Wu Yue, Wu Yanfei, Yao Boyuan, Ren Shuhua, Wu Shiman, Rui Wenting, He Min, Zhang Shuo, Yu Yifei, Ye Hongying, Zhang Zhaoyun, Ye Zhen, Han Rui, Qiao Nidan, Zhang Yichao, Yu Xuejie, Ma Zengyi, Wang Yongfei, Zhao Yao, Guan Yihui, Xie Fang, Zhang Qilin, Yao Zhenwei
From the Department of Radiology (Yue Wu, S.W., W.R., Z. Yao), Department of Neurosurgery, Shanghai Pituitary Tumor Center (B.Y., Z. Ye, R.H., N.Q., Y. Zhang, X.Y., Z.M., Y. Wang, Y. Zhao, Q.Z.), Department of Nuclear Medicine and PET Center (Yanfei Wu, S.R., Y.G., F.X.), and Department of Endocrinology (M.H., S.Z., Y.Y., H.Y., Z.Z.), Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai 200040, China; Neurosurgical Institute of Fudan University, Shanghai, China (B.Y., Z. Ye, R.H., N.Q., Y. Zhang, X.Y., Z.M., Y. Wang, Y. Zhao, Q.Z.); Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China (B.Y., Z. Ye, R.H., N.Q., Y. Zhang, X.Y., Z.M., Y. Wang, Y. Zhao, Q.Z.); Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China (B.Y., Z. Ye, R.H., N.Q., Y. Zhang, X.Y., Z.M., Y. Wang, Y. Zhao, Q.Z.); and Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Neuroendocrine Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Mass (Q.Z.).
Radiology. 2024 Dec;313(3):e233469. doi: 10.1148/radiol.233469.
Background Gallium 68 (Ga) pentixafor has emerged as a potential C-X-C chemokine receptor type 4 (CXCR4)-targeted radiotracer for neuroendocrine tumor, yet its application in Cushing disease remains uncertain. Purpose To assess the diagnostic accuracy and value of Ga-pentixafor PET/MRI in localizing adrenocorticotropic hormone (ACTH)-secreting pituitary tumors in Cushing disease. Materials and Methods A prospective single-center study was conducted from March 2023 to February 2024 in participants with Cushing disease scheduled for surgical pituitary tumor resection. All participants underwent preoperative Ga-pentixafor PET/MRI and contrast-enhanced MRI. Two radiologists and nuclear medicine physicians analyzed images. Surgical and histologic findings served as the reference standard. Diagnostic performance was compared using the McNemar test. The Wilcoxon signed rank test was used to compare the maximum standardized uptake value (SUV) between tumor and normal pituitary. Correlations between SUV and histopathologic or hormone characteristics were analyzed using the Spearman coefficient and logistic regression tests. Results A total of 43 participants (median age, 37 years [IQR, 31-49 years]; 35 female) were included, with 44 pituitary lesions identified after investigational imaging scans, 41 of which were confirmed as ACTH secreting. Sensitivity and diagnostic accuracy of Ga-pentixafor PET/MRI were 92.7% (38 of 41 lesions; 95% CI: 80.6, 97.5) and 88.6% (39 of 44 lesions; 95% CI: 76.0, 95.0), respectively, which were higher compared with that of contrast-enhanced MRI (78.0% [32 of 41 lesions; 95% CI: 63.3, 88.0] and 77.3% [34 of 44 lesions; 95% CI: 63.0, 87.2], respectively). Both techniques combined improved sensitivity to 100% (41 of 41 lesions; 95% CI: 91.4, 100.0) and accuracy to 95.5% (42 of 44 lesions; 95% CI: 84.9, 99.2) ( = .01). ACTH-secreting pituitary tumors exhibited a higher SUV than normal pituitary (3.9 vs 1.3, < .001). The SUV exhibited a positive correlation with CXCR4 H-score ( = 0.5 [95% CI: 0.2, 0.7], < .001) and ACTH levels ( = 0.4 [95% CI: 0.1, 0.6], = .01). Conclusion Ga-pentixafor PET/MRI demonstrated high sensitivity in localizing ACTH-secreting pituitary tumors. Ga-pentixafor uptake was associated with CXCR4 expression and ACTH level. © RSNA, 2024
镓68（Ga）喷替沙福已成为一种潜在的靶向C-X-C趋化因子受体4（CXCR4）的放射性示踪剂，用于神经内分泌肿瘤，但它在库欣病中的应用仍不确定。目的：评估Ga-喷替沙福PET/MRI在定位库欣病中分泌促肾上腺皮质激素（ACTH）的垂体肿瘤方面的诊断准确性和价值。材料与方法：2023年3月至2024年2月，对计划行垂体肿瘤切除术的库欣病患者进行了一项前瞻性单中心研究。所有参与者均接受了术前Ga-喷替沙福PET/MRI和对比增强MRI检查。两名放射科医生和核医学医生对图像进行了分析。手术和组织学检查结果作为参考标准。使用McNemar检验比较诊断性能。采用Wilcoxon符号秩检验比较肿瘤与正常垂体之间的最大标准化摄取值（SUV）。使用Spearman系数和逻辑回归检验分析SUV与组织病理学或激素特征之间的相关性。结果：共纳入43名参与者（中位年龄37岁[四分位间距，31 - 49岁]；35名女性），经影像学检查发现44个垂体病变，其中41个被确认为分泌ACTH。Ga-喷替沙福PET/MRI的敏感性和诊断准确性分别为92.7%（41个病变中的38个；95%CI：80.6，97.5）和88.6%（44个病变中的39个；95%CI：76.0，95.0），高于对比增强MRI（分别为78.0%[41个病变中的32个；95%CI：63.3，88.0]和77.3%[44个病变中的34个；95%CI：63.0，87.2]）。两种技术联合使用可将敏感性提高到100%（41个病变中的41个；95%CI：91.4,100.0），准确性提高到95.5%（44个病变中的42个；95%CI：84.9，99.2）（P = 0.01）。分泌ACTH的垂体肿瘤的SUV高于正常垂体（3.9对1.3，P < 0.001）。SUV与CXCR4 H评分呈正相关（r = 0.5[95%CI：0.2，0.7]，P < 0.001），与ACTH水平呈正相关（r = 0.4[95%CI：0.1，0.6]，P = 0.01）。结论：Ga-喷替沙福PET/MRI在定位分泌ACTH的垂体肿瘤方面显示出高敏感性。Ga-喷替沙福摄取与CXCR4表达和ACTH水平相关。©RSNA，2024
