Implementation of functional imaging using 11C-methionine PET-CT co-registered with MRI for advanced surgical planning and decision making in prolactinoma surgery
Pituitary, vol. 25, pp. 587–601
Abstract
Abstract Purpose To report the first experience of our multidisciplinary team with functional imaging using 11C-methionine positron emission tomography-computed tomography (11C-methionine PET-CT) co-registered with MRI (Met-PET/MRICR) in clinical decision making and surgical planning of patients with difficult to treat prolactinoma. Methods In eighteen patients with prolactinoma, referred to our tertiary referral centre because of intolerance or resistance for dopamine agonists (DA), Met-PET/MRICR was used to aid decision-making regarding therapy. Results Met-PET/MRICR was positive in 94% of the patients. MRI and Met-PET/MRICR findings were completely concordant in five patients, partially concordant in nine patients, and non-concordant in four patients. In five patients Met-PET/MRICR identified lesion(s) that were retrospectively also visible on MRI. Met-PET/MRICR was false negative in one patient, with a cystic adenoma on conventional MRI. Thirteen patients underwent transsphenoidal surgery, with nine achieving full biochemical remission, two clinical improvement and near normalized prolactin levels, and one patient clinical improvement with significant tumour reduction. Hence, nearly all patients (94%) were considered to have a positive outcome. Permanent complication rate was low. Three patients continued DA, two patients have a wait and scan policy. Conclusion Met-PET/MRICR can provide additional information to guide multidisciplinary preoperative and intraoperative decision making in selected cases of prolactinoma. This approach resulted in a high remission rate with a low rate of complications in our expert centre.
Authors 12
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Leontine E. H. Bakker corresponding Aachen Centre for Endocrine Tumors Leiden (CETL) Pituitary Center Division of Endocrinology Department of Medicine, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands. l.e.h.bakker@lumc.nl
Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands. l.e.h.bakker@lumc.nl
Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Marco J. T. Verstegen Aachen Centre for Endocrine Tumors Leiden (CETL) Pituitary Center Department of Neurosurgery, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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Eidrees Ghariq Aachen Section of Nuclear Medicine Department of Radiology, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Pieter J. Schutte Aachen Centre for Endocrine Tumors Leiden (CETL) Pituitary Center Department of Neurosurgery, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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University of Cambridge · Wellcome/MRC Institute of Metabolic Science · Addenbrooke's Hospital · NIHR Cambridge Biomedical Research Centre
Affiliation as printed
Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
Wellcome–MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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Leiden University Medical Center
Affiliation as printed
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Alberto M. Pereira Aachen Centre for Endocrine Tumors Leiden (CETL) Pituitary Center Division of Endocrinology Department of Medicine, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
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University of Cambridge · Wellcome/MRC Institute of Metabolic Science · Addenbrooke's Hospital · NIHR Cambridge Biomedical Research Centre
Affiliation as printed
Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
Wellcome–MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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Nienke Ruurdje Biermasz Aachen Centre for Endocrine Tumors Leiden (CETL) Pituitary Center Division of Endocrinology Department of Medicine, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Wouter R. van Furth Aachen Centre for Endocrine Tumors Leiden (CETL) Pituitary Center Department of Neurosurgery, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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Lenka M. Pereira Arias‐Bouda Aachen Section of Nuclear Medicine Department of Radiology, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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