Furnica Raluca Maria, Devuyst France, Mathey Céline, Constantinescu Stefan Matei, De Herdt Carlien, Alexopoulou Orsalia, Lhommel Renaud, Maiter Dominique
Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc UCL, 1200 Bruxelles, Belgium.
Department of Endocrinology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, 1070 Bruxelles, Belgium.
J Clin Endocrinol Metab. 2025 Sep 16;110(10):2845-2852. doi: 10.1210/clinem/dgaf047.
Equivocal or negative pituitary magnetic resonance imaging (MRI) findings pose a significant challenge in the management of persistent or recurrent Cushing disease (CD), compromising the chances of success of further transsphenoidal surgery (TSS).
To determine the diagnostic utility of 11C-methionine (11C-MET) positron emission tomography/computerized tomography (PET/CT) in localizing residual or relapsing corticotroph adenoma.
We retrospectively analyzed the results of all 11C-MET PET/CT performed at 2 tertiary medical centers between May 2002 and November 2023 in 22 patients with persistent/recurrent CD after initial TSS and equivocal/negative pituitary MRI. In 15 cases, 11C-MET PET/CT images were also co-registered with high-resolution 3D T1 or FLAIR MRI pituitary imaging.
Of 22 patients (18 female; mean age 36 years at diagnosis; mean initial tumor maximum diameter 6.5 mm), 13 had a suspect anomaly on conventional MRI and 9 had a negative MRI. Maximal metabolic activity in the suspect area (SUVmaxT) was found in 14 patients (63.5%; 5/9 patients with negative pituitary MRI and 9/13 with equivocal findings). Based on positive imaging, 12 patients underwent repeat TSS, successful in 7, while 2 patients underwent Gamma Knife radiosurgery (GKRS), both resulting in remission (total remission rate of 64%). Among the 5 patients not cured by TSS, the presence of corticotroph adenoma in the resected tissue was found in 3 cases. Positive 11C-MET PET/CT had a detection rate accuracy of 86% (12/14). Of the 8 PET-negative patients, 2 underwent exploratory TSS, with no remission, and 2 underwent GKRS, with 1 long-term remission.
11C-MET PET/CT imaging can provide valuable diagnostic information to detect a corticotroph microadenoma in more than half of patients with persistent/recurrent CD and equivocal or negative MRI findings, allowing targeted TSS or radiosurgery with a global success rate of 64% in the selected subgroup with positive imaging.
垂体磁共振成像（MRI）结果不明确或呈阴性，给持续性或复发性库欣病（CD）的治疗带来了重大挑战，降低了进一步经蝶窦手术（TSS）成功的几率。
确定11C-蛋氨酸（11C-MET）正电子发射断层扫描/计算机断层扫描（PET/CT）在定位残留或复发的促肾上腺皮质激素腺瘤中的诊断效用。
我们回顾性分析了2002年5月至2023年11月期间在两家三级医疗中心对22例初次TSS后持续性/复发性CD且垂体MRI结果不明确/呈阴性的患者进行的所有11C-MET PET/CT检查结果。在15例病例中，11C-MET PET/CT图像还与高分辨率3D T1或液体衰减反转恢复（FLAIR）序列垂体MRI图像进行了配准。
22例患者（18例女性；诊断时平均年龄36岁；初始肿瘤最大直径平均为6.5 mm）中，13例在传统MRI上有可疑异常，9例MRI结果为阴性。14例患者（63.5%；垂体MRI阴性的患者中有5例，结果不明确的患者中有9例）在可疑区域发现最大代谢活性（SUVmaxT）。基于阳性影像学结果，12例患者接受了再次TSS，7例成功，2例接受了伽玛刀放射外科治疗（GKRS），均获得缓解（总缓解率为64%）。在5例TSS未治愈的患者中，3例在切除组织中发现促肾上腺皮质激素腺瘤。11C-MET PET/CT阳性的检测率准确性为86%（12/14）。8例PET阴性的患者中，2例接受了探索性TSS，未获缓解，2例接受了GKRS，1例获得长期缓解。
11C-MET PET/CT成像可为一半以上持续性/复发性CD且MRI结果不明确或呈阴性的患者检测促肾上腺皮质激素微腺瘤提供有价值的诊断信息，使靶向TSS或放射外科治疗在影像学阳性的选定亚组中的总体成功率达到64%。
