11C-蛋氨酸PET成像在促肾上腺皮质激素（ACTH）依赖性库欣综合征中的作用。

A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome.

作者信息

Koulouri Olympia, Steuwe Andrea, Gillett Daniel, Hoole Andrew C, Powlson Andrew S, Donnelly Neil A, Burnet Neil G, Antoun Nagui M, Cheow Heok, Mannion Richard J, Pickard John D, Gurnell Mark

机构信息

Metabolic Research Laboratories Wellcome Trust-MRC Institute of Metabolic Science Departments of Nuclear Medicine Medical Physics Otolaryngology Oncology Neuroradiology Neurosurgery National Institute for Health Research, Cambridge Biomedical Research Centre, University of Cambridge & Addenbrooke's Hospital, Box 289, Hills Road, Cambridge CB2 0QQ, UK.

出版信息

Eur J Endocrinol. 2015 Oct;173(4):M107-20. doi: 10.1530/EJE-15-0616. Epub 2015 Aug 5.

DOI:10.1530/EJE-15-0616

PMID:26245763

Abstract

OBJECTIVE

We report our experience of functional imaging with (11)C-methionine positron emission tomography-computed tomography (PET-CT) co-registered with 3D gradient echo (spoiled gradient recalled (SPGR)) magnetic resonance imaging (MRI) in the investigation of ACTH-dependent Cushing's syndrome.

DESIGN

Twenty patients with i) de novo Cushing's disease (CD, n=10), ii) residual or recurrent hypercortisolism following first pituitary surgery (±radiotherapy; n=8) or iii) ectopic Cushing's syndrome (n=2) were referred to our centre for functional imaging studies between 2010 and 2015. Six of the patients with de novo CD and five of those with persistent/relapsed disease had a suspected abnormality on conventional MRI.

METHODS

All patients underwent (11)C-methionine PET-CT. For pituitary imaging, co-registration of PET-CT images with contemporaneous SPGR MRI (1 mm slice thickness) was performed, followed by detailed mapping of (11)C-methionine uptake across the sella in three planes (coronal, sagittal and axial). This allowed us to determine whether suspected adenomas seen on structural imaging exhibited focal tracer uptake on functional imaging.

RESULTS

In seven of ten patients with de novo CD, asymmetric (11)C-methionine uptake was observed within the sella, which co-localized with the suspected site of a corticotroph microadenoma visualised on SPGR MRI (and which was subsequently confirmed histologically following successful transsphenoidal surgery (TSS)). Focal (11)C-methionine uptake that correlated with a suspected abnormality on pituitary MRI was seen in five of eight patients with residual or recurrent Cushing's syndrome following first TSS (and pituitary radiotherapy in two cases). Two patients elected to undergo repeat TSS with histology confirming a corticotroph tumour in each case. In two patients with the ectopic ACTH syndrome, (11)C-methionine was concentrated in sites of distant metastases, with minimal uptake in the sellar region.

CONCLUSIONS

(11)C-methionine PET-CT can aid the detection of ACTH-secreting tumours in Cushing's syndrome and facilitate targeted therapy.

摘要

目的

我们报告了在促肾上腺皮质激素（ACTH）依赖性库欣综合征的研究中，使用（11）C-蛋氨酸正电子发射断层扫描-计算机断层扫描（PET-CT）与三维梯度回波（扰相梯度回波（SPGR））磁共振成像（MRI）联合进行功能成像的经验。

设计

2010年至2015年间，20例患者被转诊至我们中心进行功能成像研究，其中包括：i）初发库欣病（CD，n = 10）；ii）首次垂体手术后残留或复发的高皮质醇血症（±放疗；n = 8）；iii）异位库欣综合征（n = 2）。初发CD患者中有6例以及持续性/复发性疾病患者中有5例在传统MRI上有可疑异常。

方法

所有患者均接受（11）C-蛋氨酸PET-CT检查。对于垂体成像，将PET-CT图像与同期的SPGR MRI（层厚1毫米）进行配准，然后在三个平面（冠状面、矢状面和横断面）详细描绘蝶鞍区（11）C-蛋氨酸的摄取情况。这使我们能够确定在结构成像上看到的可疑腺瘤在功能成像上是否表现出局灶性示踪剂摄取。

结果

在10例初发CD患者中的7例中，蝶鞍区内观察到不对称的（11）C-蛋氨酸摄取，其与在SPGR MRI上可视化的促肾上腺皮质激素微腺瘤的可疑部位共定位（并且随后在成功的经蝶窦手术（TSS）后经组织学证实）。在首次TSS后残留或复发库欣综合征的8例患者中的5例（其中2例接受了垂体放疗）中，观察到与垂体MRI上的可疑异常相关的局灶性（11）C-蛋氨酸摄取。2例患者选择接受重复TSS，组织学证实每例均为促肾上腺皮质激素肿瘤。在2例异位ACTH综合征患者中，（11）C-蛋氨酸集中在远处转移部位，蝶鞍区摄取极少。