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01-11-2016 | Diagnostic Neuroradiology

Predictive value of T2 relative signal intensity for response to somatostatin analogs in newly diagnosed acromegaly

Authors: Ming Shen, Qilin Zhang, Wenjuan Liu, Meng Wang, Jingjing Zhu, Zengyi Ma, Wenqiang He, Shiqi Li, Xuefei Shou, Yiming Li, Zhaoyun Zhang, Hongying Ye, Min He, Bin Lu, Zhenwei Yao, Yun Lu, Nidan Qiao, Zhao Ye, Yichao Zhang, Yeping Yang, Yao Zhao, Yongfei Wang

Published in: Neuroradiology | Issue 11/2016

Abstract

Introduction

The difficulty of predicting the efficacy of somatostatin analogs (SSA) is not fully resolved. Here, we quantitatively evaluated the predictive value of relative signal intensity (rSI) on T1- and T2-weighted magnetic resonance imaging (MRI) for the short-term efficacy (3 months) of SSA therapy in patients with active acromegaly and assessed the correlation between MRI rSI and expression of somatostatin receptors (SSTR).

Methods

This was a retrospective review of prospectively recorded data. Ninety-two newly diagnosed patients (37 males and 55 females) with active acromegaly were recruited. All patients were treated with pre-surgical SSA, followed by reassessment and transspenoidal surgery. rSI values were generated by calculating the ratio of SI in the tumor to the SI of normal frontal white matter. The Youden indices were calculated to determine the optimal cutoff of rSI to determine the efficacy of SSA. The correlation between rSI and expression of SSTR2/5 was analyzed by the Spearman rank correlation coefficient.

Results

T2 rSI was strongly correlated with biochemical sensitivity to SSA. The cutoff value of T2 rSI to distinguish biochemical sensitivity was 1.205, with a positive predictive value (PPV) of 81.5 % and a negative predictive value (NPV) of 77.3 %. No correlation was found between MRI and tumor size sensitivity. Moreover, T2 rSI was negatively correlated with the expression of SSTR5.

Conclusion

T2 rSI correlates with the expression of SSTR5 and quantitatively predicts the biochemical efficacy of SSA in acromegaly.

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Katznelson L, Atkinson JL, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK, American Association of Clinical E (2011) American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly--2011 update. Endocr Pract 17(Suppl 4):1–44CrossRefPubMed

Melmed S (2009) Acromegaly pathogenesis and treatment. J Clin Invest 119(11):3189–3202. doi:10.1172/JCI39375 CrossRefPubMedPubMedCentral

Melmed S, Jackson I, Kleinberg D, Klibanski A (1998) Current treatment guidelines for acromegaly. J Clin Endocrinol Metab 83(8):2646–2652. doi:10.1210/jcem.83.8.4995 PubMed

Colao A, Auriemma RS, Lombardi G, Pivonello R (2011) Resistance to somatostatin analogs in acromegaly. Endocr Rev 32(2):247–271. doi:10.1210/er.2010-0002 CrossRefPubMed

Park C, Yang I, Woo J, Kim S, Kim J, Kim Y, Sohn S, Kim E, Lee M, Park H, Jung J, Park S (2004) Somatostatin (SRIF) receptor subtype 2 and 5 gene expression in growth hormone-secreting pituitary adenomas: the relationship with endogenous srif activity and response to octreotide. Endocr J 51(2):227–236CrossRefPubMed

Taboada GF, Luque RM, Bastos W, Guimaraes RF, Marcondes JB, Chimelli LM, Fontes R, Mata PJ, Filho PN, Carvalho DP, Kineman RD, Gadelha MR (2007) Quantitative analysis of somatostatin receptor subtype (SSTR1-5) gene expression levels in somatotropinomas and non-functioning pituitary adenomas. Eur J Endocrinol 156(1):65–74. doi:10.1530/eje.1.02313 CrossRefPubMed

Fougner SL, Casar-Borota O, Heck A, Berg JP, Bollerslev J (2012) Adenoma granulation pattern correlates with clinical variables and effect of somatostatin analogue treatment in a large series of patients with acromegaly. Clin Endocrinol (Oxf) 76(1):96–102. doi:10.1111/j.1365-2265.2011.04163.x CrossRef

Bhayana S, Booth GL, Asa SL, Kovacs K, Ezzat S (2005) The implication of somatotroph adenoma phenotype to somatostatin analog responsiveness in acromegaly. J Clin Endocrinol Metab 90(11):6290–6295. doi:10.1210/jc.2005-0998 CrossRefPubMed

Jenkins PJ, Emery M, Howling SJ, Evanson J, Besser GM, Monson JP (2004) Predicting therapeutic response and degree of pituitary tumour shrinkage during treatment of acromegaly with octreotide LAR. Horm Res 62(5):227–232. doi:10.1159/000081418 PubMed

10.

