Abstract
In growth hormone (GH)-producing adenomas, T2-weighted MRI signal intensity is a marker for granulation pattern and response to somatostatin analogs (SSA). Prediction of treatment response is necessary for individualized treatment, and T2 intensity assessment might improve preoperative classification of somatotropinomas. The objectives of this study are (I) to explore the feasibility of quantitative T2-weighted MRI histogram analyses in newly diagnosed somatotroph adenomas and their relation to clinical and histological parameters and (II) to compare the quantitative method to conventional, visual assessment of T2 intensity. The study was a retrospective cohort study of 58 newly diagnosed patients. In 34 of these, response to primary SSA treatment after median 6 months was evaluated. Parameters from the T2 histogram analyses (T2 intensity ratio and T2 homogeneity ratio) were correlated to visually assessed T2 intensity (hypo-, iso-, hyperintense), baseline characteristics, response to SSA treatment, and histological granulation pattern (anti-Cam5.2). T2 intensity ratio was lowest in the hypointense tumors and highest in the hyperintense tumors (0.66 ± 0.10 vs. 1.07 ± 0.11; p < 0.001). T2 intensity at baseline correlated with reduction in GH (r = −0.67; p < 0.001) and IGF-1 (r = −0.36; p = 0.037) after primary SSA treatment (n = 34). The T2 homogeneity ratio correlated with adenoma size reduction (r = −0.45; p = 0.008). Sparsely granulated adenomas had a higher T2 intensity than densely or intermediately granulated adenomas. T2 histogram analyses are an applicable tool to assess T2 intensity in somatotroph adenomas. Quantitatively assessed T2 intensity ratio in GH-producing adenomas correlates with conventional assessment of T2 intensity, baseline characteristics, response to SSA treatment, and histological granulation pattern.
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S. Melmed, A. Colao, A. Barkan, M. Molitch, A.B. Grossman, D. Kleinberg, D. Clemmons, P. Chanson, E. Laws, J. Schlechte, M.L. Vance, K. Ho, A. Giustina, Acromegaly Consensus Group: guidelines for acromegaly management: an update. J. Clin. Endocrinol. Metab. 94(5), 1509–1517 (2009). doi:10.1210/jc.2008-2421
A. Giustina, P. Chanson, D. Kleinberg, M.D. Bronstein, D.R. Clemmons, A. Klibanski, A.J. van der Lely, C.J. Strasburger, S.W. Lamberts, K.K.Y. Ho, F.F. Casanueva, S. Melmed, Expert consensus document: a consensus on the medical treatment of acromegaly. Nat. Rev. Endocrinol. 10(4), 243–248 (2014). doi:10.1038/nrendo.2014.21
L. Katznelson, E.R. Laws Jr, S. Melmed, M.E. Molitch, M.H. Murad, A. Utz, J.A. Wass, S. Endocrine, Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99(11), 3933–3951 (2014). doi:10.1210/jc.2014-2700
S.M. Carlsen, M. Lund-Johansen, T. Schreiner, S. Aanderud, O. Johannesen, J. Svartberg, J.G. Cooper, J.K. Hald, S.L. Fougner, J. Bollerslev, Preoperative Octreotide Treatment of Acromegaly study group: preoperative octreotide treatment in newly diagnosed acromegalic patients with macroadenomas increases cure short-term postoperative rates: a prospective, randomized trial. J. Clin. Endocrinol. Metab. 93(8), 2984–2990 (2008). doi:10.1210/jc.2008-0315
Z.-G. Mao, Y.-H. Zhu, H.-L. Tang, D.-Y. Wang, J. Zhou, D.-S. He, H. Lan, B.-N. Luo, H.-J. Wang, Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial. Eur. J. Endocrinol. 162(4), 661–666 (2010). doi:10.1530/eje-09-0908
M. Shen, X. Shou, Y. Wang, Z. Zhang, J. Wu, Y. Mao, S. Li, Y. Zhao, Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study. Endocr. J. 57(12), 1035–1044 (2010)
S. Bacigaluppi, F. Gatto, P. Anania, N.L. Bragazzi, D.C. Rossi, G. Benvegnu, E. Nazzari, R. Spaziante, M. Giusti, D. Ferone, G. Zona, Impact of pre-treatment with somatostatin analogs on surgical management of acromegalic patients referred to a single center. Endocrine (2015). doi:10.1007/s12020-015-0619-5
L. Zhang, X. Wu, Y. Yan, J. Qian, Y. Lu, C. Luo, Preoperative somatostatin analogs treatment in acromegalic patients with macroadenomas. A meta-analysis. Brain Dev. (2014). doi:10.1016/j.braindev.2014.04.009
