Usefulness of 68 Ga-Pentixafor PET/CT on Diagnosis and Management of Cushing Syndrome.

Abstract

PURPOSE:

This pilot study investigated the performance of C-X-C motif chemokine receptor 4 (CXCR4) molecular imaging ( 68 Ga-pentixafor PET/CT) in Cushing syndrome (CS) and the correlation between CXCR4 signaling interactions and glucose metabolism in adrenocorticotropin-cortisol pathway.

METHODS:

We retrospectively evaluated 31 patients (16 patients with CS and 15 patients with nonfunctioning pituitary or adrenal adenomas). All patients underwent 68 Ga-pentixafor PET/CT, and 11 with pituitary adenoma also underwent 18 F-FDG PET/CT. The diagnosis accuracy of 68 Ga-pentixafor PET/CT was calculated. The correlation between radiouptake along the pituitary-adrenal axis and hormone levels was calculated.

RESULTS:

Patients with Cushing disease characterized a focal uptake in adrenocorticotropic hormone-producing pituitary adenoma (ACTH-PA). In ACTH-independent CS, there was increased uptake of 68 Ga-pentixafor in adrenal lesions but not in the pituitary fossa. The nonfunctioning pituitary or adrenal adenomas showed negative 68 Ga-pentixafor signal. The one patient with metastatic ectopic ACTH syndrome had multiple 68 Ga-pentixafor-avid lesions. Using the threshold of SUV max >8.5 in the adrenal lesions, the sensitivity and specificity of 68 Ga-pentixafor PET/CT to diagnose cortisol-producing adenoma were 100% and 84.9%. A cutoff SUV max value of 3.0 on 68 Ga-pentixafor PET/CT had 100% sensitivity and specificity for differentiating ACTH-PA. The corresponding hormone level was significantly correlated with uptake of 68 Ga-pentixafor in pituitary adenoma and adrenal tissue but not with glucose metabolism.

CONCLUSION:

We have characterized the performance of 68 Ga-pentixafor in different subtypes of CS. 68 Ga-pentixafor PET/CT is promising in the differential diagnosis of both ACTH-independent and ACTH-dependent CS. Activated CXCR4 molecular signaling along the pituitary-adrenal axis was found in patients with Cushing disease.

• Authors: Jie Ding, Anli Tong, Marcus Hacker, Ming Feng, Li Huo, Xiang Li
• Journal: Clinical nuclear medicine (Clin Nucl Med) Vol. 47 Issue 8 Pg. 669-676 (Aug 01 2022) ISSN: 1536-0229 [Electronic] United States
• PMID: 35452014 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• 68Ga-pentixafor
• Coordination Complexes
• Peptides, Cyclic
• Adrenocorticotropic Hormone
• Glucose
• Hydrocortisone

Topics

• Adenoma
• Adrenocorticotropic Hormone
• Coordination Complexes
• Cushing Syndrome (diagnostic imaging)
• Glucose
• Humans
• Hydrocortisone
• Peptides, Cyclic
• Pilot Projects
• Pituitary ACTH Hypersecretion
• Pituitary Neoplasms (diagnostic imaging)
• Positron Emission Tomography Computed Tomography (methods)
• Retrospective Studies