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PET/MRI in the Diagnosis of Hormone-Producing Pituitary Microadenoma: A Prospective Pilot Study
The Journal of Nuclear Medicine ( IF 9.1 ) Pub Date : 2018-03-01 , DOI: 10.2967/jnumed.117.191916
Hao Wang , Bo Hou , Lin Lu , Ming Feng , Jie Zang , Shaobo Yao , Feng Feng , Renzhi Wang , Fang Li , Zhaohui Zhu

This study was designed to evaluate the ability of PET/MRI, using 18F-FDG and 68Ga-DOTATATE as tracers, to detect hormone-producing pituitary microadenoma when diagnosis is difficult using MRI alone. Methods: We recruited 37 patients with elevated hormone levels, including 19 with undiagnosable primary pituitary adenoma and 18 with suspected recurrent pituitary adenoma. 18F-FDG PET/MRI and 68Ga-DOTATATE PET/MRI were performed within 1 wk of each other in all patients. Within 2 wk afterward, 27 of the 37 patients underwent transsphenoidal adenomectomy, 3 underwent sella region radiotherapy, 1 underwent somatostatin therapy, and 6 had only clinical follow-up. The image characteristics and uptake levels were correlated with the surgical findings and pathologic results. Receiver-operating-characteristic curves were analyzed to determine the optimal cutoff to differentiate adenoma from normal pituitary tissue. The area under the receiver-operating-characteristic curve was calculated to compare diagnostic performance. Results: The PET/MR images were of diagnostic quality and without obvious image artifacts. The high contrast of the PET images provided complementary information to the fine anatomic display of the MR images. Increased 18F-FDG uptake was clearly observed in all patients. MRI enhanced using a 0.05 mmol/kg dose of gadopentetate dimeglumine showed suggestive findings in only 47% of the patients with primary adenoma and 39% of those with recurrent adenoma; when a 0.1 mmol/kg dose was used, the respective percentages were 37% and 50%. The 18F-FDG SUVmax of the 16 primary adenomas that underwent transsphenoidal adenomectomy (6.8 ± 3.7) was significantly higher than that of normal pituitary tissue (3.2 ± 1.1, P < 0.01). The adenomas showed moderate 68Ga-DOTATATE uptake (SUVmax, 3.8 ± 2.6), but the 68Ga-DOTATATE uptake was generally lower than that of normal pituitary tissue (SUVmax, 6.2 ± 3.2, P < 0.05). In the 11 suspected recurrent pituitary adenomas that underwent transsphenoidal adenomectomy, the 18F-FDG SUVmax was 6.1 ± 3.5, significantly higher than that of normal pituitary tissue (2.5 ± 1.1, P < 0.01), and the 68Ga-DOTATATE SUVmax was 3.0 ± 1.1, significantly lower than that of normal pituitary tissue (5.5 ± 1.7, P < 0.01). The 18F-FDG/68Ga-DOTATATE SUVmax ratio of the adenomas (2.3 ± 1.5) was significantly higher than that of normal pituitary tissue (0.6 ± 0.3, P < 0.05). When the 18F-FDG SUVmax alone and the 18F-FDG/68Ga-DOTATATE SUVmax ratio were used as criteria to discriminate between adenoma and pituitary tissue, the best analysis came from the ratio, and that from 18F-FDG SUVmax alone was slightly less, with optimal diagnostic cutoffs of 1.04 and 3.88, respectively. Conclusion: PET/MRI provides an ideal tool for the detection of hormone-producing pituitary microadenoma. Dual-tracer 18F-FDG and 68Ga-DOTATATE PET/MRI was useful for distinguishing pituitary microadenoma from normal pituitary tissue.



中文翻译:

PET / MRI在产生激素的垂体微腺瘤的诊断中的前瞻性研究

这项研究旨在评估PET / MRI的能力,使用18 F-FDG和68 Ga-DOTATATE作为示踪剂,当仅凭MRI难以诊断时,可检测产生激素的垂体微腺瘤。方法:我们招募了37例激素水平升高的患者,其中19例患有不可诊断的原发性垂体腺瘤,18例疑似复发性垂体腺瘤。18 F-FDG PET / MRI和68在所有患者中,彼此间隔1周内进行了Ga-DOTATATE PET / MRI。之后的2周内,在37例患者中,有27例接受了经蝶窦切除术,3例接受蝶鞍区放疗,1例接受了生长抑素治疗,6例仅接受了临床随访。图像特征和摄取水平与手术结果和病理结果相关。分析了接收者的操作特征曲线,以确定区分正常腺垂体腺瘤的最佳临界值。计算接收器工作特性曲线下的面积以比较诊断性能。结果:PET / MR图像具有诊断质量,并且没有明显的图像伪影。PET图像的高对比度为MR图像的精细解剖显示提供了补充信息。在所有患者中均清楚地观察到18 F-FDG摄取增加。使用0.05 mmol / kg剂量的ado戊二酸二聚丁二胺增强的MRI仅在47%的原发性腺瘤患者和39%的复发性腺瘤患者中显示出提示性发现;当使用0.1mmol / kg剂量时,各自的百分比为37%和50%。经蝶窦切除术的16例原发性腺瘤的18 F-FDG SUV max(6.8±3.7)显着高于正常垂体组织(3.2±1.1,P <0.01)。腺瘤表现出中等的68 Ga-DOTATATE摄取(SUV max,3.8±2.6),但68 Ga-DOTATATE摄取通常低于正常垂体组织(SUV max,6.2±3.2,P < 0.05)。在经蝶窦切除术的11例疑似垂体腺瘤复发中,18 F-FDG SUV max为6.1±3.5,显着高于正常垂体组织(2.5±1.1,P <0.01)和68 Ga-DOTATATE SUV max为3.0±1.1,显着低于正常垂体组织(5.5±1.7,P <0.01)。在18腺瘤的F-FDG / 68 Ga-DOTATATE SUV最大比率(2.3±1.5)显着高于正常垂体组织的比率(0.6±0.3,P <0.05)。当单独使用18 F-FDG SUV max18 F-FDG / 68 Ga-DOTATATE SUV max比率作为区分腺瘤和垂体组织的标准时,最佳分析来自比率,而18 F-FDG单独的SUV max略少一些,最佳诊断阈值分别为1.04和3.88。结论:PET / MRI为检测产生激素的垂体微腺瘤提供了理想的工具。双示踪剂18 F-FDG和68 Ga-DOTATATE PET / MRI可用于区分垂体微腺瘤和正常垂体组织。

更新日期:2018-03-01
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