A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome

作者：Olympia Koulouri, Andrea Steuwe, Daniel Gillett, Andrew C.F. Hoole, Andrew Powlson, Neil P. Donnelly, N.G. Burnet, Nagui M. Antoun, Heok Cheow, Richard Mannion, John Douglas Pickard, Mark Gurnell · 发表于：European Journal of Endocrinology · 年份：2015 · DOI：10.1530/eje-15-0616 · 被引用次数：104 · 研究领域：Pituitary Gland Disorders and Treatments、Adrenal and Paraganglionic Tumors、Adrenal Hormones and Disorders

OBJECTIVE: We report our experience of functional imaging with (11)C-methionine positron emission tomography-computed tomography (PET-CT) co-registered with 3D gradient echo (spoiled gradient recalled (SPGR)) magnetic resonance imaging (MRI) in the investigation of ACTH-dependent Cushing's syndrome. DESIGN: Twenty patients with i) de novo Cushing's disease (CD, n=10), ii) residual or recurrent hypercortisolism following first pituitary surgery (±radiotherapy; n=8) or iii) ectopic Cushing's syndrome (n=2) were referred to our centre for functional imaging studies between 2010 and 2015. Six of the patients with de novo CD and five of those with persistent/relapsed disease had a suspected abnormality on conventional MRI. METHODS: All patients underwent (11)C-methionine PET-CT. For pituitary imaging, co-registration of PET-CT images with contemporaneous SPGR MRI (1 mm slice thickness) was performed, followed by detailed mapping of (11)C-methionine uptake across the sella in three planes (coronal, sagittal and axial). This allowed us to determine whether suspected adenomas seen on structural imaging exhibited focal tracer uptake on functional imaging. RESULTS: In seven of ten patients with de novo CD, asymmetric (11)C-methionine uptake was observed within the sella, which co-localized with the suspected site of a corticotroph microadenoma visualised on SPGR MRI (and which was subsequently confirmed histologically following successful transsphenoidal surgery (TSS)). Focal (11)C-met...