Zhou Jinxin, Ju Huijun, Zhu Liying, Pan Yu, Lv Jing, Zhang Yifan
Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine.
Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Nucl Med Commun. 2019 May;40(5):539-544. doi: 10.1097/MNM.0000000000000989.
This study aimed to present a proper understanding of the fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) value in localizing the primary lesion in adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome in a relatively large case cohort.
This retrospective study included 47 patients with ACTH-dependent Cushing syndrome, who underwent an F-FDG PET/CT examination in our hospital from November 2010 to January 2018. The serum cortisol, 24 h urine cortisol, serum ACTH, and high-dose dexamethasone suppression test were measured in all the patients. Bilateral inferior petrosal sinus sampling was performed in 28/47 patients. Pituitary magnetic resonance imaging and whole-body F-FDG PET/CT were performed in all patients.
Serum ACTH at 8 a.m. higher than 161.8 pg/ml as the cut-off value showed the best diagnostic accuracy (73.9%) for the successful localization of the primary lesions. In Cushing disease patients, the pituitary maximum standardized uptake value F-FDG PET/CT (n=11) did not show significant differences compared with that in ectopic ACTH syndrome (EAS) patients (n=20). In terms of EAS, the descending order of maximum standardized uptake value was 13.2±8.3 (4.8-26.4) in pancreatic neuroendocrine tumors (n=4), 7.1±2.4 (3.5-10.1) in mediastinal carcinoid (n=11), and 2.0±0.1 (1.9-2.2) in bronchial carcinoid (n=4). This study first reported the F-FDG PET/CT images of ACTH-secreting olfactory neuroblastoma.
Serum ACTH level determines the success rate of localization of the primary ACTH-secreting tumor in ACTH-dependent syndrome. F-FDG PET/CT plays a role in localizing the site for EAS, although it plays a limited role in Cushing disease.
本研究旨在通过一个相对较大的病例队列，恰当理解氟-18-氟脱氧葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在促肾上腺皮质激素（ACTH）依赖性库欣综合征原发病灶定位中的价值。
这项回顾性研究纳入了47例ACTH依赖性库欣综合征患者，他们于2010年11月至2018年1月在我院接受了F-FDG PET/CT检查。对所有患者测定了血清皮质醇、24小时尿皮质醇、血清ACTH以及大剂量地塞米松抑制试验。47例患者中有28例进行了双侧岩下窦采血。所有患者均进行了垂体磁共振成像和全身F-FDG PET/CT检查。
以上午8点时血清ACTH高于161.8 pg/ml作为截断值，对原发病灶成功定位显示出最佳诊断准确性（73.9%）。在库欣病患者中，垂体F-FDG PET/CT最大标准化摄取值（n = 11）与异位ACTH综合征（EAS）患者（n = 20）相比无显著差异。就EAS而言，最大标准化摄取值从高到低依次为：胰腺神经内分泌肿瘤中为13.2±8.3（4.8 - 26.4）（n = 4），纵隔类癌中为7.1±2.4（3.5 - 10.1）（n = 11），支气管类癌中为2.0±0.1（1.9 - 2.2）（n = 4）。本研究首次报道了分泌ACTH的嗅神经母细胞瘤的F-FDG PET/CT图像。
血清ACTH水平决定了ACTH依赖性综合征中原发性ACTH分泌肿瘤的定位成功率。F-FDG PET/CT在EAS的定位中发挥作用，尽管其在库欣病中的作用有限。
