99mTechnetium pentavalent dimercaptosuccinic acid scintigraphy in the follow-up of clinically nonfunctioning pituitary adenomas after radiotherapy

Annamaria Colao, Diego Ferone, Gaetano Lombardi, Secondo Lastoria

Research output: Contribution to journalArticle

Abstract

BACKGROUND: It is still difficult to differentiate pituitary adenoma remnants from postradiotherapy fibrosis by computed tomography (CT) or magnetic resonance imaging (MRI), especially in patients with clinically nonfunctioning pituitary adenomas (NFA), lacking circulating markers to follow disease progression or cure. OBJECTIVE: We investigated the usefulness of scintigraphy with technetium-99m pentavalent dimercaptosuccinic acid [99mTc(V)DMSA], shown previously to detect most pituitary GH- and PRL-secreting adenomas and NFA, with tumour-to-background ratios (T/B) as high as 25-fold. PATIENTS: Eighteen patients with NFA (study group), 10 patients with GH- and three patients with PRL-secreting adenomas (control group), all of whom had undergone previous surgery. DESIGN: The study was an open longitudinal design. Pituitary CT/MRI and 99mTc(V)DMSA scintigraphy was performed before and 1, 3 and 5 years after conventional radiotherapy. Tumour size was measured as maximal diameter of the residual lesion, while uptake of 99mTc(V)DMSA was measured as a T/B ratio. RESULTS: At study entry, pituitary 99mTc(V)DMSA uptake was found in 13 NFA (72.2%), seven GH-secreting (70%) and all PRL-secreting adenomas; remnant tumour was documented by CT/MRI in all 31 patients. Maximal remnant diameter was significantly higher in patients with positive (13.3±0.9 mm) than in those with negative scintigraphy (7.0±0.3 mm, P <0.001). During the 5-year follow-up postradiotherapy, a significant decrease in 99mTc(V)DMSA uptake (9.7±0.8 vs. 3.2±0.5, P <0.0001) occurred in all but three patients. Two NFA patients died of tumour invasion 19 and 36 months after radiotherapy and one acromegalic patient had no change in his hormone levels. In the eight negative patients (five NFA and three GH), scintigraphy remained negative throughout follow-up. A remarkable shrinkage of the remnant tumour was observed in both the patients with negative (from 7.0±0.3 to 1.9±0.6 mm, P <0.001) and in those with positive scintigraphy (from 13.3±0.9 to 7.3±0.6 mm, P <0.001). At the end of the study, CT/MRI showed evident remnant tumour in 13 of 16 NFA (81.2%), nine GH-secreting (90%) and all three prolactinomas (100%), while the scintigraphy was negative (T/B <1) or faintly positive (T/B 1-2) in eight of 16 NFA (50%), five GH-secreting (50%) and one prolactinoma (33.3%). CONCLUSIONS: Functional imaging of pituitary remnant adenomas (> 10 mm in size) by 99mTc(V)DMSA depicts viable pituitary adenoma remnants. This approach may be of clinical value in patients with clinically nonfunctioning adenomas to monitor the effects of radiotherapy.

Original languageEnglish
Pages (from-to)713-721
Number of pages9
JournalClinical Endocrinology
Volume56
Issue number6
DOIs
Publication statusPublished - 2002

Fingerprint

Succimer
Technetium Tc 99m Dimercaptosuccinic Acid
Pituitary Neoplasms
Radionuclide Imaging
Radiotherapy
Adenoma
Tomography
Magnetic Resonance Imaging
Growth Hormone-Secreting Pituitary Adenoma
Prolactinoma
Neoplasms
Disease Progression
Fibrosis
Control Groups

