Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India.
Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, 560066 Bengaluru, India.
Ann Endocrinol (Paris). 2024 Dec;85(6):596-603. doi: 10.1016/j.ando.2024.07.001. Epub 2024 Jul 11.
To elucidate the role of various imaging modalities for tumor localization in ectopic ACTH Cushing's syndrome (EAS).
Systematic review of the literature published between January 2015-2024 was performed. Patients (290 EAS patients, 23.8% Occult) who underwent contrast enhanced CT (CECT) and at least one PET/CT-scan (Ga-SSTR, FDG and/or F-DOPA) were included.
The sensitivity for identifying EAS tumor was comparable across CECT (63.1%, n=290), SSTR-PET/CT (58.2%, n=187), and FDG-PET/CT (57.6%, n=191), but was poor for DOPA-PET/CT (30.8%, n=26). Sensitivity for detecting metastasis was also comparable across CECT (78%, n=73), SSTR-PET/CT (85.3%, n=41), and FDG-PET (73.7%, n=38). For localised lesions, sensitivity as per etiology and grade of NET were similar for three scans, with exception of Thymic NET and grade 1 NET where CECT was better than FDG PET/CT. In patients not localised on CECT, sensitivity of SSTR PET/CT was 33.3% (vs. 18.9% FDG-PET/CT) whereas for patients negative on CECT and FDG-PET, sensitivity of SSTR-PET/CT was 15%. In cases where CECT and SSTR-PET/CT failed to localize, the sensitivities of FDG-PET/CT and DOPA-PET/CT were only 5.7% (2/35) and 0% (0/9), respectively. SSTR-PET/CT has a distinct advantage with significantly lesser false positive (FP) lesions (2.6%, mostly in thyroid/or pancreas). In comparison, CECT and FDG-PET/CT had FP ∼11% (mostly in lung and/or mediastinum), most of which were negative on SSTR-PET/CT.
As per the current evidence, SSTR-PET/CT can be considered as the scan of choice in EAS evaluation, and further research is needed as one-fourth of the lesions remain occult.
为了阐明各种成像方式在异位 ACTH 库欣综合征 (EAS) 肿瘤定位中的作用。
对 2015 年 1 月至 2024 年期间发表的文献进行了系统回顾。纳入了接受增强 CT（CECT）和至少一次 PET/CT 扫描（Ga-SSTR、FDG 和/或 F-DOPA）的患者（290 例 EAS 患者，23.8%为隐匿性）。
CECT（63.1%，n=290）、SSTR-PET/CT（58.2%，n=187）和 FDG-PET/CT（57.6%，n=191）对 EAS 肿瘤的识别敏感性相当，但 DOPA-PET/CT（30.8%，n=26）的敏感性较差。CECT（78%，n=73）、SSTR-PET/CT（85.3%，n=41）和 FDG-PET（73.7%，n=38）对转移的检测敏感性也相当。对于局限性病变，根据病因和 NET 分级，三种扫描的敏感性相似，但胸腺 NET 和 1 级 NET 除外，CECT 优于 FDG-PET/CT。在 CECT 未定位的患者中，SSTR-PET/CT 的敏感性为 33.3%（vs. FDG-PET/CT 为 18.9%），而在 CECT 和 FDG-PET 均为阴性的患者中，SSTR-PET/CT 的敏感性为 15%。在 CECT 和 SSTR-PET/CT 均未能定位的情况下，FDG-PET/CT 和 DOPA-PET/CT 的敏感性仅为 5.7%（2/35）和 0%（0/9）。SSTR-PET/CT 具有明显的优势，假阳性（FP）病变明显较少（2.6%，主要在甲状腺/胰腺）。相比之下，CECT 和 FDG-PET/CT 的 FP 约为 11%（主要在肺部和/或纵隔），其中大多数在 SSTR-PET/CT 上为阴性。
根据目前的证据，SSTR-PET/CT 可作为 EAS 评估的首选扫描方法，需要进一步研究，因为四分之一的病变仍然隐匿。
