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CC BY 4.0 · World J Nucl Med
DOI: 10.1055/s-0044-1787967
Original Article

Utility of F18-FDG PET/CT in the Evaluation of Pituitary Uptake

Adersh Stanly
1   Department of Nuclear Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Saumya Sara Sunny
1   Department of Nuclear Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Justin Benjamin
1   Department of Nuclear Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Hesarghatta Shyamasunde Asha
2   Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
David Mathew
1   Department of Nuclear Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Junita Rachel John
1   Department of Nuclear Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
,
Julie Hephzibah
1   Department of Nuclear Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Abstract

Introduction Pituitary adenoma is the most common disease that affects the gland and may be classified as functional/nonsecretory tumors. Inflammatory/infective causes may also affect the pituitary gland. The 18F-fluorodeoxyglucose positron emission tomography/computed tomography (F18-FDG PET/CT) may have an incremental value in assessing these lesions and in determining their clinical significance.

Aim This article assesses the utility of F18-FDG PET/CT in detecting and determining clinical profile of pituitary lesions with abnormal uptake.

Methodology Retrospective analysis of all patients who underwent F18-FDG PET/CT from January 2015 to January 2023 was done. Those with abnormal pituitary uptake (standardized uptake value [SUV] > 2.5) were included in the study. SUV value along with relevant anatomical details, biochemical parameters, histopathological details, and follow-up imaging were analyzed.

Results Among 15,085 studies, a total of 36 patients (21 males/15 females, average age 47.36 years, range: 17–75 years) with pituitary uptake (0.23%) were included. Out of 36 patients, causes are primary pituitary tumor (21/36, 58%), tubercular hypophysitis (3/36, 8%), lymphocytic hypophysitis (2/36, 6%), lymphomatous involvement (2/36, 6%), autoimmune hypophysitis (1/36, 3%), questionable significance/incidental (4/36, 11%), and metastasis (3/36, 8%)—one each from neuroendocrine tumor ileum, chondrosarcoma, and adenocarcinoma lung. There was no difference in the SUV range between the different etiologies.

Among 21 patients with pituitary tumor, biochemical evaluation was done in 19 patients. Two patients were lost to follow-up and did not have biochemical evaluation. Among them, 8 underwent endoscopic transsphenoidal radical excision and 1 patient had PET-CT-guided stereotactic radiosurgery alone. In another 8 patients who had prior endoscopic transsphenoidal radical excision, uptake was noted as residual lesion on PET-CT. Of them, 3 underwent subtotal excision and 5 had PET-CT-guided stereotactic radiosurgery. Biopsy was done in 14 patients, of which 11 were macroadenoma and 3 were microadenoma. Overall, magnetic resonance imaging (MRI) brain was performed in 22 of them and the findings were concordant with F18-FDG PET/CT.

Conclusion F18-FDG PET/CT is a useful modality in the evaluation of pituitary uptake. It has an incremental value along with MRI brain and biochemical parameters and is useful for follow-up. Due to its high diagnostic accuracy, it is particularly useful in those with suspected residual/recurrent adenomas.

Keywords

F18-FDG PET/CT - hypophysitis - macroadenoma - pituitary adenoma - pituitary uptake

Ethical Approval

This study was approved by the Institutional Review Board and Ethics Committee.


Prior Presentation

Presented as poster at the 21st ANMPICON (Association of Nuclear Medicine Physicians of India) annual conference on September 30, 2023 in Faridabad, Delhi, India.


Authors' Contributions

A.S. contributed in data collection, planning, acquisition of data, literature search, reporting, and interpretation of data while H.J. helped in conception and design, acquisition of data and interpretation, guide, and review of manuscript. S.S.S. contributed to conception and design, technical support, review of manuscript, guide, and critical revision and S.H.A. did review of manuscript, guide, and critical revision. J.B. provides technical support, review of manuscript, guide, and critical revision. D.M. and J.R.J. provided technical support, review of manuscript, guide, and critical revision.




Publication History

Article published online:
25 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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