SFEBES2023 Oral Poster Presentations Late Breaking Abstracts Respectively (4 abstracts)
Real-world experience with 11C-methionine PET co-registered with MRI in the management of acromegaly – Insights from a single reference centre 12 year observation
Linus Haberbosch 1,2,3 , James MacFarlane 1 , Olympia Koulouri 1 , Daniel Gillett 1 , Kevin A. Huynh 1 , Jonathan Jones 4 , Heok K. Cheow 5 , Joachim Spranger 2 , Knut Mai 6 , Christian J. Strasburger 2 , Richard Mannion 7 & Mark Gurnell 1
1Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome Trust-MRC; Institute of Metabolic Science, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom. 2Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Endocrinology and Metabolism, Berlin, Germany. 3Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Digital Clinician Scientist Program, Berlin, Germany. 4Department of Radiology, Addenbrooke’s Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom. 5Department of Nuclear Medicine, Addenbrooke’s Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom. 6Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Endocrinology and Metabolism, Cambridge, Germany. 7Department of Neurosurgery, Addenbrooke’s Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
Background: 11C-methionine positron emission tomography (Met-PET) is a potentially important imaging adjunct in the diagnostic workup of pituitary adenomas, including somatotroph tumours. Met-PET can identify residual or occult disease and make definitive therapies accessible for a subgroup of patients who would otherwise require lifelong medical therapy. However, data on its use is still limited to small case series. Here, we report the currently largest single centre experience (n = 61) in acromegaly.
Methods: 189 cases of acromegaly were referred to our national Met-PET service in the last decade. We have reviewed outcomes in the 61 patients managed exclusively by our multidisciplinary team (single centre, single surgeon). The patients were referred for the following indications: Occult de novo tumour (n =3, 4.9%), occult residual (n =14, 23.0%), indeterminate MRI (n =38, 62.3%) and (radio-)surgical planning (n =6, 9.8%).
Results: 33/61 patients (54.1%) underwent PET-guided surgery. 24/33 patients (72.7%) achieved complete biochemical remission following (re-)surgery. IGF-1 levels were reduced to <2xULN (upper limit of normal) in 6 of the remaining 9 cases, 3 of whom achieved levels of <1.1xULN compared to mean pre-operative levels of 2.4xULN (SD 0.8) for n =9. In 4 patients with persistent or suspected residual disease, repeat PET was performed and led to further surgery in two cases, while the other two were referred for fractionated radiotherapy. Of the operated patients, only 3 developed single new hormonal deficits (gonadotropic insufficiency). There were no cases of neurovascular complications post-surgery.
Conclusion: In patients with persistent/recurrent acromegaly or occult tumours, Met-PET can potentially facilitate further targeted intervention (surgery/radiosurgery). This led to complete remission in the majority of cases (24/33) or significant improvement with comparatively low risk of complications. Met-PET should therefore be considered in all patients who are potential candidates for further (radio-)surgical intervention, but present no clear target on MRI.
Volume 94
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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