S.L. Fougner, J. Bollerslev, J. Svartberg, M. Oksnes, J. Cooper, S.M. Carlsen, Preoperative octreotide treatment of acromegaly: long-term results of a randomised controlled trial. Eur. J. Endocrinol. 171(2), 229–235 (2014). doi:10.1530/EJE-14-0249
S.M. Carlsen, J. Svartberg, T. Schreiner, S. Aanderud, O. Johannesen, S. Skeie, M. Lund-Johansen, S.L. Fougner, J. Bollerslev, Preoperative Octreotide Treatment of Acromegaly study group: six-month preoperative octreotide treatment in unselected, de novo patients with acromegaly: effect on biochemistry, tumour volume, and postoperative cure. Clin. Endocrinol. 74(6), 736–743 (2011). doi:10.1111/j.1365-2265.2011.03982.x
A. Colao, R.S. Auriemma, G. Lombardi, R. Pivonello, Resistance to somatostatin analogs in acromegaly. Endocr. Rev. 32(2), 247–271 (2011). doi:10.1210/er.2010-0002
S.L. Fougner, O. Casar-Borota, A. Heck, J.P. Berg, J. Bollerslev, Adenoma granulation pattern correlates with clinical variables and effect of somatostatin analogue treatment in a large series of patients with acromegaly. Clin. Endocrinol. 76(1), 96–102 (2012). doi:10.1111/j.1365-2265.2011.04163.x
A. Hagiwara, Y. Inoue, K. Wakasa, T. Haba, T. Tashiro, T. Miyamoto, Comparison of growth hormone-producing and non-growth hormone-producing pituitary adenomas: imaging characteristics and pathologic correlation. Radiology 228(2), 533–538 (2003). doi:10.1148/radiol.2282020695
M. Puig-Domingo, E. Resmini, B. Gomez-Anson, J. Nicolau, M. Mora, E. Palomera, C. Marti, I. Halperin, S.M. Webb, Magnetic resonance imaging as a predictor of response to somatostatin analogs in acromegaly after surgical failure. J. Clin. Endocrinol. Metab. 95(11), 4973–4978 (2010). doi:10.1210/jc.2010-0573
A. Heck, G. Ringstad, S.L. Fougner, O. Casar-Borota, T. Nome, J. Ramm-Pettersen, J. Bollerslev, Intensity of pituitary adenoma on T2-weighted magnetic resonance imaging predicts the response to octreotide treatment in newly diagnosed acromegaly. Clin. Endocrinol. 77(1), 72–78 (2012). doi:10.1111/j.1365-2265.2011.04286.x
I. Potorac, P. Petrossians, A.F. Daly, F. Schillo, C. Ben Slama, S. Nagi, M. Sahnoun, T. Brue, N. Girard, P. Chanson, G. Nasser, P. Caron, F. Bonneville, G. Raverot, V. Lapras, F. Cotton, B. Delemer, B. Higel, A. Boulin, S. Gaillard, F. Luca, B. Goichot, J.L. Dietemann, A. Beckers, J.F. Bonneville, Pituitary MRI characteristics in 297 acromegaly patients based on T2-weighted sequences. Endocr. Relat. Cancer 22(2), 169–177 (2015). doi:10.1530/ERC-14-0305
K.E. Emblem, B. Nedregaard, T. Nome, P. Due-Tonnessen, J.K. Hald, D. Scheie, O.C. Borota, M. Cvancarova, A. Bjornerud, Glioma grading by using histogram analysis of blood volume heterogeneity from MR-derived cerebral blood volume maps. Radiology 247(3), 808–817 (2008). doi:10.1148/radiol.2473070571
W.B. Pope, X.J. Qiao, H.J. Kim, A. Lai, P. Nghiemphu, X. Xue, B.M. Ellingson, D. Schiff, D. Aregawi, S. Cha, V.K. Puduvalli, J. Wu, W.K. Yung, G.S. Young, J. Vredenburgh, D. Barboriak, L.E. Abrey, T. Mikkelsen, R. Jain, N.A. Paleologos, P.L. Rn, M. Prados, J. Goldin, P.Y. Wen, T. Cloughesy, Apparent diffusion coefficient histogram analysis stratifies progression-free and overall survival in patients with recurrent GBM treated with bevacizumab: a multi-center study. J. Neurooncol. 108(3), 491–498 (2012). doi:10.1007/s11060-012-0847-y
S. Melmed, F.F. Casanueva, F. Cavagnini, P. Chanson, L. Frohman, A. Grossman, K. Ho, D. Kleinberg, S. Lamberts, E. Laws, G. Lombardi, M.L. Vance, K.V. Werder, J. Wass, A. Giustina, Acromegaly treatment consensus workshop participants: guidelines for acromegaly management. J. Clin. Endocrinol. Metab. 87(9), 4054–4058 (2002)
D. Ferone, W.W. de Herder, R. Pivonello, J.M. Kros, P.M. van Koetsveld, T. de Jong, F. Minuto, A. Colao, S.W.J. Lamberts, L.J. Hofland, Correlation of in vitro and in vivo somatotropic adenoma responsiveness to somatostatin analogs and dopamine agonists with immunohistochemical evaluation of somatostatin and dopamine receptors and electron microscopy. J. Clin. Endocrinol. Metab. 93(4), 1412–1417 (2008). doi:10.1210/jc.2007-1358
