Abstract
Objectives
Currently, the main challenge in tumour-induced osteomalacia (TIO) is the difficulty in locating culprit tumours for definitive diagnosis and surgical therapy. Herein, we retrospectively evaluate the efficiency of 68Ga-DOTANOC PET/CT in the localisation and diagnosis of TIO, and compared with 18F-FDG.
Methods
Twenty-four consecutive patients with hypophosphataemic osteomalacia (HO) and suspicion of TIO who were referred to our centre for 68Ga-DOTANOC PET/CT scanning were retrospectively reviewed. The images were evaluated qualitatively as well as semi-quantitatively, and imaging results were compared with the final diagnoses.
Results
Among the total of 21 patients who were included in the final analyses, 17 were diagnosed with TIO, while four were proven to have other causes of HO. 68Ga-DOTANOC PET/CT produced positive results in 16 of the 17 patients with TIO, representing a sensitivity of 94.1%. Moreover, the 68Ga-DOTANOC PET/CT results were negative in 3 of the 4 patients without TIO, representing a specificity of 75.0%. The overall accuracy of 68Ga-DOTANOC PET/CT in locating the tumours responsible for TIO is 90.5%. In particular, 68Ga-DOTANOC PET/CT detected the culprit tumours in 4 out of 10 patients with negative results on previous 18F-FDG PET/CT and showed a significantly higher T/M ratio of tumours than 18F-FDG PET/CT in the same patients (n = 10; 4.76 ± 3.08 vs 1.95 ± 1.33, p < 0.05).
Conclusions
68Ga-DOTANOC PET/CT is an accurate imaging modality in the localisation of tumours for TIO. It is superior to 18F-FDG PET/CT and may be useful in the differential diagnosis of HO.
Key Points
• TIO should be considered a possible cause for patients diagnosed with HO, which usually needs to be differentiated from other aetiologies.
• 68 Ga-DOTANOC PET/CT is an accurate imaging modality in locating culprit tumours for TIO, superior to 18 F-FDG PET/CT.
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Abbreviations
- 18F-FDG:
-
18F-Fluorodeoxyglucose
- 68Ga-DOTANOC:
-
68Ga-DOTA-1-NaI (3)-octreotide
- 99mTc-HYNIC-TOC:
-
99mTc-Hydrazinonicotinyl-Tyr3-octreotide
- ADV:
-
Adefovir dipivoxil
- ALP:
-
Alkaline phosphatase
- CT:
-
Computed tomography
- DOTA:
-
1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid
- FGF23:
-
Fibroblast growth factor 23
- HCl:
-
Hydrochloric acid
- HO:
-
Hypophosphataemic osteomalacia
- iPTH:
-
Intact parathyroid hormone
- MRI:
-
Magnetic resonance imaging
- PET:
-
Positron emission tomography
- PMT:
-
Phosphaturic mesenchymal tumour
- RAMLA:
-
Row action maximum likelihood algorithm
- SPECT:
-
Single-photon emission computed tomography
- SSTR:
-
Somatostatin receptors
- SUV:
-
Standard uptake value
- T/M:
-
Ratio of tumour SUVmax to mediastinal blood pool SUVmax
- TIO:
-
Tumour-induced osteomalacia
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Acknowledgements
We would like to thank Fuhua Wen and Dake Zhang for the preparation of PET tracers and all the technicians for PET/CT image acquisition and processing in PET/CT Center at the First Affiliated Hospital of Sun Yat-Sen University.
Funding
The authors state that this study has received funding from the Medical Scientific Research Foundation of Guangdong Province of China (No. A2019528) and Natural Science Foundation of Guangdong Province of China (No. 2019A1515010845).
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The scientific guarantor of this publication is Xiangsong Zhang.
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Written informed consent was waived by the Institutional Review Board.
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One study subject has been previously reported in Clin Nucl Med. 2018 Jun;43(6):e198–e199.
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• retrospective
• diagnostic or prognostic study
• performed at one institution
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He, Q., Zhang, B., Zhang, L. et al. Diagnostic efficiency of 68Ga-DOTANOC PET/CT in patients with suspected tumour-induced osteomalacia. Eur Radiol 31, 2414–2421 (2021). https://doi.org/10.1007/s00330-020-07342-2
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DOI: https://doi.org/10.1007/s00330-020-07342-2