T2-weighted MRI signal predicts hormone and tumor responses to somatostatin analogs in acromegaly

    1. Albert Beckers1
    1. 1CHU de Liège-University of Liège, Liège, Belgium
    2. 2Université Catholique de Louvain, Brussels, Belgium
    3. 3CHU Jean Minjoz, Besancon, France
    4. 4CHU Marseille, Marseille, France
    5. 5Université Libre de Bruxelles, Bruxelles, Belgium
    6. 6Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila and Neuroendocrinology, Neuromed IRCCS, Pozzilli, Italy
    7. 7CHU Angers, Angers, France
    8. 8CHU Strasbourg, Strasbourg, France
    9. 9CHU Lyon, Lyon, France
    10. 10Universitätsklinikum Erlangen, Erlangen, Germany
    11. 11CHU Bocage, Dijon, France
    12. 12CHU Reims, Reims, France
    13. 13Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
    14. 14Faculty of Medicine, Erciyes University, Kayseri, Turkey
    15. 15University of Genova, Genova, Italy
    16. 16Hospital Universitario Gregorio Marañon, Madrid, Spain
    17. 17Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
    18. 18CHU Bordeaux, Bordeaux, France
    19. 19Charles University, Prague, Czech Republic
    20. 20CHU Nancy, Nancy, France
    21. 21Moscow Regional Research and Clinical Institute, Russia
    22. 22Kazan State Medical Academy, Kazan, Russia
    23. 23Centre Pierre et Marie Curie, Algiers, Algeria
    24. 24Center of Endocrinology & Metabolism, Bamberg, Germany
    1. Correspondence should be addressed to A Beckers; Email: albert.beckers{at}chu.ulg.ac.be


    GH-secreting pituitary adenomas can be hypo-, iso- or hyper-intense on T2-weighted MRI sequences. We conducted the current multicenter study in a large population of patients with acromegaly to analyze the relationship between T2-weighted signal intensity on diagnostic MRI and hormonal and tumoral responses to somatostatin analogs (SSA) as primary monotherapy. Acromegaly patients receiving primary SSA for at least 3 months were included in the study. Hormonal, clinical and general MRI assessments were performed and assessed centrally. We included 120 patients with acromegaly. At diagnosis, 84, 17 and 19 tumors were T2-hypo-, iso- and hyper-intense, respectively. SSA treatment duration, cumulative and mean monthly doses were similar in the three groups. Patients with T2-hypo-intense adenomas had median SSA-induced decreases in GH and IGF-1 of 88% and 59% respectively, which were significantly greater than the decreases observed in the T2-iso- and hyper-intense groups (P < 0.001). Tumor shrinkage on SSA was also significantly greater in the T2-hypo-intense group (38%) compared with the T2-iso- and hyper-intense groups (8% and 3%, respectively; P < 0.0001). The response to SSA correlated with the calculated T2 intensity: the lower the T2-weighted intensity, the greater the decrease in random GH (P < 0.0001, r = 0.22), IGF-1 (P < 0.0001, r = 0.14) and adenoma volume (P < 0.0001, r = 0.33). The T2-weighted signal intensity of GH-secreting adenomas at diagnosis correlates with hormone reduction and tumor shrinkage in response to primary SSA treatment in acromegaly. This study supports its use as a generally available predictive tool at diagnosis that could help to guide subsequent treatment choices in acromegaly.

    • Received 7 September 2016
    • Accepted 20 September 2016
    • Made available online as an Accepted Preprint 20 September 2016
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