Abstract：
OBJECTIVE: To report our experience with 18F-fluoro-ethyl-tyrosine (FET) positron emission tomography-computed tomography (PET-CT) co-registered with magnetic resonance imaging (MRI) (FET-PET/MRICR) in the care trajectory for persistent acromegaly.
METHODS: Prospective case series.
METHODS: Ten patients with insufficiently controlled acromegaly referred to our team to evaluate surgical options.
METHODS: FET-PET/MRICR was used to support decision-making if MRI alone and multidisciplinary team evaluation did not provide sufficient clarity to proceed to surgery.
RESULTS: FET-PET/MRICR showed suspicious (para)sellar tracer uptake in all patients. In five patients FET-PET/MRICR was fully concordant with conventional MRI, and in one patient partially concordant. FET-PET/MRICR identified suggestive new foci in four other patients. Surgical re-exploration was performed in nine patients (aimed at total resection (6), debulking (2), diagnosis (1)), and one patient underwent radiation therapy. In 7 of 9 (78%) operated patients FET-PET/MRICR findings were confirmed intraoperatively, and in six (67%) also histologically. IGF-1 decreased significantly in eight patients (89%). All patients showed clinical improvement. Complete biochemical remission was achieved in three patients (50% of procedures in which total resection was anticipated feasible). Biochemistry improved in five and was unchanged in one patient. No permanent complications occurred. At six months, optimal outcome (preoperative intended goal achieved without permanent complications) was achieved in six (67%) patients and an intermediate outcome (goal not achieved, but no complications) in the other three patients.
CONCLUSIONS: In patients with persisting acromegaly without a clear surgical target on MRI, FET-PET/MRICR is a new tracer to provide additional information to aid decision-making by the multidisciplinary pituitary team.
METHODS: Prospective case series.
METHODS: Ten patients with insufficiently controlled acromegaly referred to our team to evaluate surgical options.
METHODS: FET-PET/MRICR was used to support decision-making if MRI alone and multidisciplinary team evaluation did not provide sufficient clarity to proceed to surgery.
RESULTS: FET-PET/MRICR showed suspicious (para)sellar tracer uptake in all patients. In five patients FET-PET/MRICR was fully concordant with conventional MRI, and in one patient partially concordant. FET-PET/MRICR identified suggestive new foci in four other patients. Surgical re-exploration was performed in nine patients (aimed at total resection (6), debulking (2), diagnosis (1)), and one patient underwent radiation therapy. In 7 of 9 (78%) operated patients FET-PET/MRICR findings were confirmed intraoperatively, and in six (67%) also histologically. IGF-1 decreased significantly in eight patients (89%). All patients showed clinical improvement. Complete biochemical remission was achieved in three patients (50% of procedures in which total resection was anticipated feasible). Biochemistry improved in five and was unchanged in one patient. No permanent complications occurred. At six months, optimal outcome (preoperative intended goal achieved without permanent complications) was achieved in six (67%) patients and an intermediate outcome (goal not achieved, but no complications) in the other three patients.
CONCLUSIONS: In patients with persisting acromegaly without a clear surgical target on MRI, FET-PET/MRICR is a new tracer to provide additional information to aid decision-making by the multidisciplinary pituitary team.
摘要：
目的：报告我们在持续性肢端肥大症的护理轨迹中使用18F-氟-乙基-酪氨酸（FET）正电子发射断层扫描（PET-CT）与磁共振成像（MRI）（FET-PET/MRICR）共配准的计算机断层扫描（PET-CT）的经验。
方法：前瞻性病例系列。
方法：10例肢端肥大症控制不充分的患者向我们的团队推荐手术方案。
方法：FET-PET/MRICR用于支持决策，如果单独的MRI和多学科团队评估不能提供足够的清晰度来进行手术。
结果：FET-PET/MRICR在所有患者中均显示可疑的（对侧）鞍区示踪剂摄取。在5例患者中，FET-PET/MRICR与常规MRI完全一致，一名患者部分一致。FET-PET/MRICR在其他四名患者中发现了提示新的病灶。对9例患者进行了手术再探查（旨在全切除（6），剔除(2)，诊断（1）），一名患者接受了放射治疗。9例手术患者中有7例（78%）的FET-PET/MRICR结果在术中得到证实，在组织学上也有6例（67%）。8例患者中IGF-1显著下降(89%)。所有患者均显示临床改善。在三名患者中实现了完全的生化缓解（预计完全切除可行的手术的50％）。5例患者的生化改善，1例患者的生化没有变化。无永久性并发症发生。六个月的时候，6例（67%）患者达到了最佳结局（术前预期目标，无永久性并发症），中间结局（目标未实现，但没有并发症）在其他三名患者中。
结论：在MRI上没有明确手术目标的持续肢端肥大症患者中，FET-PET/MRICR是一种新的示踪剂，可提供其他信息以帮助多学科垂体团队做出决策。
方法：前瞻性病例系列。
方法：10例肢端肥大症控制不充分的患者向我们的团队推荐手术方案。
方法：FET-PET/MRICR用于支持决策，如果单独的MRI和多学科团队评估不能提供足够的清晰度来进行手术。
结果：FET-PET/MRICR在所有患者中均显示可疑的（对侧）鞍区示踪剂摄取。在5例患者中，FET-PET/MRICR与常规MRI完全一致，一名患者部分一致。FET-PET/MRICR在其他四名患者中发现了提示新的病灶。对9例患者进行了手术再探查（旨在全切除（6），剔除(2)，诊断（1）），一名患者接受了放射治疗。9例手术患者中有7例（78%）的FET-PET/MRICR结果在术中得到证实，在组织学上也有6例（67%）。8例患者中IGF-1显著下降(89%)。所有患者均显示临床改善。在三名患者中实现了完全的生化缓解（预计完全切除可行的手术的50％）。5例患者的生化改善，1例患者的生化没有变化。无永久性并发症发生。六个月的时候，6例（67%）患者达到了最佳结局（术前预期目标，无永久性并发症），中间结局（目标未实现，但没有并发症）在其他三名患者中。
结论：在MRI上没有明确手术目标的持续肢端肥大症患者中，FET-PET/MRICR是一种新的示踪剂，可提供其他信息以帮助多学科垂体团队做出决策。
