Re-evaluation of MRI in the follow-up of acromegaly - a path towards long-term remission?

Shahriar Atai; Martin Knudtzon Andersen; Jens Bollerslev; Daniel Dahlberg; Markus Wiedmann; Geir Andre Ringstad; Ansgar Heck

doi:10.1530/endoabs.90.EP770

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Endocrine Abstracts (2023) 90 EP770 | DOI: 10.1530/endoabs.90.EP770

ECE2023 Eposter Presentations Pituitary and Neuroendocrinology (234 abstracts)

Re-evaluation of MRI in the follow-up of acromegaly – a path towards long-term remission?

Shahriar Atai ^1,2 , Martin Knudtzon Andersen ^3,4 , Jens Bollerslev ^1,2 , Daniel Dahlberg ⁵ , Markus Wiedmann ⁵ , Geir Andre Ringstad ³ & Ansgar Heck ^1,2

Err

Author affiliations

¹Oslo Universitetssykehus HF, Rikshospitalet, Endocrinology, Oslo, Norway; ²University of Oslo, Faculty of Medicine, Oslo, Norway; ³Oslo Universitetssykehus HF, Rikshospitalet, Radiology, Oslo, Norway; ⁴Diakonhjemmet Hospital, Radiology, Oslo, Norway; ⁵Oslo Universitetssykehus HF, Rikshospitalet, Neurosurgery, Oslo, Norway.

Introduction: Remission by complete surgical tumour removal is not achieved in all patients with acromegaly and a subset of patients remain on long-term pharmacological treatment. Repeated surgery or targeted radiation therapy can be considered in patients with residual or recurrent tumour. Identification of residual or recurrent tumour available for surgical treatment can be challenging, and underreporting may lead to a loss in treatment opportunity. The aim of the present study was therefore to identify pituitary tumour remnants by systematic re-assessment of MRIs in pharmacologically treated patients with acromegaly.

Methods: Adult patients diagnosed and managed at a tertiary care centre 2005–2021 and presently on pharmacological treatment for acromegaly were included. Main outcome: Number and proportion of patients with a visible tumour, no visible tumour or a possible finding on MRI. A trained clinician (SA) and radiologist (MK) separately classified the latest routine MRI in a standardized manner, also taking into consideration baseline and all follow-up MRIs. In case of discrepant classification, consensus was achieved together with an experienced neuroradiologist (GR). Routine MRI reports were compared with the consensus classification.

Results: The study cohort consisted of 78 patients, of which 35 were women. Visible tumours and possible findings were seen in 31 (40%) and 36 (46%) patients, respectively. In 11 (14%) patients no visible tumours were seen. No visible tumours were reported in 23 (29%) patients in the routine MRI report, while we identified visible tumours in 2 (9%) and possible findings in 12 (52%) of the same 23 patients. Discrepancies between the routine reports and consensus classification were found in 31 (40%) patients.

Conclusion: Our study found visible tumours or possible findings in the majority of the patients. Identification of tumour remnants in patients with secretory activity is important as they may be candidates for redo surgery or targeted radiotherapy. Better imaging protocols or more advanced imaging may further contribute to tumour identification in uncertain findings.