The role of magnetic resonance imaging in the implementation of a precision approach to the treatment of acromegaly
AbstractThe review discusses the topic of implementing a precision approach for differential diagnosis between the most common morphotypes of somatotropic tumors (ST) in patients with acromegaly. The predictive significance of the magnitude of the relative signal intensity (RSI) on T2-weighted MRI images (T2-WI) for the diagnosis of the pathomorphological variant of ST, determination of the biological scenario of tumor development and prediction of the biochemical and tumor response to primary or secondary drug therapy with 1st generation somatostatin analogues (SA1) is considered.
Modern methods for determining the intensity of the tumor signal on T2-WI are described, as well as practical applications of the integrated use of RSI for evaluating surgical and pharmacotherapeutic outcomes. It is shown that densely granulated ST differ in low signal intensity on T2-WI, small in size and a good response to traditional drug therapy, compared with hyperintense sparsely granulated tumors characterized by aggressive course and resistance to SA1.
The first domestic data on quantitative registration of RSI for T2-WI in patients with densely granulated and sparsely granulated STs, correlating with the receptor phenotype and the effectiveness of long-term drug therapy SA1. It is shown that the introduction into domestic local clinical practice of the digital radiological method for determining the RSI of a tumor on T2-WI will contribute to expanding the possibilities of diagnostic search and the implementation of a personalized approach to the treatment of patients with acromegaly syndrome.
Keywords:acromegaly; somatotropic tumors; T2-weighted MRI signal; drug therapy; somatostatin analogues
Funding. The study had no sponsor support.
Conflict of interest. The author declare no conflict of interest.
For citation: Pronin V.S., Antsiferov M.B., Vasiliev Yu.A., Petryaykin A.V., Alexeeva T.M., Pronin E.V., Khoruzhaya A.N., Tamaeva S.M. The role of magnetic resonance imaging in the implementation of a precision approach to the treatment of acromegaly. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2023; 12 (2): 78–94. DOI: https://doi.org/10.33029/2304-9529-2023-12-2-78-94 (in Russian)
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