Biermasz NR, Pereira AM, Smit JW, Romijn JA, Roelfsema F (2005) Intravenous octreotide test predicts the long term outcome of treatment with octreotide-long-acting repeatable in active acromegaly. Growth Hormon IGF Res 15(3):200–206. doi:10.1016/j.ghir.2005.02.007 CrossRef

11.

Puig-Domingo M, Resmini E, Gomez-Anson B, Nicolau J, Mora M, Palomera E, Marti C, Halperin I, Webb SM (2010) Magnetic resonance imaging as a predictor of response to somatostatin analogs in acromegaly after surgical failure. J Clin Endocrinol Metab 95(11):4973–4978. doi:10.1210/jc.2010-0573 CrossRefPubMed

12.

Heck A, Ringstad G, Fougner SL, Casar-Borota O, Nome T, Ramm-Pettersen J, Bollerslev J (2012) Intensity of pituitary adenoma on T2-weighted magnetic resonance imaging predicts the response to octreotide treatment in newly diagnosed acromegaly. Clin Endocrinol (Oxf) 77(1):72–78. doi:10.1111/j.1365-2265.2011.04286.x CrossRef

13.

Pokrajac A, Claridge AG, Shakoor SK, Trainer PJ (2006) The octreotide test dose is not a reliable predictor of the subsequent response to somatostatin analogue therapy in patients with acromegaly. Eur J Endocrinol 154(2):267–274. doi:10.1530/eje.1.02073 CrossRefPubMed

14.

Heck A, Emblem KE, Casar-Borota O, Bollerslev J, Ringstad G (2016) Quantitative analyses of T2-weighted MRI as a potential marker for response to somatostatin analogs in newly diagnosed acromegaly. Endocrine 52(2):333–343. doi:10.1007/s12020-015-0766-8 CrossRefPubMed

15.

Di Chiro G, Nelson KB (1962) The volume of the sella turcica. Am J Roentgenol Radium Therapy Nucl Med 87:989–1008

16.

Ma Z, He W, Zhao Y, Yuan J, Zhang Q, Wu Y, Chen H, Yao Z, Li S, Wang Y (2015) Predictive value of PWI for blood supply and T1-spin echo MRI for consistency of pituitary adenoma. Neuroradiology. doi:10.1007/s00234-015-1591-8

17.

Bala A, Lojek E, Marchel A (2015) Cognitive functioning of patients with a PRL-secreting pituitary adenoma: a preliminary report. Neurology. doi:10.1212/WNL.0000000000002252 PubMed

18.

Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB (1998) Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab 83(10):3411–3418. doi:10.1210/jcem.83.10.5111 CrossRefPubMed

19.

Bates AS, Van’t Hoff W, Jones JM, Clayton RN (1993) An audit of outcome of treatment in acromegaly. Q J Med 86(5):293–299PubMed

20.

Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A, Acromegaly Consensus G (2009) Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94(5):1509–1517. doi:10.1210/jc.2008-2421 CrossRefPubMed

21.

Fougner SL, Bollerslev J, Svartberg J, Oksnes M, Cooper J, Carlsen SM (2014) Preoperative octreotide treatment of acromegaly: long-term results of a randomised controlled trial. Eur J Endocrinol 171(2):229–235. doi:10.1530/EJE-14-0249 CrossRefPubMed

22.

Shen M, Shou X, Wang Y, Zhang Z, Wu J, Mao Y, Li S, Zhao Y (2010) Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study. Endocr J 57(12):1035–1044CrossRefPubMed

23.

Taboada GF, Luque RM, Neto LV, Machado Ede O, Sbaffi BC, Domingues RC, Marcondes JB, Chimelli LM, Fontes R, Niemeyer P, de Carvalho DP, Kineman RD, Gadelha MR (2008) Quantitative analysis of somatostatin receptor subtypes (1–5) gene expression levels in somatotropinomas and correlation to in vivo hormonal and tumor volume responses to treatment with octreotide LAR. Eur J Endocrinol 158(3):295–303. doi:10.1530/EJE-07-0562 CrossRefPubMed

24.

Gadelha MR, Kasuki L, Korbonits M (2013) Novel pathway for somatostatin analogs in patients with acromegaly. Trends Endocrinol Metab 24(5):238–246. doi:10.1016/j.tem.2012.11.007 CrossRefPubMed

25.

Potorac I, Petrossians P, Daly AF, Schillo F, Ben Slama C, Nagi S, Sahnoun M, Brue T, Girard N, Chanson P, Nasser G, Caron P, Bonneville F, Raverot G, Lapras V, Cotton F, Delemer B, Higel B, Boulin A, Gaillard S, Luca F, Goichot B, Dietemann JL, Beckers A, Bonneville JF (2015) Pituitary MRI characteristics in 297 acromegaly patients based on T2-weighted sequences. Endocr Relat Cancer 22(2):169–177. doi:10.1530/ERC-14-0305 CrossRefPubMed

26.

