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

Abstract

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.

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

“…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].…”

“…Three articles were excluded from the meta-analysis for possible patient data overlap [18,25,26]. Overall, 11 articles (166 patients with TIO) were included in the quantitative analysis (meta-analysis) [16,17,[19][20][21][22][23][24][27][28][29]. The characteristics of the 14 studies included in the systematic review are presented in Tables 1 and 2.…”

“…As shown in Table 3, most of the selected studies showed a good DR of culprit tumors in patients with TIO using SSTR-PET/CT. The culprit lesions were usually small benign tumors located in the bones or soft tissues, presenting a high uptake of radiolabeled somatostatin analogues ( 68 Ga-DOTATATE, 68 Ga-DOTATOC or 68 Ga-DOTANOC) at SSTR-PET/CT [16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The most frequent site of culprit tumors were the lower limbs; other frequent sites were the cranio-facial region and the trunk, whereas the localization of culprit tumors in the upper limbs was less frequent.…”

“…Most of the culprit tumors detected by SSTR-PET/CT were confirmed by histopathology and phosphaturic mesenchymal tumor was the most frequent histological type. Malignant or metastatic tumors detected by SSTR-PET/CT in patients with TIO were rare [16][17][18][19][20][21][22][23][24][25][26][27][28][29]. A very high inter-observer concordance among PET/CT masked readers was reported by one study for the visual detection of culprit tumors by SSTR-PET/CT [20].…”

Controlling Water Exchange Kinetics and Improving ParaCEST Imaging

“…This technique is often performed to identify tissue that have higher blood flow rates and therefore accelerated growth and metabolic rates, like cancer, metastasis, and infection. [19][20][21][22][23][24] PET imaging has been used to assess the effectiveness of cancer therapies [25][26][27] , psychiatric drug treatments [28][29][30][31][32] , and anti-atherosclerosis therapies 33,34 , to examine links between brain activity and psychological processes 29,[35][36][37][38][39] , to study vascular diseases including stroke risk and inflammation responses [40][41][42][43][44][45] , and to look at musculoskeletal development 46,47 . SPECT imaging has been primarily used in functional cardiac and brain imaging.…”