Ga-DOTATATE for Tumor Localization in Tumor-Induced Osteomalacia

Overview

Journal J Clin Endocrinol Metab

Publisher Oxford University Press

Specialty Endocrinology

Date 2016 Aug 18

PMID 27533306

Citations 64

Authors

Diala El-Maouche

Samira M Sadowski

Georgios Z Papadakis

Lori Guthrie

Candice Cottle-Delisle

Roxanne Merkel

Corina Millo

Clara C Chen

Electron Kebebew

Michael T Collins

Affiliations

Soon will be listed here.

Abstract

Context: Phosphaturic mesenchymal tumors (PMTs) are small, typically difficult to localize, and express somatostatin receptors. Recent work suggests imaging studies using Gallium (Ga)-conjugated somatostatin peptide analogues, such as 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)TATE, which enables somatostatin receptor imaging with positron emission tomography (PET), may be useful at identifying these tumors.

Objective: Our objective was to evaluate the use of Ga-DOTATATE PET/computed tomography (CT) for tumor localization in tumor-induced osteomalacia (TIO).

Design: This was a single-center prospective study of patients with TIO.

Setting: The study was conducted at the National Institutes of Health Clinical Center between February 2014 and February 2015.

Subjects: Eleven subjects (six females, five males) with TIO were included.

Intervention: Subjects underwent Ga-DOTATATE PET/CT in addition to In-pentetreotide single-photon emission CT (Octreoscan- SPECT/CT) and fluorodeoxyglucose-PET/CT (F FDG-PET/CT) scan.

Main Outcome Measures: Localization of PMTs on the previously described imaging modalities were determined.

Results: The tumor was successfully localized in 6/11 (54.5%) subjects (one was metastatic). The tumor was identified by Ga-DOTATATE in all six cases. Both Octreoscan-SPECT/CT and F FDG-PET each identified the tumor in 4/6. In no cases was Ga-DOTATATE the only imaging study to identify the tumor.

Conclusions: In this first prospective study comparing Ga-DOTATATE PET/CT to Octreoscan-SPECT/CT and F FDG-PET in TIO localization, Ga-DOTATATE PET/CT demonstrated the greatest sensitivity and specificity, suggesting that it may be the best single study for localization of PMTs in TIO.

Citing Articles

Acquired Osteomalacia Associated with Autoantibodies against PHEX.

Hoshino Y, Okamoto K, Ogawa T, Kato H, Irie K, Watanabe S N Engl J Med. 2025; 392(5):513-515.

PMID: 39879599 PMC: 11781776. DOI: 10.1056/NEJMc2405746.

Tumor-Induced Osteomalacia Localized by Systemic Venous Sampling and Ga-DOTATOC Positron Emission Tomography.

Nakao T, Takeshima K, Morita S, Yamauchi I, Koyasu S, Matsuoka T JCEM Case Rep. 2025; 3(2):luaf012.

PMID: 39866919 PMC: 11758137. DOI: 10.1210/jcemcr/luaf012.

Clinical features and treatment of hypophosphatemia and associated complications induced by Phosphaturic mesenchymal tumors: A case series of six patients.

Lai G, Zuo W, Tang R, Lu Z, Shi D Bone Rep. 2025; 24:101822.

PMID: 39866529 PMC: 11760829. DOI: 10.1016/j.bonr.2024.101822.

Treatment Advances in Tumor-Induced Osteomalacia.

Hartley I, Roszko K Calcif Tissue Int. 2025; 116(1):24.

PMID: 39755803 PMC: 11700048. DOI: 10.1007/s00223-024-01317-x.

Phosphaturic Mesenchymal Tumor and Tumor-Induced Osteomalacia: A Report of 5 Cases, Including 2 Skull Base Cases With Arterial Spin Label Perfusion.

Grewal I, Fischbein N, Dodd R, Lee K, Fernandez-Miranda J, Sellmeyer E J Comput Assist Tomogr. 2024; .

PMID: 39511819 PMC: 11902577. DOI: 10.1097/RCT.0000000000001676.

References

Jing H, Li F, Zhuang H, Wang Z, Tian J, Xing X . Effective detection of the tumors causing osteomalacia using [Tc-99m]-HYNIC-octreotide (99mTc-HYNIC-TOC) whole body scan. Eur J Radiol. 2013; 82(11):2028-34. DOI: 10.1016/j.ejrad.2013.04.006. View

Intenzo C, Jabbour S, Lin H, Miller J, Kim S, Capuzzi D . Scintigraphic imaging of body neuroendocrine tumors. Radiographics. 2007; 27(5):1355-69. DOI: 10.1148/rg.275065729. View

Bhavani N, Asirvatham A, Kallur K, Menon A, Pavithran P, Nair V . Utility of Gallium-68 DOTANOC PET/CT in the localization of Tumour-induced osteomalacia. Clin Endocrinol (Oxf). 2015; 84(1):134-40. DOI: 10.1111/cen.12822. View