ASJC Scopus subject areas

  • Endocrinology

Cite this

@article{2c8bd7208e1b460eb1e4a69f3ddcf087,
title = "99mTechnetium pentavalent dimercaptosuccinic acid scintigraphy in the follow-up of clinically nonfunctioning pituitary adenomas after radiotherapy",
abstract = "BACKGROUND: It is still difficult to differentiate pituitary adenoma remnants from postradiotherapy fibrosis by computed tomography (CT) or magnetic resonance imaging (MRI), especially in patients with clinically nonfunctioning pituitary adenomas (NFA), lacking circulating markers to follow disease progression or cure. OBJECTIVE: We investigated the usefulness of scintigraphy with technetium-99m pentavalent dimercaptosuccinic acid [99mTc(V)DMSA], shown previously to detect most pituitary GH- and PRL-secreting adenomas and NFA, with tumour-to-background ratios (T/B) as high as 25-fold. PATIENTS: Eighteen patients with NFA (study group), 10 patients with GH- and three patients with PRL-secreting adenomas (control group), all of whom had undergone previous surgery. DESIGN: The study was an open longitudinal design. Pituitary CT/MRI and 99mTc(V)DMSA scintigraphy was performed before and 1, 3 and 5 years after conventional radiotherapy. Tumour size was measured as maximal diameter of the residual lesion, while uptake of 99mTc(V)DMSA was measured as a T/B ratio. RESULTS: At study entry, pituitary 99mTc(V)DMSA uptake was found in 13 NFA (72.2{\%}), seven GH-secreting (70{\%}) and all PRL-secreting adenomas; remnant tumour was documented by CT/MRI in all 31 patients. Maximal remnant diameter was significantly higher in patients with positive (13.3±0.9 mm) than in those with negative scintigraphy (7.0±0.3 mm, P <0.001). During the 5-year follow-up postradiotherapy, a significant decrease in 99mTc(V)DMSA uptake (9.7±0.8 vs. 3.2±0.5, P <0.0001) occurred in all but three patients. Two NFA patients died of tumour invasion 19 and 36 months after radiotherapy and one acromegalic patient had no change in his hormone levels. In the eight negative patients (five NFA and three GH), scintigraphy remained negative throughout follow-up. A remarkable shrinkage of the remnant tumour was observed in both the patients with negative (from 7.0±0.3 to 1.9±0.6 mm, P <0.001) and in those with positive scintigraphy (from 13.3±0.9 to 7.3±0.6 mm, P <0.001). At the end of the study, CT/MRI showed evident remnant tumour in 13 of 16 NFA (81.2{\%}), nine GH-secreting (90{\%}) and all three prolactinomas (100{\%}), while the scintigraphy was negative (T/B <1) or faintly positive (T/B 1-2) in eight of 16 NFA (50{\%}), five GH-secreting (50{\%}) and one prolactinoma (33.3{\%}). CONCLUSIONS: Functional imaging of pituitary remnant adenomas (> 10 mm in size) by 99mTc(V)DMSA depicts viable pituitary adenoma remnants. This approach may be of clinical value in patients with clinically nonfunctioning adenomas to monitor the effects of radiotherapy.",
author = "Annamaria Colao and Diego Ferone and Gaetano Lombardi and Secondo Lastoria",
year = "2002",
doi = "10.1046/j.1365-2265.2002.01537.x",
language = "English",
volume = "56",
pages = "713--721",
journal = "Clinical Endocrinology",
issn = "0300-0664",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - 99mTechnetium pentavalent dimercaptosuccinic acid scintigraphy in the follow-up of clinically nonfunctioning pituitary adenomas after radiotherapy

AU - Colao, Annamaria

AU - Ferone, Diego

AU - Lombardi, Gaetano

AU - Lastoria, Secondo

PY - 2002

Y1 - 2002

N2 - BACKGROUND: It is still difficult to differentiate pituitary adenoma remnants from postradiotherapy fibrosis by computed tomography (CT) or magnetic resonance imaging (MRI), especially in patients with clinically nonfunctioning pituitary adenomas (NFA), lacking circulating markers to follow disease progression or cure. OBJECTIVE: We investigated the usefulness of scintigraphy with technetium-99m pentavalent dimercaptosuccinic acid [99mTc(V)DMSA], shown previously to detect most pituitary GH- and PRL-secreting adenomas and NFA, with tumour-to-background ratios (T/B) as high as 25-fold. PATIENTS: Eighteen patients with NFA (study group), 10 patients with GH- and three patients with PRL-secreting adenomas (control group), all of whom had undergone previous surgery. DESIGN: The study was an open longitudinal design. Pituitary CT/MRI and 99mTc(V)DMSA scintigraphy was performed before and 1, 3 and 5 years after conventional radiotherapy. Tumour size was measured as maximal diameter of the residual lesion, while uptake of 99mTc(V)DMSA was measured as a T/B ratio. RESULTS: At study entry, pituitary 99mTc(V)DMSA uptake was found in 13 NFA (72.2%), seven GH-secreting (70%) and all PRL-secreting adenomas; remnant tumour was documented by CT/MRI in all 31 patients. Maximal remnant diameter was significantly higher in patients with positive (13.3±0.9 mm) than in those with negative scintigraphy (7.0±0.3 mm, P <0.001). During the 5-year follow-up postradiotherapy, a significant decrease in 99mTc(V)DMSA uptake (9.7±0.8 vs. 3.2±0.5, P <0.0001) occurred in all but three patients. Two NFA patients died of tumour invasion 19 and 36 months after radiotherapy and one acromegalic patient had no change in his hormone levels. In the eight negative patients (five NFA and three GH), scintigraphy remained negative throughout follow-up. A remarkable shrinkage of the remnant tumour was observed in both the patients with negative (from 7.0±0.3 to 1.9±0.6 mm, P <0.001) and in those with positive scintigraphy (from 13.3±0.9 to 7.3±0.6 mm, P <0.001). At the end of the study, CT/MRI showed evident remnant tumour in 13 of 16 NFA (81.2%), nine GH-secreting (90%) and all three prolactinomas (100%), while the scintigraphy was negative (T/B <1) or faintly positive (T/B 1-2) in eight of 16 NFA (50%), five GH-secreting (50%) and one prolactinoma (33.3%). CONCLUSIONS: Functional imaging of pituitary remnant adenomas (> 10 mm in size) by 99mTc(V)DMSA depicts viable pituitary adenoma remnants. This approach may be of clinical value in patients with clinically nonfunctioning adenomas to monitor the effects of radiotherapy.

