Breer Stefan, Brunkhorst Thomas, Beil F Timo, Peldschus Kersten, Heiland Max, Klutmann Susanne, Barvencik Florian, Zustin Jozef, Gratz Klaus-Friedrich, Amling Michael
Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Germany.
Department of Nuclear Medicine, Hannover Medical School, Germany.
Bone. 2014 Jul;64:222-7. doi: 10.1016/j.bone.2014.04.016. Epub 2014 Apr 24.
Tumor-induced osteomalacia (TIO) is a paraneoplastic syndrome characterized by renal phosphate wasting, hypophosphatemia and low calcitriol levels as well as clinical symptoms like diffuse bone and muscle pain, fatigue fractures or increased fracture risk. Conventional imaging methods, however, often fail to detect the small tumors. Lately, tumor localization clearly improved by somatostatin-receptor (SSTR) imaging, such as octreotide scintigraphy or octreotide SPECT/CT. However, recent studies revealed that still a large number of tumors remained undetected by octreotide imaging. Hence, studies focused on different SSTR imaging methods such as 68Ga DOTA-NOC, 68Ga DOTA-TOC and 68Ga DOTA-TATE PET/CT with promising first results. Studies comparing different SSTR imaging methods for tumor localization in TIO are rare and thus little is known about diagnostic alternatives once a particular method failed to detect a tumor in patients with TIO. Here, we report the data of 5 consecutive patients suffering from TIO, who underwent both 111Indium-octreotide scintigraphy (111In-OCT) SPECT/CT as well as 68Ga DOTA-TATE PET/CT for tumor detection. While 111In-OCT SPECT/CT allowed tumor detection in only 1 of 5 patients, 68Ga DOTA-TATE PET/CT was able to localize the tumor in all patients. Afterwards, anatomical imaging of the region of interest was performed with CT and MRI. Thus, successful surgical resection of the tumor was achieved in all patients. Serum phosphate levels returned to normal and all patients reported relief of symptoms within weeks. Moreover, an iliac crest biopsy was obtained from every patient and revealed marked osteomalacia in all cases. Follow-up DXA revealed an increase in BMD of up to 34.5% 1-year postoperative, indicating remineralization. No recurrence was observed. In conclusion our data indicates that 68Ga DOTA-TATE PET/CT is an effective and promising diagnostic tool in the diagnosis of TIO, even in patients in whom 111In-OCT prior failed to detect a tumor.
肿瘤诱导的骨软化症（TIO）是一种副肿瘤综合征，其特征为肾性磷酸盐消耗、低磷血症、低骨化三醇水平以及弥漫性骨痛和肌肉疼痛、疲劳性骨折或骨折风险增加等临床症状。然而，传统成像方法常常无法检测到这些小肿瘤。近来，生长抑素受体（SSTR）成像，如奥曲肽闪烁扫描或奥曲肽SPECT/CT，显著改善了肿瘤定位。然而，最近的研究表明，奥曲肽成像仍有大量肿瘤未被检测到。因此，研究聚焦于不同的SSTR成像方法，如68Ga DOTA-NOC、68Ga DOTA-TOC和68Ga DOTA-TATE PET/CT，取得了令人鼓舞的初步结果。比较不同SSTR成像方法用于TIO肿瘤定位的研究很少，因此一旦某种特定方法未能在TIO患者中检测到肿瘤，对于诊断替代方法知之甚少。在此，我们报告5例连续TIO患者的数据，这些患者接受了111铟-奥曲肽闪烁扫描（111In-OCT）SPECT/CT以及68Ga DOTA-TATE PET/CT以检测肿瘤。虽然111In-OCT SPECT/CT仅在5例患者中的1例检测到肿瘤，但68Ga DOTA-TATE PET/CT能够在所有患者中定位肿瘤。之后，使用CT和MRI对感兴趣区域进行解剖成像。因此，所有患者均成功进行了肿瘤手术切除。血清磷酸盐水平恢复正常，所有患者均报告在数周内症状缓解。此外，从每位患者获取了髂嵴活检，所有病例均显示明显的骨软化症。术后1年的随访DXA显示骨密度增加高达34.5%，表明有再矿化。未观察到复发。总之，我们的数据表明，68Ga DOTA-TATE PET/CT是诊断TIO的一种有效且有前景的诊断工具，即使在先前111In-OCT未能检测到肿瘤的患者中也是如此。
