68Ga DOTATATE PET/CT is an Accurate Imaging Modality in the Detection of Culprit Tumors Causing Osteomalacia

Zhang, Jingjing; Zhu, Zhaohui; Zhong, Dingrong; Dang, Yongyan; Xing, Haiqun; Du, Ying; Jing, Hongli; Qiao, Zhen; Xing, Xiaoping; Zhuang, Hongming; Li, Fang

doi:10.1097/rlu.0000000000000854

Cited by 90 publications

(67 citation statements)

References 29 publications

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“…No additional records were found screening the references of these articles, whereas six articles were excluded after the analysis of the full text. Therefore, 14 articles were included in the qualitative analysis (systematic review) [16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Three articles were excluded from the meta-analysis for possible patient data overlap [18,25,26].…”

Section: Literature Searchmentioning

confidence: 99%

Detection Rate of Culprit Tumors Causing Osteomalacia Using Somatostatin Receptor PET/CT: Systematic Review and Meta-Analysis

et al. 2019

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Background: Tumor-induced or oncogenic osteomalacia (TIO) is a rare paraneoplastic syndrome in which osteomalacia is a consequence of fibroblast growth factor 23 (FGF23) secretion by a mesenchymal tumor. The localization of the culprit lesion in patients with TIO is often challenging. Several studies have evaluated the detection rate (DR) of these tumors using somatostatin receptor positron emission tomography (SSTR-PET/CT). We aimed to summarize literature findings on this topic providing pooled estimates of DR. Methods: A comprehensive literature search by screening PubMed, Embase and Cochrane library electronic databases through August 2019 was performed. The pooled DR of culprit tumors using SSTR-PET/CT in patients with TIO was calculated using a random-effects statistical model. Results: Fourteen studies on the use of SSTR-PET/CT in detecting the culprit tumor in patients with TIO were included in the qualitative analysis. The pooled DR of SSTR-PET/CT on a per-patient-based analysis calculated using eleven studies (166 patients) was 87.6% (95% confidence interval (95% CI) 80.2–95.1%). Statistical heterogeneity among studies was detected (I-square = 63%), likely due to the use of different radiolabeled somatostatin analogues, as demonstrated by a subgroup analysis. Conclusions: Despite limited literature data due to the rarity of the disease, SSTR-PET/CT demonstrated a very high DR of culprit tumors in patients with TIO and it could be used as first-line imaging method for this indication.

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Section: Literature Searchmentioning

confidence: 99%

Detection Rate of Culprit Tumors Causing Osteomalacia Using Somatostatin Receptor PET/CT: Systematic Review and Meta-Analysis

et al. 2019

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“…E PET/CT imaging had a sensitivity of 100% (32/32) and a specificity of 90.9% (10/11) with overall accuracy of 97.7% in the detection of tumours responsible for osteomalacia. 26 However, in this large study, the lesions were identified clearly on imaging. In our experience with 68 Ga-DOTANOC PET/CT, we were able to find multiple lesions.…”

Section: Discussionmentioning

confidence: 56%

“…However, the data available in the literature with the SSTR PET/CT-based imaging in these tumours are limited ( Table 2). [18][19][20][21][22][23][24][25][26] Among the variety of somatostatin analogues, most commonly used for imaging are 68 Ga-DOTA 0 -Ty 3 octreotate (DOTATATE), 68 Ga-DOTA 0 -Ty 3 octreotide (DOTATOC) and 68 Ga-DOTA 0 -NaI 3 octreotide (DOTANOC) with variable SSTR subtype specificity. The specific modification of octreotide at Position 3 in 68 Ga-DOTANOC leads to higher affinity to SSTR-2 and SSTR-5.…”

Section: Discussionmentioning

confidence: 99%

Oncogenic osteomalacia: role of Ga-68 DOTANOC PET/CT scan in identifying the culprit lesion and its management

Singh

Chopra

Ravina

et al. 2017

BJR

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There is some overlap in SUV between fracture-/bone-associated lesions and culprit lesions with a tendency of most non-culprit lesions to have lower SUV and no associated soft-tissue component. In such scenario, intensely tracer-avid, larger non-fracture lesions with soft-tissue component may lead to identification of culprit lesion among multiple lesions. Following detection of culprit lesion, surgical removal is the best treatment. RFA is alternative to surgery in cases where surgery is not possible owing to osteopenia/poor bone health. Advances in knowledge: The main challenge in patients of long-standing OOM is the presence of multiple skeletal lesions (both tumour- or tracer-avid fractures), and it is confusing to identify culprit lesion. This was noted in our study with Ga-DOTANOC and has not been mentioned in studies performed withGa-DOTATATE/TOC PET/CT. In such scenario, Ga-DOTANOC PET/CT needs to be reviewed and read thoroughly to localize the culprit lesion out of the multiple tracer-avid lesions.

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“…[15,16] 18 F-FDG PET/CT, 99m Tc-OCT scintigraphy, and 68 Ga DOTATATE PET/CT played a considerable role in revealing TIO-associated tumors. [17–19] For these patients with TIO, complete surgical resection of causative tumors is the definitive treatment.…”

Section: Discussionmentioning

confidence: 99%

Adult-onset hypophosphatemic osteomalacia associated with Sjogren syndrome

Shen

Zhang²,

Hu³

et al. 2017

Medicine

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Rationale:Hypophosphatemic osteomalacia (HO) is a metabolic bone disease, exhibiting different etiologies such as genetic mutation, tumor induction, dysimmunity, or renal disease. Sjogren's syndrome (SS) is a connective tissue disorder commonly involving exocrine glands; however kidney involvement is also encountered, leading to abnormal phosphorus metabolism, even HO.Patient concerns:A 47-year-old female patient presented progressively worsening pain in the chest wall, back and bilateral lower extremities as well as muscle weakness was referred to our department.Diagnoses, interventions and outcomes:Due to the laboratory test results, radiographic findings and pathologic results, she was diagnosed with adult-onset HO associated with SS. She was then treated with alkalinization, steroids, neutral phosphate, calcium supplements together with activated vitamin D. So far, she recovered uneventfully with relieved pain and increased serum phosphorus level.Lessons:HO may be secondary to renal tubular acidosis of SS patients, and it might be a diagnostic challenge when the kidney involvement in SS is latent and precede the typical sicca symptoms.

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68Ga DOTATATE PET/CT is an Accurate Imaging Modality in the Detection of Culprit Tumors Causing Osteomalacia

Abstract: (68)Ga DOTATATE PET/CT scan is an accurate imaging modality in the detection of tumors causing TIO.

Cited by 90 publications

References 29 publications

Detection Rate of Culprit Tumors Causing Osteomalacia Using Somatostatin Receptor PET/CT: Systematic Review and Meta-Analysis

Detection Rate of Culprit Tumors Causing Osteomalacia Using Somatostatin Receptor PET/CT: Systematic Review and Meta-Analysis

Oncogenic osteomalacia: role of Ga-68 DOTANOC PET/CT scan in identifying the culprit lesion and its management

Adult-onset hypophosphatemic osteomalacia associated with Sjogren syndrome

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