68Ga DOTA-TATE PET/CT allows tumor localization in patients with tumor-induced osteomalacia but negative 111In-octreotide SPECT/CT.
Tumor-induced osteomalacia (TIO) is a paraneoplastic syndrome characterized by renal phosphate wasting, hypophosphatemia and low calcitriol levels as well as clinical symptoms like diffuse bone and muscle pain, fatigue fractures or increased fracture risk. Conventional imaging methods, however, often fail to detect the small tumors. Lately, tumor localization clearly improved by somatostatin-receptor (SSTR) imaging, such as octreotide scintigraphy or octreotide SPECT/CT. However, recent studies revealed that still a large number of tumors remained undetected by octreotide imaging. Hence, studies focused on different SSTR imaging methods such as 68Ga DOTA-NOC, 68Ga DOTA-TOC and 68Ga DOTA-TATE PET/CT with promising first results. Studies comparing different SSTR imaging methods for tumor localization in TIO are rare and thus little is known about diagnostic alternatives once a particular method failed to detect a tumor in patients with TIO. Here, we report the data of 5 consecutive patients suffering from TIO, who underwent both 111Indium-octreotide scintigraphy (111In-OCT) SPECT/CT as well as 68Ga DOTA-TATE PET/CT for tumor detection. While 111In-OCT SPECT/CT allowed tumor detection in only 1 of 5 patients, 68Ga DOTA-TATE PET/CT was able to localize the tumor in all patients. Afterwards, anatomical imaging of the region of interest was performed with CT and MRI. Thus, successful surgical resection of the tumor was achieved in all patients. Serum phosphate levels returned to normal and all patients reported relief of symptoms within weeks. Moreover, an iliac crest biopsy was obtained from every patient and revealed marked osteomalacia in all cases. Follow-up DXA revealed an increase in BMD of up to 34.5% 1-year postoperative, indicating remineralization. No recurrence was observed. In conclusion our data indicates that 68Ga DOTA-TATE PET/CT is an effective and promising diagnostic tool in the diagnosis of TIO, even in patients in whom 111In-OCT prior failed to detect a tumor.
Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Germany.
Stefan
S
Breer
Department of Nuclear Medicine, Hannover Medical School, Germany.
Thomas
T
Brunkhorst
Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Germany; Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Germany.
F Timo
FT
Beil
Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Germany.
Kersten
K
Peldschus
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Germany.
Max
M
Heiland
Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany.
Susanne
S
Klutmann
Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Germany.
Florian
F
Barvencik
Institute of Pathology, University Medical Center Hamburg-Eppendorf, Germany.
Jozef
J
Zustin
Department of Nuclear Medicine, Hannover Medical School, Germany.
Klaus-Friedrich
KF
Gratz
Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Germany. Electronic address: amling@uke.de.
Michael
M
Amling
D000328:Adult; D015331:Cohort Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005710:Gallium Radioisotopes; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009369:Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D010018:Osteomalacia / Q000209:etiology*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
C000717427:FGF23 protein, human; D005710:Gallium Radioisotopes; D019275:Radiopharmaceuticals; D000089703:Fibroblast Growth Factor-23
(68)Ga DOTA-TATE PET/CT; FGF23; Hypophosphatemia; Octreotide scintigraphy; Oncogenic osteomalacia; Tumor-induced osteomalacia