Naswa N, Sharma P, Kumar R, Malhotra A, Bal C . Successful localization of residual culprit tumor in a case of tumor-induced osteomalacia using 68Ga-DOTANOC PET/CT. Clin Nucl Med. 2013; 38(8):639-40. DOI: 10.1097/RLU.0b013e318279eb13. View

Hofman M, Lau W, Hicks R . Somatostatin receptor imaging with 68Ga DOTATATE PET/CT: clinical utility, normal patterns, pearls, and pitfalls in interpretation. Radiographics. 2015; 35(2):500-16. DOI: 10.1148/rg.352140164. View

Hesse E, Moessinger E, Rosenthal H, Laenger F, Brabant G, Petrich T . Oncogenic osteomalacia: exact tumor localization by co-registration of positron emission and computed tomography. J Bone Miner Res. 2006; 22(1):158-62. DOI: 10.1359/jbmr.060909. View

Jadhav S, Kasaliwal R, Lele V, Rangarajan V, Chandra P, Shah H . Functional imaging in primary tumour-induced osteomalacia: relative performance of FDG PET/CT vs somatostatin receptor-based functional scans: a series of nine patients. Clin Endocrinol (Oxf). 2014; 81(1):31-7. DOI: 10.1111/cen.12426. View

Dalm S, Nonnekens J, Doeswijk G, de Blois E, van Gent D, Konijnenberg M . Comparison of the Therapeutic Response to Treatment with a 177Lu-Labeled Somatostatin Receptor Agonist and Antagonist in Preclinical Models. J Nucl Med. 2015; 57(2):260-5. DOI: 10.2967/jnumed.115.167007. View

Agrawal K, Bhadada S, Mittal B, Shukla J, Sood A, Bhattacharya A . Comparison of 18F-FDG and 68Ga DOTATATE PET/CT in localization of tumor causing oncogenic osteomalacia. Clin Nucl Med. 2014; 40(1):e6-e10. DOI: 10.1097/RLU.0000000000000460. View

10.

Ho C . Ga68-DOTA Peptide PET/CT to Detect Occult Mesenchymal Tumor-Inducing Osteomalacia: A Case Series of Three Patients. Nucl Med Mol Imaging. 2015; 49(3):231-6. PMC: 4532688. DOI: 10.1007/s13139-015-0328-2. View

11.

Jiang Y, Xia W, Xing X, Silva B, Li M, Wang O . Tumor-induced osteomalacia: an important cause of adult-onset hypophosphatemic osteomalacia in China: Report of 39 cases and review of the literature. J Bone Miner Res. 2012; 27(9):1967-75. DOI: 10.1002/jbmr.1642. View

12.

Haeusler G, Freilinger M, Dominkus M, Egerbacher M, Amann G, Kolb A . Tumor-induced hypophosphatemic rickets in an adolescent boy--clinical presentation, diagnosis, and histological findings in growth plate and muscle tissue. J Clin Endocrinol Metab. 2010; 95(10):4511-7. DOI: 10.1210/jc.2010-0543. View

13.

Chong W, Andreopoulou P, Chen C, Reynolds J, Guthrie L, Kelly M . Tumor localization and biochemical response to cure in tumor-induced osteomalacia. J Bone Miner Res. 2013; 28(6):1386-98. PMC: 3900247. DOI: 10.1002/jbmr.1881. View

14.

Zhang J, Zhu Z, Zhong D, Dang Y, Xing H, Du Y . 68Ga DOTATATE PET/CT is an Accurate Imaging Modality in the Detection of Culprit Tumors Causing Osteomalacia. Clin Nucl Med. 2015; 40(8):642-6. DOI: 10.1097/RLU.0000000000000854. View

15.

von Falck C, Rodt T, Rosenthal H, Langer F, Goesling T, Knapp W . (68)Ga-DOTANOC PET/CT for the detection of a mesenchymal tumor causing oncogenic osteomalacia. Eur J Nucl Med Mol Imaging. 2008; 35(5):1034. DOI: 10.1007/s00259-008-0755-8. View

16.

Clifton-Bligh R, Hofman M, Duncan E, Sim I, Darnell D, Clarkson A . Improving diagnosis of tumor-induced osteomalacia with Gallium-68 DOTATATE PET/CT. J Clin Endocrinol Metab. 2013; 98(2):687-94. DOI: 10.1210/jc.2012-3642. View

17.

Breer S, Brunkhorst T, Beil F, Peldschus K, Heiland M, Klutmann S . 68Ga DOTA-TATE PET/CT allows tumor localization in patients with tumor-induced osteomalacia but negative 111In-octreotide SPECT/CT. Bone. 2014; 64:222-7. DOI: 10.1016/j.bone.2014.04.016. View