Pituitary microadenomas: a PET study.

Souza, B De; Brunetti, Arturo; Fulham, Michael; Brooks, Rodney A.; DeMichele, D; Cook, Paul; Nieman, Lynnette K.; Doppman, John L.; Eh, Oldfield; Chiro, G Di

doi:10.1148/radiology.177.1.2399336

Cited by 73 publications

(48 citation statements)

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“…The use of FDG-PET in the diagnosis of pituitary adenoma has been reported in case reports and limited investigations, particularly with Cushing disease, and as an imaging tool before radiosurgery resection. [28][29][30][31] One difficulty that limits the utility of FDG-PET for pituitary adenoma imaging is that brain uptake is usually higher than that of the tumor, so images must be carefully registered to MR images to delineate accurately the boundary between tumor and brain. 32 Even so, as was found in our study, active tumor areas in these investigations show increased metabolism as opposed to areas of necrosis, MR images of rats 2 and 3 have less-intense uptake with a more heterogeneous appearance, which may correspond to hemorrhage and cystic spaces on pathology.…”

Section: Discussionmentioning

confidence: 99%

In Vivo Manganese MR Imaging of Calcium Influx in Spontaneous Rat Pituitary Adenoma

Cross¹,

Flexman²,

Anzai³

et al. 2007

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Rapid uptake of the calcium analog manganese (Mn 2ϩ ) into spontaneous pituitary adenoma during MR imaging of aged rats generated the hypothesis that neuroendocrine tumors may have a corresponding increase in calcium influx required to trigger hormonal release. A goal of this study was to investigate the potential for clinical evaluation of pituitary adenoma by MR imaging combined with administration of Mn 2ϩ (Mn-MR imaging).

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Section: Discussionmentioning

confidence: 99%

In Vivo Manganese MR Imaging of Calcium Influx in Spontaneous Rat Pituitary Adenoma

Cross¹,

Flexman²,

Anzai³

et al. 2007

American Journal of Neuroradiology

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“…18 F-FDG PET has been found to have a high sensitivity for the detection of PAs (7,8). Somatostatin receptors are expressed by both normal pituitary gland and pituitary tumor.…”

Section: Introductionmentioning

confidence: 99%

PET/MRI in the Diagnosis of Hormone-Producing Pituitary Microadenoma: A Prospective Pilot Study

et al. 2017

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Ga-DOTATATE PET/MR within one week. Finally, 27 patients underwent transsphenoidal adenomectomy within two weeks, 3 patients underwent sella region radiotherapy, 1 patient underwent somatostatin therapy, and the other 6 patients had a clinical follow-up. The image characteristics and uptake levels were correlated with the surgical findings and pathological results. Receiver-operating-characteristic (ROC) curve analysis was performed to determine an optimal cutoff pituitary to differentiate pituitary adenoma from normal pituitary tissue. The area under the ROC curve was calculated to compare the diagnostic performance. Results:The PET/MR images were in diagnostic quality without obvious image artifacts. The high contrast of PET imaging provided complementary information to the fine anatomy display of MRI.Increased 18 F-FDG uptake was clearly observed in the all patients, whereas enhanced MRI enhanced MRI using 0.05 mmol/kg Gadopentetate dimeglumine had suspicious findings only in 47% primary and 39% recurrent PAs patients, which were 37% and 50%, respectively when using 0.1 mmol/kg Gadopentetate dimeglumine. The maximum standardized uptake values (SUVmax) of 18 F-FDG activity (6.8 ± 3.7) in 16 primary pituitary adenomas who underwent transsphenoidal adenomectomy, was significantly higher than that of the rest of the normal pituitary gland (3.2 ± 1.1, P < 0.01). The adenoma showed moderate 68 Ga-DOTATATE uptake (3.8 ± 2.6), but generally lower than that of the normal pituitary gland (6.2 ± 3.2, P < 0.05). In the 11 patients with suspected recurrent pituitary tumors who underwent transsphenoidal adenomectomy, the SUVmax of 18

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“…4,5,13,16,33 Further, using PET Muhr et al, and others, demonstrated consistent high uptake of [ 11 C]-l-methionine by pituitary adenomas of various types. 6,26 This high uptake of these metabolic tracers occurs with micro-and macroadenomas as well as secretory and nonfunctioning tumors.…”

Section: Arguments Supporting the Proposed Mechanism Pituitary Tumorsmentioning

confidence: 76%

Apoplexy of pituitary adenomas: the perfect storm

Oldfield

Merrill

2015

JNS

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Pituitary tumors spontaneously infarct at a relatively high rate, higher than any other CNS tumor. This occurs with or without hemorrhage. The typical clinical entity was described relatively late, in 1950, by Brougham et al. 12 Since then pituitary apoplexy has been the subject of many reports describing the clinical presentation, patient management, imaging features, and outcome, as well as reports of acute circumstances predisposing to its occurrence. 9,10,14,15,17,[22][23][24][25]29,32,36,37,39,45 We propose here that infarction of these tumors is the product of a combination of intrinsic features of these tumors and that it is the tenuous imbalance between their high rate of demand for nutrients combined with their limited intrinsic blood supply that makes them vulnerable to infarction, with or without precipitating events, and suggest that this circumstance may permit new approaches to treatment based on this peculiar vulnerability. case of Pituitary apoplexyA 57-year-old male had the sudden onset of headache followed by excessive thirst, polydipsia, loss of energy, and abbreviatioNs FDG = fluorodeoxyglucose; PET = positron emission tomography; VEGF = vascular endothelial growth factor. submitted July 25, 2014. accePted October 8, 2014. iNclude wheN citiNg Published online April 10, 2015; DOI: 10.3171/2014.10.JNS141720. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect Pituitary adenomas occasionally undergo infarction, apoplexy, which often destroys much of the tumor. It is well known that apoplexy can be precipitated by several acute factors, including cardiac surgery, other types of surgery, trauma, insulin infusion, and stimulation with administration of hypothalamic releasing factors. methods The prior focus on mechanisms underlying pituitary apoplexy has been on these acute events. Less attention has been given to the endogenous features of pituitary tumors that make them susceptible to spontaneous infarction, despite that most pituitary apoplexy occurs in the absence of a recognized precipitating event. The authors examine intrinsic features of pituitary adenomas that render them vulnerable to apoplexy-features such as high metabolic demand, paucity of angiogenesis, and sparse vascularity, qualities that have previously not been linked with apoplexy-and argue that it is these features of adenomas that underlie their susceptibility to spontaneous infarction. The sensitivity of freshly cultured pituitary adenomas to hypoglycemia is assessed. results Adenomas have high metabolic demand, limited angiogenesis, and reduced vessel density compared with the normal gland. Pituitary adenoma cells do not survive in the presence of reduced or absent concentrations of glucose. coNclusioNs The authors propose that the frequent ischemic infarction of pituitary adenomas is the product of intrinsic features of these tumors. These endogenous qualities create a tenuous balance between high metabolic demand and ...

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Pituitary microadenomas: a PET study.

Cited by 73 publications

References 0 publications

In Vivo Manganese MR Imaging of Calcium Influx in Spontaneous Rat Pituitary Adenoma

In Vivo Manganese MR Imaging of Calcium Influx in Spontaneous Rat Pituitary Adenoma

PET/MRI in the Diagnosis of Hormone-Producing Pituitary Microadenoma: A Prospective Pilot Study

Apoplexy of pituitary adenomas: the perfect storm

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