ISSN: | 1386-341X 1573-7403 |
DOI: | 10.1007/s11102-024-01430-y |