Implementation of functional imaging using 11C-methionine PET-CT co-registered with MRI for advanced surgical planning and decision making in prolactinoma surgery
Leontine E. H. Bakker, Marco J. T. Verstegen, Eidrees Ghariq, Berit M. Verbist, Pieter J. Schutte, Waiel Bashari, Mark C. Kruit, Alberto M. Pereira, Mark Gurnell, Nienke R. Biermasz, Wouter R. van Furth, Lenka M. Pereira Arias‐Bouda
Abstract
Abstract Purpose To report the first experience of our multidisciplinary team with functional imaging using 11 C-methionine positron emission tomography-computed tomography ( 11 C-methionine PET-CT) co-registered with MRI (Met-PET/MRI CR ) in clinical decision making and surgical planning of patients with difficult to treat prolactinoma. Methods In eighteen patients with prolactinoma, referred to our tertiary referral centre because of intolerance or resistance for dopamine agonists (DA), Met-PET/MRI CR was used to aid decision-making regarding therapy. Results Met-PET/MRI CR was positive in 94% of the patients. MRI and Met-PET/MRI CR findings were completely concordant in five patients, partially concordant in nine patients, and non-concordant in four patients. In five patients Met-PET/MRI CR identified lesion(s) that were retrospectively also visible on MRI. Met-PET/MRI CR was false negative in one patient, with a cystic adenoma on conventional MRI. Thirteen patients underwent transsphenoidal surgery, with nine achieving full biochemical remission, two clinical improvement and near normalized prolactin levels, and one patient clinical improvement with significant tumour reduction. Hence, nearly all patients (94%) were considered to have a positive outcome. Permanent complication rate was low. Three patients continued DA, two patients have a wait and scan policy. Conclusion Met-PET/MRI CR can provide additional information to guide multidisciplinary preoperative and intraoperative decision making in selected cases of prolactinoma. This approach resulted in a high remission rate with a low rate of complications in our expert centre.