gallium-ga-68-dotatate and Adenoma

In addition to gastroenteropancreatic neuroendocrine neoplasms, a wide variety of tumors express somatostatin receptors. Somatostatin receptor imaging, heavily utilized in neuroendocrine oncology, may also have utility in the diagnosis of other neoplasms and raises the possibility of potential therapeutic options. We describe the case of a 60-year-old man who underwent 68Ga-DOTATATE PET/CT, demonstrating an avid invasive pituitary macroadenoma. This mass was persistent and refractory despite traditional treatment options. Because of the avidity, 177Lu-DOTATATE therapy was offered, although not ultimately performed, demonstrating a potential treatment for challenging cases utilizing the principles of theranostics.

Topics: Adenoma; Humans; Male; Middle Aged; Octreotide; Orbit; Organometallic Compounds; Pituitary Neoplasms; Positron Emission Tomography Computed Tomography; Treatment Failure

A 67-year-old man was referred to our department to undergo a 68Ga-DOTATOC PET/CT during the systematic follow-up of a small intestine neuroendocrine tumor. PET revealed an incidental focal increased uptake of 68Ga-DOTATOC matching with a left intraparotid lesion on the combined contrast-enhanced CT, suggestive of a benign salivary tumor. An MRI was performed to characterize this lesion, and finally, the patient underwent surgery. Histological analysis confirmed the presence of a basal cell adenoma.

Topics: Adenoma; Aged; Biological Transport; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radioactive Tracers; Salivary Gland Neoplasms

A 47-year-old woman with atypical pituitary adenoma was referred to the neurosurgery department due to recent back pain. She had multiple transsphenoidal surgery, stereotactic body radiation, and 177Lu-DOTATATE therapy. Her spinal MRI showed multiple spinal masses. The patient underwent 68Ga-DOTATATE PET/CT to confirm the metastatic spread of the disease. PET/CT images showed increased uptake at the local recurrent tumor site and spinal metastases confirmed by biopsy to pituitary carcinoma. Our case presents the role of 68Ga-DOTATATE PET/CT in patients with pituitary carcinoma.

Topics: Adenoma; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Organometallic Compounds; Pituitary Neoplasms; Positron Emission Tomography Computed Tomography

Multiple endocrine neoplasia type 1 (MEN1) is a hereditary syndrome predisposing to many endocrine and neuroendocrine tumors (NET). Conventional imaging (CI) cannot provide satisfactory results for all the different types of MEN1-related tumors. Objective of this prospective observational study was to evaluate the role of (68)Ga-DOTATATE PET/CT in MEN1 compared to CI. Diagnostic performance of (68)Ga-DOTATATE PET/CT for the detection of NET was evaluated as well as the prognostic role of SUVmax. Eighteen patients with genetically confirmed MEN1 were evaluated by (68)Ga-DOTATATE PET/CT, endoscopic ultrasounds, multidetector-row computed tomography, magnetic resonance imaging, and hormone/markers serum measurements. Four MEN1-related tumor sites (pancreas, pituitary, parathyroids, adrenals) were considered. Sensitivity and specificity of (68)Ga-DOTATATE PET/CT for the detection of NET were calculated. There was (68)Ga-DOTATATE PET/CT uptake in 11/11 patients with pancreatic lesions, in 9/12 with pituitary adenoma, in 5/15 with parathyroid enlargements, and in 5/7 with adrenal lesions. (68)Ga-DOTATATE PET/CT showed sensitivity and specificity of 100 and 100 % in pancreas, 75 and 83 % in pituitary, 28 and 100 % in parathyroids, and 62.5 and 100 % in adrenals, respectively. Compared with CI, no significant difference in sensitivity for pancreas, pituitary, and adrenals was found, while CI had a better sensitivity for parathyroids (p = 0.002). On the ROC analysis, progression of pancreatic lesions was significantly associated to SUVmax <12.3 (p < 0.05). (68)Ga-DOTATATE PET/CT is greatly helpful in the work-up of MEN1 providing a panoramic view of MEN1-related lesions. There is also a prognostic role of (68)Ga-PET in patients with MEN1-pancreatic lesions.

Topics: Adenoma; Adolescent; Adult; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Multiple Endocrine Neoplasia Type 1; Neuroendocrine Tumors; Organometallic Compounds; Parathyroid Neoplasms; Pituitary Neoplasms; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Sensitivity and Specificity; Young Adult

The coexistence of a pituitary neoplasm and pheochromocytoma is a rare condition, which may be another undefined variant of Multiple endocrine neoplasia (MEN) syndrome. Moreover, the coexistence of pituitary macroadenoma and multiple paragangliomas is more uncommon and only few authors have reported these findings. We are reporting the use of Ga DOTATATE PET/CT in a rare case of coexisting pituitary macroadenoma and multiple paragangliomas.

Topics: Adenoma; Female; Humans; Middle Aged; Multimodal Imaging; Organometallic Compounds; Paraganglioma; Pituitary Neoplasms; Positron-Emission Tomography; Tomography, X-Ray Computed

The evaluation of the remaining pituitary tissue and recurrent or residual tumor after the pituitary adenoma resection is difficult. However, it is essential to assess the size of the recurrent tumor and remaining pituitary reserve before resurgery. This study aimed to distinguish the remaining pituitary tissue from pituitary adenoma with Ga 1,4,7,10-tetraazacyclododecane-N,N',N″,N″'-tetraacetic acid-D-Phe,Tyr3-octreotate (DOTATATE) and F-FDG PET imaging in patients status post transsphenoidal adenomectomy.. Thirty-five patients with suspected recurrent/residual pituitary tumors were retrospectively evaluated. All of these patients underwent DOTATATE and FDG PET/CT within 1 week before additional surgery. The DOTATATE and FDG uptake levels were compared. The image findings were then compared with pathology results after the additional surgery.. Residual or recurrent pituitary adenoma were confirmed pathologically in all 35 patients. One recurrent pituitary adenoma did not have either DOTATATE or FDG uptake. In the remaining 34 adenomas, 33 had higher FDG uptake than DOTATATE uptake. In comparison, DOTATATE had significant higher uptake than FDG in the remaining pituitary tissues in all cases.. Different degree of uptake of Ga DOTATATE and F-FDG PET/CT in the remaining pituitary tissue and recurrent/residual pituitary tumor indicated that combined analysis of Ga DOTATATE and F-FDG PET/CT might be of clinical value in differentiating recurrent/residual pituitary adenoma from the remaining pituitary tissue.

Topics: Adenoma; Adult; Cicatrix; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm, Residual; Organometallic Compounds; Pituitary Gland; Pituitary Neoplasms; Radionuclide Imaging; Sphenoid Bone

The images of a patient with acromegaly, who previously underwent operation for pituitary adenoma, were obtained. The MRI scan showed a mass in the right cavernous sinus, with biochemical test results positive for the presence of a hormonally active adenoma. The patient was scheduled for CyberKnife radiotherapy. Radiotherapy planning was carried out using MRI and PET/CT scan with somatostatin analog ⁶⁸Ga DOTATATE. The latter showed radiopharmaceutical uptake on the adenomatous residual mass. Contours were drawn on MRI and PET images and were summed up to devise the radiotherapy plan. The patient was treated with a total dose of 24 Gy.

Topics: Adenoma; Humans; Magnetic Resonance Imaging; Multimodal Imaging; Organometallic Compounds; Pituitary Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Radiosurgery; Radiotherapy Planning, Computer-Assisted