18F‐fluoro‐ethyl‐tyrosine PET co‐registered with MRI in patients with persisting acromegaly

Abstract Objective To report our experience with 18 F‐fluoro‐ethyl‐tyrosine (FET) positron emission tomography‐computed tomography (PET‐CT) co‐registered with magnetic resonance imaging (MRI) (FET‐PET/MRI CR ) in the care trajectory for persistent acromegaly. Design Prospective case series. Patients Ten patients with insufficiently controlled acromegaly referred to our team to evaluate surgical options. Measurements 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/MRI CR showed suspicious (para)sellar tracer uptake in all patients. In five patients FET‐PET/MRI CR was fully concordant with conventional MRI, and in one patient partially concordant. FET‐PET/MRI CR 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/MRI CR 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/MRI CR is a new tracer to provide additional information to aid decision‐making by the multidisciplinary pituitary team.