Bourdelot A, Coste J, Hazebroucq V, Gaillard S, Cazabat L, Bertagna X, Bertherat J (2004) Clinical, hormonal and magnetic resonance imaging (MRI) predictors of transsphenoidal surgery outcome in acromegaly. Eur J Endocrinol 150(6):763–771CrossRefPubMed

27.

Cozzi R, Montini M, Attanasio R, Albizzi M, Lasio G, Lodrini S, Doneda P, Cortesi L, Pagani G (2006) Primary treatment of acromegaly with octreotide LAR: a long-term (up to nine years) prospective study of its efficacy in the control of disease activity and tumor shrinkage. J Clin Endocrinol Metab 91(4):1397–1403. doi:10.1210/jc.2005-2347 CrossRefPubMed

28.

Guler HP, Zapf J, Schmid C, Froesch ER (1989) Insulin-like growth factors I and II in healthy man. Estimations of half-lives and production rates. Acta Endocrinol (Copenh) 121(6):753–758

29.

Heck A, Emblem KE, Casar-Borota O, Bollerslev J, Ringstad G (2015) Quantitative analyses of T2-weighted MRI as a potential marker for response to somatostatin analogs in newly diagnosed acromegaly. Endocrine. doi:10.1007/s12020-015-0766-8

30.

Pierallini A, Caramia F, Falcone C, Tinelli E, Paonessa A, Ciddio AB, Fiorelli M, Bianco F, Natalizi S, Ferrante L, Bozzao L (2006) Pituitary macroadenomas: preoperative evaluation of consistency with diffusion-weighted MR imaging--initial experience. Radiology 239(1):223–231. doi:10.1148/radiol.2383042204 CrossRefPubMed

31.

Mahmoud OM, Tominaga A, Amatya VJ, Ohtaki M, Sugiyama K, Sakoguchi T, Kinoshita Y, Takeshima Y, Abe N, Akiyama Y, El-Ghoriany AI, Abd Alla AK, El-Sharkawy MA, Arita K, Kurisu K, Yamasaki F (2011) Role of PROPELLER diffusion-weighted imaging and apparent diffusion coefficient in the evaluation of pituitary adenomas. Eur J Radiol 80(2):412–417. doi:10.1016/j.ejrad.2010.05.023 CrossRefPubMed

32.

Patel YC (1999) Somatostatin and its receptor family. Front Neuroendocrinol 20(3):157–198. doi:10.1006/frne.1999.0183 CrossRefPubMed

33.

Giustina A, Karamouzis I, Patelli I, Mazziotti G (2013) Octreotide for acromegaly treatment: a reappraisal. Expert Opin Pharmacother 14(17):2433–2447. doi:10.1517/14656566.2013.847090 CrossRefPubMed

34.

Kato M, Inoshita N, Sugiyama T, Tani Y, Shichiri M, Sano T, Yamada S, Hirata Y (2012) Differential expression of genes related to drug responsiveness between sparsely and densely granulated somatotroph adenomas. Endocr J 59(3):221–228CrossRefPubMed

35.

Mayr B, Buslei R, Theodoropoulou M, Stalla GK, Buchfelder M, Schofl C (2013) Molecular and functional properties of densely and sparsely granulated GH-producing pituitary adenomas. Eur J Endocrinol 169(4):391–400. doi:10.1530/EJE-13-0134 CrossRefPubMed

36.

Gatto F, Feelders RA, van der Pas R, Kros JM, Waaijers M, Sprij-Mooij D, Neggers SJ, van der Lelij AJ, Minuto F, Lamberts SW, de Herder WW, Ferone D, Hofland LJ (2013) Immunoreactivity score using an anti-sst2A receptor monoclonal antibody strongly predicts the biochemical response to adjuvant treatment with somatostatin analogs in acromegaly. J Clin Endocrinol Metab 98(1):E66–E71. doi:10.1210/jc.2012-2609 CrossRefPubMed

37.

Casar-Borota O, Heck A, Schulz S, Nesland JM, Ramm-Pettersen J, Lekva T, Alafuzoff I, Bollerslev J (2013) Expression of SSTR2a, but not of SSTRs 1, 3, or 5 in somatotroph adenomas assessed by monoclonal antibodies was reduced by octreotide and correlated with the acute and long-term effects of octreotide. J Clin Endocrinol Metab 98(11):E1730–E1739. doi:10.1210/jc.2013-2145 CrossRefPubMed

Title: Predictive value of T2 relative signal intensity for response to somatostatin analogs in newly diagnosed acromegaly
Authors: Ming Shen
Qilin Zhang
Wenjuan Liu
Meng Wang
Jingjing Zhu
Zengyi Ma
Wenqiang He
Shiqi Li
Xuefei Shou
Yiming Li
Zhaoyun Zhang
Hongying Ye
Min He
Bin Lu
Zhenwei Yao
Yun Lu
Nidan Qiao
Zhao Ye
Yichao Zhang
Yeping Yang
Yao Zhao
Yongfei Wang
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 11/2016
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-016-1728-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictive value of T2 relative signal intensity for response to somatostatin analogs in newly diagnosed acromegaly

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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