AB - BACKGROUND: It is still difficult to differentiate pituitary adenoma remnants from postradiotherapy fibrosis by computed tomography (CT) or magnetic resonance imaging (MRI), especially in patients with clinically nonfunctioning pituitary adenomas (NFA), lacking circulating markers to follow disease progression or cure. OBJECTIVE: We investigated the usefulness of scintigraphy with technetium-99m pentavalent dimercaptosuccinic acid [99mTc(V)DMSA], shown previously to detect most pituitary GH- and PRL-secreting adenomas and NFA, with tumour-to-background ratios (T/B) as high as 25-fold. PATIENTS: Eighteen patients with NFA (study group), 10 patients with GH- and three patients with PRL-secreting adenomas (control group), all of whom had undergone previous surgery. DESIGN: The study was an open longitudinal design. Pituitary CT/MRI and 99mTc(V)DMSA scintigraphy was performed before and 1, 3 and 5 years after conventional radiotherapy. Tumour size was measured as maximal diameter of the residual lesion, while uptake of 99mTc(V)DMSA was measured as a T/B ratio. RESULTS: At study entry, pituitary 99mTc(V)DMSA uptake was found in 13 NFA (72.2%), seven GH-secreting (70%) and all PRL-secreting adenomas; remnant tumour was documented by CT/MRI in all 31 patients. Maximal remnant diameter was significantly higher in patients with positive (13.3±0.9 mm) than in those with negative scintigraphy (7.0±0.3 mm, P <0.001). During the 5-year follow-up postradiotherapy, a significant decrease in 99mTc(V)DMSA uptake (9.7±0.8 vs. 3.2±0.5, P <0.0001) occurred in all but three patients. Two NFA patients died of tumour invasion 19 and 36 months after radiotherapy and one acromegalic patient had no change in his hormone levels. In the eight negative patients (five NFA and three GH), scintigraphy remained negative throughout follow-up. A remarkable shrinkage of the remnant tumour was observed in both the patients with negative (from 7.0±0.3 to 1.9±0.6 mm, P <0.001) and in those with positive scintigraphy (from 13.3±0.9 to 7.3±0.6 mm, P <0.001). At the end of the study, CT/MRI showed evident remnant tumour in 13 of 16 NFA (81.2%), nine GH-secreting (90%) and all three prolactinomas (100%), while the scintigraphy was negative (T/B <1) or faintly positive (T/B 1-2) in eight of 16 NFA (50%), five GH-secreting (50%) and one prolactinoma (33.3%). CONCLUSIONS: Functional imaging of pituitary remnant adenomas (> 10 mm in size) by 99mTc(V)DMSA depicts viable pituitary adenoma remnants. This approach may be of clinical value in patients with clinically nonfunctioning adenomas to monitor the effects of radiotherapy.

UR - http://www.scopus.com/inward/record.url?scp=0036065150&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036065150&partnerID=8YFLogxK

U2 - 10.1046/j.1365-2265.2002.01537.x

DO - 10.1046/j.1365-2265.2002.01537.x

M3 - Article

C2 - 12072040

AN - SCOPUS:0036065150

VL - 56

SP - 713

EP - 721

JO - Clinical Endocrinology

JF - Clinical Endocrinology

SN - 0300-0664

IS - 6

ER -