Successful treatment of residual pituitary adenoma in persistent acromegaly following localisation by 11C-methionine PET co-registered with MRI

Koulouri, Olympia; Kandasamy, Narayanan; Hoole, A.; Gillett, Daniel; Heard, Sarah; Powlson, Andrew S; O’Donovan, Dominic G; Annamalai, Anand K; Simpson, Helen; Akker, Scott; Aylwin, Simon; Brooke, Antonia; Buch, Harit; Levy, Miles; Martin, Niamh; Morris, Damian; Parkinson, Craig; Tysome, James R.; Santarius, Thomas; Donnelly, Neil; Buscombe, J. R.; Boros, István; Smith, Rebekah E.; Aigbirhio, Franklin I.; Antoun, Nagui M.; Burnet, N.G.; Cheow, Heok; Mannion, Richard; Pickard, John D.; Gurnell, Mark

doi:10.1530/eje-16-0639

Cited by 50 publications

(43 citation statements)

References 23 publications

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“…Residual active adenoma tissue following surgery is a challenge, as it is often difficult to identify the residual tumour by MRI. So far, modern amino-acid PET investigations for remnant tumours have had limited use in most centres, but is one of the areas to be developed further (103).…”

Section: Discussion Perspectives and Conclusionmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

Bollerslev

Heck

Olarescu

2019

European Journal of Endocrinology

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Acromegaly is a rare and challenging disease calling for management in highly specialised multidisciplinary teams (MDTs). Untreated disease has severe morbidity and a clearly increased mortality. Major attainments have been gained over the latest decades, and therefore, the aim of this review is to discuss recent achievements in modern multimodal therapy of acromegaly performed by MDTs, with an emphasis on an individualised, proactive management from the time of diagnosis to long-term outcome. Treatment by surgery is the only potential curative treatment, however, even with modern techniques still with modest cure rates, leaving the patients to often long-term medical treatment. Treatment strategies have changed dramatically in the Western world over recent years, implying a more proactive treatment algorithm often with a shorter or longer pre-surgical treatment period with somatostatin receptor ligands (SRLs). Not all patients will however respond to primary treatment with conventional SRLs and there has recently been a development of potential biomarkers for response that has been implemented in the clinical routine. By today, multimodal treatment can bring every patient in remission, but still almost a third of all patients are undertreated according to large, international registries. On the other hand, it might be a challenge not to over treat thereby bringing the patient into a state of relative or absolute growth hormone deficiency. Clinical series published during the last decade on treatment of patients with acromegaly have indicated a normalisation of mortality, most probably reflecting the proactive and individualised modern treatment. In conclusion, modern, multimodal treatment seems to have normalised mortality, but still the patients suffer from a high multi-organ morbidity and often multipharmacy. Every patient should receive an individualised, proactive treatment in order to improve long-term outcome and to reduce costs for the society.Correspondence should be addressed to J Bollerslev . His special interest is within clinical and translational endocrinology, and in particular, in classical endocrine diseases, such as acromegaly and Cushing's, often studying bone as target tissues for clinical activity. A major topic has been clinical management of acromegaly, and especially searching for biomarkers for responsiveness to medical therapy. Prospectively collected data of newly diagnosed patients with acromegaly has been the background for current studies of individualised, multimodal and transdisciplinary treatment. European Journal of Endocrinology 181:2 R60 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R61 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R63 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R64 Review J Bollerslev and others Managing acromegaly https://eje.bioscie...

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Section: Discussion Perspectives and Conclusionmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

Bollerslev

Heck

Olarescu

2019

European Journal of Endocrinology

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“…The 11 C-methionine tracer has also been reported to show a high uptake in pituitary tissue in some patients with PAs (12,27). However, 11 C-methionine commonly showed a higher uptake in PAs than in pituitary tissue and is more compatible with detection of PAs (15,28). Zhao et al showed that 68 Ga DOTATATE was useful for differentiating pituitary tissue from PAs.…”

Section: Discussionmentioning

confidence: 99%

Utility of 13N-Ammonia PET/CT to Detect Pituitary Tissue in Patients with Pituitary Adenomas

et al. 2019

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“…The acquisition took place 19 ± 2 min, range 14 to 25 minutes after tracer administration The PET/CT acquisition (Discovery 690 PET/CT, GE Healthcare) followed the site's default protocol for pituitary imaging. First, a helical CT scan was acquired: 140 kV, 220 mAs, matrix size 512×512, slice thickness 1.25 mm, field of view 300 mm, pixel size 0.59×0.59 mm 2 . Subsequently, a single-bed brain PET dataset, not relevant for the present study, was acquired for 20 minutes.…”

Section: B Data Acquisitionmentioning

confidence: 99%

“…Recent work has shown 11 C-Methionine positron emission imaging (PET) to provide valuable complementary information: E.g. to identify residual adenoma in patients with persistent acromegaly after therapy [2] or to facilitate targeted surgical therapy of corticotropin-secreting tumors in Cushing's syndrome [3], as well as radiosurgery planning and radiotherapy [4].…”

Section: Introductionmentioning

confidence: 99%

Clinical Evaluation of ¹¹C-Met-Avid Pituitary Lesions Using a ZTE-Based AC Method

Delso¹,

Gillett

Bashari

et al. 2019

IEEE Trans. Radiat. Plasma Med. Sci.

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Pituitary tumours account for ~16% of central nervous system tumors and they are the second most frequently reported histology in this group. Due to their small size, pituitary surgery is challenging and precise lesion localization through imaging is therefore a critical factor for a successful outcome. Simultaneous PET/MR is well suited for lesion identification and localization but it requires accurate attenuation correction to ensure optimal PET imaging. Atlas-based attenuation correction methods are often used for this purpose, as they overcome the difficulty of estimating bone tissue density with conventional MR sequences. However, atlas methods can only partially account for inter-patient variability. The goal of the present study was to investigate whether direct bone measurement, by means of a zero echo time (ZTE) MR sequence, can significantly improve the accuracy of pituitary tumor imaging with PET.

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Successful treatment of residual pituitary adenoma in persistent acromegaly following localisation by 11C-methionine PET co-registered with MRI

Cited by 50 publications

References 23 publications

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

Utility of 13N-Ammonia PET/CT to Detect Pituitary Tissue in Patients with Pituitary Adenomas

Clinical Evaluation of ¹¹C-Met-Avid Pituitary Lesions Using a ZTE-Based AC Method

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Successful treatment of residual pituitary adenoma in persistent acromegaly following localisation by 11C-methionine PET co-registered with MRI

Cited by 50 publications

References 23 publications

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

Utility of 13N-Ammonia PET/CT to Detect Pituitary Tissue in Patients with Pituitary Adenomas

Clinical Evaluation of 11C-Met-Avid Pituitary Lesions Using a ZTE-Based AC Method

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Clinical Evaluation of ¹¹C-Met-Avid Pituitary Lesions Using a ZTE-Based AC Method