Walia Rama, Chakraborty Ananda Mohan, Pandey Somit, Rana Nivedita, Kumar Rajender, Ahuja Chirag, Singh Harmandeep, Dhandapani Sivashanmugam, Sahoo Sushant Kumar, Chhabra Rajesh, Singh Apinderpreet, Bhadada Sanjay Kumar, Mittal B R, Chatterjee Debajyoti, Grossman Ashley, Shukla Jaya
Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
Department of Nuclear Medicine, PGIMER, Chandigarh, 160012, India.
Eur J Nucl Med Mol Imaging. 2025 Apr 30. doi: 10.1007/s00259-025-07304-0.
Localizing the source of adrenocorticotropic hormone (ACTH) in patients with ACTH-dependent Cushing's syndrome (CS) poses significant challenges. There is a pressing need for novel imaging modalities that provide both anatomical delineation and functional confirmation of corticotropinomas.
This study utilized a modified form of desmopressin (mDesmo), an agonist of the V1b receptor, which is overexpressed in tumoral corticotrophs. After modification, radionuclide Ga was chelated to produce a new radiopharmaceutical for positron emission tomography (PET) imaging. A total of 234 patients with CS were screened and 30 underwent [Ga]Ga-mDesmo imaging. Patient demographics and hormonal levels (plasma cortisol and ACTH) were recorded, and the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) and [Ga]Ga-mDesmo was compared, with histopathological evidence of a corticotropinoma serving as the reference standard.
The cohort comprised 10 males (33%, CI: 16-50%) and 20 females (67%, CI: 50-84), with a mean age of 33.5 ± 13.5 years. Of 30 patients with CS, 24 patients had treatment naïve Cushing's disease (CD) of which 17 (71%, CI: 53-89%) had microadenomas and 7 (30%, CI: 12-48%) had macroadenoma; 4 (13%, CI: 0-25%) patients had ectopic Cushing syndrome (ECS). CE-MRI identified lesions in 16 patients (67%, CI: 48-86%), while [Ga]Ga-mDesmo successfully identified corticotropinomas in all 24 patients (100%, CI: 86-100%). In patients with microadenomas, CE-MRI had a diagnostic accuracy of 53% (CI: 29-77%), whereas [Ga]Ga-mDesmo achieved 100% (CI: 86-100%). There was no uptake of [Ga]Ga-mDesmo in the pituitary of patients with ECS.
This study demonstrates that [Ga]Ga-mDesmo imaging is an effective in vivo molecular imaging technique for delineating corticotropinomas, surpassing the accuracy of CE-MRI and BIPSS, regardless of adenoma size.
CTRI/2022/08/044615 dated 03/08/2022.
在促肾上腺皮质激素（ACTH）依赖性库欣综合征（CS）患者中定位促肾上腺皮质激素的来源具有重大挑战。迫切需要能够提供促肾上腺皮质激素瘤解剖学描绘和功能确认的新型成像方式。
本研究使用了一种改良形式的去氨加压素（mDesmo），它是V1b受体的激动剂，在肿瘤性促肾上腺皮质细胞中过表达。经过修饰后，将放射性核素镓螯合以生产一种用于正电子发射断层扫描（PET）成像的新型放射性药物。总共筛选了234例CS患者，其中30例接受了[镓]Ga-mDesmo成像。记录患者的人口统计学信息和激素水平（血浆皮质醇和ACTH），并将对比增强磁共振成像（CE-MRI）和[镓]Ga-mDesmo的诊断准确性与促肾上腺皮质激素瘤的组织病理学证据作为参考标准进行比较。
该队列包括10名男性（33%，置信区间：16 - 50%）和20名女性（67%，置信区间：50 - 84%），平均年龄为33.5 ± 13.5岁。在30例CS患者中，24例为未经治疗的库欣病（CD），其中17例（71%，置信区间：53 - 89%）为微腺瘤，7例（30%，置信区间：12 - 48%）为大腺瘤；4例（13%，置信区间：0 - 25%）患者患有异位库欣综合征（ECS）。CE-MRI在16例患者（67%，置信区间：48 - 86%）中发现了病变，而[镓]Ga-mDesmo在所有24例患者（100%，置信区间：86 - 100%）中成功识别出促肾上腺皮质激素瘤。在微腺瘤患者中，CE-MRI的诊断准确性为53%（置信区间：29 - 77%），而[镓]Ga-mDesmo达到了100%（置信区间：86 - 100%）。ECS患者的垂体未摄取[镓]Ga-mDesmo。
本研究表明，[镓]Ga-mDesmo成像对于描绘促肾上腺皮质激素瘤是一种有效的体内分子成像技术，无论腺瘤大小，其准确性均超过CE-MRI和双侧岩下窦采血（BIPSS）。
CTRI/2022/08/044615，日期为2022年8月3日。
