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Related Experiment Video

Updated: Aug 16, 2025

Multi-modal Imaging of Angiogenesis in a Nude Rat Model of Breast Cancer Bone Metastasis Using Magnetic Resonance Imaging, Volumetric Computed Tomography and Ultrasound
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Utility of Multimodality Approach Including Systemic FGF23 Venous Sampling in Localizing Phosphaturic Mesenchymal

Hajime Kato1,2, Minae Koga1,2, Yuka Kinoshita1,2

  • 1Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan.

Journal of the Endocrine Society
|December 21, 2022
PubMed
Summary

Tumor-induced osteomalacia (TIO) is often hard to diagnose due to tumor location. Combining 18F-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography (FDG-PET) with fibroblast growth factor 23 (FGF23) venous sampling offers the highest success rate for localizing these tumors.

Keywords:
111In-pentetreotide scintigraphy18F-FDG PET/CTfibroblast growth factor 23phosphaturic mesenchymal tumortumor-induced osteomalaciavenous sampling

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Area of Science:

  • Endocrinology
  • Oncology
  • Radiology

Background:

  • Tumor-induced osteomalacia (TIO) is a common cause of acquired fibroblast growth factor 23 (FGF23)-related hypophosphatemia, typically caused by phosphaturic mesenchymal tumors (PMTs).
  • Complete resection of PMTs cures TIO, but preoperative localization is challenging with standard imaging.
  • Advanced imaging techniques like FDG-PET, SRS, and FGF23VS aid in PMT localization.

Purpose of the Study:

  • To evaluate the diagnostic performance of FDG-PET, SRS, and FGF23VS, individually and in combination, for localizing PMTs.

Main Methods:

  • An observational retrospective study included 30 Japanese patients with TIO who underwent FDG-PET, SRS, and FGF23VS.
  • Tumor localization success rates were assessed in 18 patients with pathologically confirmed PMTs.

Main Results:

  • Individual test localization rates were 72% for FDG-PET, 72% for SRS, and 94% for FGF23VS.
  • Combinations improved localization: FDG-PET/SRS (89%), FDG-PET/FGF23VS (100%), SRS/FGF23VS (94%).
  • The combination of FDG-PET and FGF23VS achieved a 100% localization rate.

Conclusions:

  • The combination of FDG-PET and FGF23VS demonstrated the highest preoperative localization rate for PMTs in patients with TIO.
  • These findings highlight the utility of combining imaging modalities for improved diagnostic accuracy in TIO management.