P.J. Caron, J.S. Bevan, S. Petersenn, D. Flanagan, A. Tabarin, G. Prevost, P. Maisonobe, A. Clermont, P. Investigators, Tumor shrinkage with lanreotide Autogel 120 mg as primary therapy in acromegaly: results of a prospective multicenter clinical trial. J. Clin. Endocrinol. Metab. 99(4), 1282–1290 (2014). doi:10.1210/jc.2013-3318
A. Obari, T. Sano, K. Ohyama, E. Kudo, Z.R. Qian, A. Yoneda, N. Rayhan, M. Mustafizur Rahman, S. Yamada, Clinicopathological features of growth hormone-producing pituitary adenomas: difference among various types defined by cytokeratin distribution pattern including a transitional form. Endocr. Pathol. 19(2), 82–91 (2008). doi:10.1007/s12022-008-9029-z
P. Lundin, F. Pedersen, Volume of pituitary macroadenomas - assessment by MRI. J. Comput. Assist. Tomogr. 16(4), 519–528 (1992). doi:10.1097/00004728-199207000-00004
A.L. Edal, K. Skjodt, H.J. Nepper-Rasmussen, SIPAP–a new MR classification for pituitary adenomas. Suprasellar, infrasellar, parasellar, anterior and posterior. Acta Radiol. 38(1), 30–36 (1997)
E. Knosp, E. Steiner, K. Kitz, C. Matula, Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33(4), 610–617 (1993); discussion 617–618
J.F. Bonneville, F. Bonneville, F. Cattin, Magnetic resonance imaging of pituitary adenomas. Eur. Radiol. 15(3), 543–548 (2005). doi:10.1007/s00330-004-2531-x
A. Giustina, R. Berardelli, C. Gazzaruso, G. Mazziotti, Insulin and GH-IGF-I axis: endocrine pacer or endocrine disruptor? Acta Diabetol. (2014). doi:10.1007/s00592-014-0635-6
N.C. Olarescu, A. Heck, K. Godang, T. Ueland, J. Bollerslev, The metabolic risk in newly diagnosed patients with acromegaly is related to fat distribution and circulating adipokines and improves after treatment. Neuroendocrinology (2015). doi:10.1159/000371818
S. Bhayana, G.L. Booth, S.L. Asa, K. Kovacs, S. Ezzat, The implication of somatotroph adenoma phenotype to somatostatin analog responsiveness in acromegaly. J. Clin. Endocrinol. Metab. 90(11), 6290–6295 (2005). doi:10.1210/jc.2005-0998
K. Kiseljak-Vassiliades, N.E. Carlson, M.T. Borges, B.K. Kleinschmidt-DeMasters, K.O. Lillehei, J.M. Kerr, M.E. Wierman, Growth hormone tumor histological subtypes predict response to surgical and medical therapy. Endocrine 49(1), 231–241 (2015). doi:10.1007/s12020-014-0383-y
Y. Bakhtiar, H. Hirano, K. Arita, S. Yunoue, S. Fujio, A. Tominaga, T. Sakoguchi, K. Sugiyama, K. Kurisu, J. Yasufuku-Takano, K. Takano, Relationship between cytokeratin staining patterns and clinico-pathological features in somatotropinomae. Eur. J. Endocrinol. 163(4), 531–539 (2010). doi:10.1530/EJE-10-0586
S. Yamada, T. Aiba, T. Sano, K. Kovacs, Y. Shishiba, S. Sawano, K. Takada, Growth hormone-producing pituitary adenomas: correlations between clinical characteristics and morphology. Neurosurgery 33(1), 20–27 (1993)
P. Boulby, T2: the transverse relaxation time, in Quantitative MRI of the brain—measuring changes caused by disease, vol. 1, ed. by P. Tofts (Wiley, Chichester, 2004), pp. 143–201
A. Giustina, P. Chanson, M.D. Bronstein, A. Klibanski, S. Lamberts, F.F. Casanueva, P. Trainer, E. Ghigo, K. Ho, S. Melmed, G. Acromegaly Consensus, A consensus on criteria for cure of acromegaly. J. Clin. Endocrinol. Metab. 95(7), 3141–3148 (2010). doi:10.1210/jc.2009-2670
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AH has received speaker fees from Novartis, Ipsen, NovoNordisk, and Pfizer and participated in Novartis’ nordic advisory board. KEE has intellectual property rights at NordicNeuroLab AS. JB has received an unrestricted research Grant from Novartis, Pfizer, and Merck Norway AS. The other authors have nothing to disclose.
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Heck, A., Emblem, K.E., Casar-Borota, O. et al. Quantitative analyses of T2-weighted MRI as a potential marker for response to somatostatin analogs in newly diagnosed acromegaly. Endocrine 52, 333–343 (2016). https://doi.org/10.1007/s12020-015-0766-8
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DOI: https://doi.org/10.1007/s12020-015-0766-8