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Aim <p>To evaluate the efficacy of somatostatin receptor (SSTR)-directed PET/CT in localizing phosphaturic mesenchymal tumors (PMT) in patients with suspected tumor-induced osteomalacia (TIO) and to explore relationships between imaging parameters and biochemical markers.</p> Methods <p>This retrospective analysis included 20 patients with suspected TIO, undergoing SSTR-directed PET/CT. Imaging findings and laboratory markers were assessed. SSTR-positive tumors were resected, while patients without detectable tumor, but persistent renal phosphate wasting, continued on medical treatment. Follow-up assessments included laboratory values and clinical examinations.</p> Results <p>PMT were detected on PET in 12 patients (60%), were resected, and confirmed immunohistochemically. Phosphorus levels (<i>r</i> = 0.26; <i>p</i> = 0.03), tubular reabsorption of phosphate (TRP; <i>r</i> = 0.77; <i>p</i> &lt; 0.01) and tubular maximum of phosphate reabsorption over GFR (TmP/GFR; <i>r</i> = 0.44; <i>p</i> = 0.07) were lower in patients with detected PMT compared to those without. Elevation of fibroblast growth factor 23 (FGF23) was not significantly higher in PMT positive vs negative patients (253% vs 134% above the upper limit of normal; <i>p</i> = 0.97). Total lesion uptake (TLU) negatively correlated with TmP/GFR (<i>r</i> = -0.71; <i>p</i> = 0.03). A maximum standardized uptake value (SUVmax) threshold of 7.6 differentiated PMT from bone fractures (83% sensitivity; 100% specificity). Post-resection follow-up confirmed clinical cure in all cases.</p> Conclusion <p>In SSTR-directed PET/CT, a distinction between PMT and bone fracture may be possible with a SUVmax threshold of 7.6. The integration of PET derived TLU, along with TmP/GFR may improve diagnosis and treatment planning for TIO.</p>

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Diagnostic Performance of Somatostatin Receptor-directed PET/CT for Tumor-induced Osteomalacia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月4日

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  • Marieke Heinrich,
  • Aleksander Kosmala,
  • Alexander Dierks,
  • Franca Genest,
  • Elena Gerhard-Hartmann,
  • Lukas Haug,
  • Silke Achtziger,
  • Peter Raab,
  • Andreas K. Buck,
  • Constantin Lapa,
  • Kerstin Michalski,
  • Lothar Seefried

摘要

Aim

To evaluate the efficacy of somatostatin receptor (SSTR)-directed PET/CT in localizing phosphaturic mesenchymal tumors (PMT) in patients with suspected tumor-induced osteomalacia (TIO) and to explore relationships between imaging parameters and biochemical markers.

Methods

This retrospective analysis included 20 patients with suspected TIO, undergoing SSTR-directed PET/CT. Imaging findings and laboratory markers were assessed. SSTR-positive tumors were resected, while patients without detectable tumor, but persistent renal phosphate wasting, continued on medical treatment. Follow-up assessments included laboratory values and clinical examinations.

Results

PMT were detected on PET in 12 patients (60%), were resected, and confirmed immunohistochemically. Phosphorus levels (r = 0.26; p = 0.03), tubular reabsorption of phosphate (TRP; r = 0.77; p < 0.01) and tubular maximum of phosphate reabsorption over GFR (TmP/GFR; r = 0.44; p = 0.07) were lower in patients with detected PMT compared to those without. Elevation of fibroblast growth factor 23 (FGF23) was not significantly higher in PMT positive vs negative patients (253% vs 134% above the upper limit of normal; p = 0.97). Total lesion uptake (TLU) negatively correlated with TmP/GFR (r = -0.71; p = 0.03). A maximum standardized uptake value (SUVmax) threshold of 7.6 differentiated PMT from bone fractures (83% sensitivity; 100% specificity). Post-resection follow-up confirmed clinical cure in all cases.

Conclusion

In SSTR-directed PET/CT, a distinction between PMT and bone fracture may be possible with a SUVmax threshold of 7.6. The integration of PET derived TLU, along with TmP/GFR may improve diagnosis and treatment planning for TIO.