Utility of 18F-AlF-NOTA-Octreotide PET/CT in the Localization of Tumor-Induced Osteomalacia

Abstract

Context: Tumor-induced osteomalacia (TIO) is a paraneoplastic disorder, usually caused by benign mesenchymal tumors that produce high levels of fibroblast growth factor 23. The only curative therapy is resection of the causative tumors.

Objective: This research was conducted to evaluate the efficacy of 18F-AlF-NOTA-octreotide (18F-OC) positron emission tomography/computed tomography (PET/CT) in detecting TIO and its impact on patient management.

Methods: Retrospective analysis was conducted of 17 patients with hypophosphatemic osteomalacia suspected to be TIO. A 18F-OC PET/CT study was performed in all 17 patients to localize the tumor and 68Ga-DOTATATE PET/CT was performed in 4 out of 17 patients; both studies were performed within 1 week of each other. Both studies were interpreted blindly without the knowledge of other imaging findings. The image findings were compared with the results of histopathological examinations and clinical follow-ups.

Results: The 18F-OC PET/CT scans were positive in 14 patients. Furthermore, 4 of 14 patients were scanned with both 18F-OC and 68Ga-DOTATATE PET/CT. Both studies were able to localize the tumor in all 4 patients. In total, 14 patients had surgery to remove the lesions. Postsurgical pathological examination confirmed causative tumors in these patients, whose symptoms diminished promptly. Serum phosphate levels normalized, confirming the diagnosis of TIO. 18F-OC PET/CT sensitivity, specificity, and accuracy were 87.5%, 100%, and 88.2% respectively. 18F-OC PET/CT findings affected patient management in 88.2% of cases.

Conclusion: 18F-OC PET/CT scan is useful in the detection of tumors causing TIO. Further studies with larger patient populations are needed to validate the result.

Keywords: 18F-AlF-NOTA-octreotide; 18F-OC PET/CT; 68Ga-DOTATATE PET/CT; TIO; hypophosphatemia; tumor-induced osteomalacia.