Quantitative analyses of T2-weighted MRI as a potential marker for response to somatostatin analogs in newly diagnosed a
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ORIGINAL ARTICLE
Quantitative analyses of T2-weighted MRI as a potential marker for response to somatostatin analogs in newly diagnosed acromegaly Ansgar Heck1,2 • Kyrre E. Emblem3 • Olivera Casar-Borota4,5 • Jens Bollerslev1,2 Geir Ringstad6
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Received: 18 July 2015 / Accepted: 29 September 2015 Springer Science+Business Media New York 2015
Abstract In growth hormone (GH)-producing adenomas, T2-weighted MRI signal intensity is a marker for granulation pattern and response to somatostatin analogs (SSA). Prediction of treatment response is necessary for individualized treatment, and T2 intensity assessment might improve preoperative classification of somatotropinomas. The objectives of this study are (I) to explore the feasibility of quantitative T2-weighted MRI histogram analyses in newly diagnosed somatotroph adenomas and their relation to clinical and histological parameters and (II) to compare the quantitative method to conventional, visual assessment of T2 intensity. The study was a retrospective cohort study of 58 newly diagnosed patients. In 34 of these, response to primary SSA treatment after median 6 months was evaluated. Parameters from the T2 histogram analyses (T2 intensity ratio and T2 homogeneity ratio) were correlated to visually assessed T2 intensity (hypo-, iso-, hyperintense), baseline characteristics, response to SSA treatment, and histological granulation pattern (anti-Cam5.2). T2 & Ansgar Heck [email protected] 1
Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, P.b 4950, Nydalen, 0424 Oslo, Norway
2
Faculty of Medicine, University of Oslo, Oslo, Norway
3
The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
4
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
5
Department of Pathology, Oslo University Hospital, Oslo, Norway
6
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
intensity ratio was lowest in the hypointense tumors and highest in the hyperintense tumors (0.66 ± 0.10 vs. 1.07 ± 0.11; p \ 0.001). T2 intensity at baseline correlated with reduction in GH (r = -0.67; p \ 0.001) and IGF-1 (r = -0.36; p = 0.037) after primary SSA treatment (n = 34). The T2 homogeneity ratio correlated with adenoma size reduction (r = -0.45; p = 0.008). Sparsely granulated adenomas had a higher T2 intensity than densely or intermediately granulated adenomas. T2 histogram analyses are an applicable tool to assess T2 intensity in somatotroph adenomas. Quantitatively assessed T2 intensity ratio in GH-producing adenomas correlates with conventional assessment of T2 intensity, baseline characteristics, response to SSA treatment, and histological granulation pattern. Keywords Acromegaly T2 MRI Somatostatin analog Granulation
Introduction Transsphenoidal surgery and treatment with somatostatin analogs (SSA) are available options for first-line treatment of patients with acromegaly [1–3]. The choice of treatment
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