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Diagnostic efficiency of 68Ga-DOTANOC PET/CT in patients with suspected tumour-induced osteomalacia

  • Molecular Imaging
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Currently, the main challenge in tumour-induced osteomalacia (TIO) is the difficulty in locating culprit tumours for definitive diagnosis and surgical therapy. Herein, we retrospectively evaluate the efficiency of 68Ga-DOTANOC PET/CT in the localisation and diagnosis of TIO, and compared with 18F-FDG.

Methods

Twenty-four consecutive patients with hypophosphataemic osteomalacia (HO) and suspicion of TIO who were referred to our centre for 68Ga-DOTANOC PET/CT scanning were retrospectively reviewed. The images were evaluated qualitatively as well as semi-quantitatively, and imaging results were compared with the final diagnoses.

Results

Among the total of 21 patients who were included in the final analyses, 17 were diagnosed with TIO, while four were proven to have other causes of HO. 68Ga-DOTANOC PET/CT produced positive results in 16 of the 17 patients with TIO, representing a sensitivity of 94.1%. Moreover, the 68Ga-DOTANOC PET/CT results were negative in 3 of the 4 patients without TIO, representing a specificity of 75.0%. The overall accuracy of 68Ga-DOTANOC PET/CT in locating the tumours responsible for TIO is 90.5%. In particular, 68Ga-DOTANOC PET/CT detected the culprit tumours in 4 out of 10 patients with negative results on previous 18F-FDG PET/CT and showed a significantly higher T/M ratio of tumours than 18F-FDG PET/CT in the same patients (n = 10; 4.76 ± 3.08 vs 1.95 ± 1.33, p < 0.05).

Conclusions

68Ga-DOTANOC PET/CT is an accurate imaging modality in the localisation of tumours for TIO. It is superior to 18F-FDG PET/CT and may be useful in the differential diagnosis of HO.

Key Points

• TIO should be considered a possible cause for patients diagnosed with HO, which usually needs to be differentiated from other aetiologies.

• 68 Ga-DOTANOC PET/CT is an accurate imaging modality in locating culprit tumours for TIO, superior to 18 F-FDG PET/CT.

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Abbreviations

18F-FDG:

18F-Fluorodeoxyglucose

68Ga-DOTANOC:

68Ga-DOTA-1-NaI (3)-octreotide

99mTc-HYNIC-TOC:

99mTc-Hydrazinonicotinyl-Tyr3-octreotide

ADV:

Adefovir dipivoxil

ALP:

Alkaline phosphatase

CT:

Computed tomography

DOTA:

1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid

FGF23:

Fibroblast growth factor 23

HCl:

Hydrochloric acid

HO:

Hypophosphataemic osteomalacia

iPTH:

Intact parathyroid hormone

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

PMT:

Phosphaturic mesenchymal tumour

RAMLA:

Row action maximum likelihood algorithm

SPECT:

Single-photon emission computed tomography

SSTR:

Somatostatin receptors

SUV:

Standard uptake value

T/M:

Ratio of tumour SUVmax to mediastinal blood pool SUVmax

TIO:

Tumour-induced osteomalacia

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Acknowledgements

We would like to thank Fuhua Wen and Dake Zhang for the preparation of PET tracers and all the technicians for PET/CT image acquisition and processing in PET/CT Center at the First Affiliated Hospital of Sun Yat-Sen University.

Funding

The authors state that this study has received funding from the Medical Scientific Research Foundation of Guangdong Province of China (No. A2019528) and Natural Science Foundation of Guangdong Province of China (No. 2019A1515010845).

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Author notes

  1. Qiao He and Bing Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People’s Republic of China

    Qiao He, Bing Zhang, Zhifeng Chen, Xinchong Shi, Chang Yi, Xiaoyan Wang & Xiangsong Zhang

  2. Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, People’s Republic of China

    Linqi Zhang

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  1. Qiao He
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Correspondence to Linqi Zhang or Xiangsong Zhang.

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The scientific guarantor of this publication is Xiangsong Zhang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

One study subject has been previously reported in Clin Nucl Med. 2018 Jun;43(6):e198–e199.

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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He, Q., Zhang, B., Zhang, L. et al. Diagnostic efficiency of 68Ga-DOTANOC PET/CT in patients with suspected tumour-induced osteomalacia. Eur Radiol 31, 2414–2421 (2021). https://doi.org/10.1007/s00330-020-07342-2

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  • DOI: https://doi.org/10.1007/s00330-020-07342-2

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