Loren van der Hoeven1, Siebren van Vugt2, Tessa Timmers2, Eva Heshof1, Miou Koopman3, Eleonora Aronica4, Jantien Hoogmoed5, Alberto Pereira1, Elsmarieke van de Giessen6, Dirk Jan Stenvers1
(1) Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology and Metabolism (AGEM), Amsterdam, the Netherlands.
(2) Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.
(3) Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
(4) Department of (Neuro)Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
(5) Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
(6) Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit and Amsterdam Neuroscience, Brain Imaging, Amsterdam, the Netherlands.
Objective
To assess the clinical value of [18F]fluoroethyl-L-tyrosine PET ([18F]FET-PET) correlated with MRI in patients with functioning pituitary adenoma (FPA) with negative or equivocal conventional MRIs during diagnosis, persistent disease and recurrence.
Methods
Retrospective observational cohort study of 34 patients with FPAs who underwent a total of 37 [18F]FET-PET/s (Cushing’s disease: n=19, acromegaly: n=14, prolactinoma: n=3, and TSH producing adenoma: n=1) between January 2022 and April 2025. The clinical performance was assessed in the surgically treated cohort, using confirmative histopathology and/or postoperative remission as reference standard.
Results
[18F]FET-PET identified a single lesion in 28 scans (76%), two lesions in 1 scan (3%), and no lesion in 8 scans (22%). [18F]FET-PET and MRI were concordant positive in 14/37 scans, concordant negative in 1/37, discordant MRI+/[18F]FET-PET+ different location in 2/37, discordant MRI-/[18F]FET-PET+ in 8/37, discordant MRI+/[18F]FET-PET- in 7/37 and partly concordant in 5/37 scans. In 14 cases surgery resulted in confirmative histopathology and/or postoperative remission, 12 of those had a positive [18F]FET-PET. In 6 cases surgery did not result in confirmative histopathology and/or postoperative remission, of whom 5 had a positive [18F]FET-PET. Overall, the sensitivity was 86% and the positive predictive value 71%. In three patients with acromegaly, [18F]FET-PET was able to localize a lesion, despite biochemical control under continued somatostatin analogue treatment.
Conclusion
[18F]FET-PET enhances lesion detection and improves personalized treatment in patients with FPA and negative or equivocal conventional MRIs throughout the disease course. Consensus on the timing of [18F]FET-PET with respect to medication and biochemical status is warranted.