Introduction: Cushing syndrome (CS) is a medical condition resulting from prolonged hypercortisolemia. The most common reason for endogenous CS is ACTH overproduction by pituitary adenoma, and then it is called Cushing disease (CD). The gold standard of CD diagnostic remains bilateral inferior petrosal sinus sampling (BIPSS); nevertheless, non-invasive diagnostic methods are being sought to provide a higher safety profile. The aim of this study was to evaluate whether [11C]C-MET PET/CT can serve as a non-invasive alternative to BIPSS and MRI in CD diagnosis.Methods: This prospective study included 21 patients with CD who underwent BIPSS, MRI of the pituitary, and [11C]C-MET PET/CT.Results: Sensitivity of BIPSS, MRI and [11C]C-MET PET/CT was 100%, 59% and 24%, respectively, while specificity was 100%, 75%, and 13%. Next, we retrospectively compared PET/CT results for patients with corticotrope pituitary adenomas (n= 18) with those for individuals with no pituitary pathology (n= 18), and the results showed significantly higher SUVmaxin the study group (3.74 ± 0.90 vs. 1.87 ± 1.17;p< 0.001). In ROC curve analysis, the area under the curve (AUC) was 0.889 (p<0.001; 95% CI 0.784–0.994). For SUVmax2.60, the calculated sensitivity and specificity were 89% and 78% respectively, and for SUVmax3.56, sensitivity and specificity were 67% and 89%, respectively.Conclusions: [11C]C-MET PET/CT seems not to be a reliable diagnostic option in the diagnosis of pituitary corticotropic adenomas. BIPSS proved still to be the best diagnostic option for CD. Nevertheless, a higher than normal pituitary accumulation of the radiotracer may suggest the presence of increased amino acid metabolism, thus, the presence of adenoma.
引言：库欣综合征（CS）是一种由长期皮质醇过多引起的疾病。内源性CS最常见的原因是垂体腺瘤过度分泌促肾上腺皮质激素（ACTH），此时称为库欣病（CD）。CD诊断的金标准仍是双侧岩下窦采样（BIPSS），但医学界正寻求非侵入性诊断方法以提高安全性。本研究旨在评估[11C]C-MET PET/CT能否作为BIPSS和MRI在CD诊断中的非侵入性替代方案。 方法：这项前瞻性研究纳入21例CD患者，所有患者均接受BIPSS、垂体MRI和[11C]C-MET PET/CT检查。 结果：BIPSS、MRI和[11C]C-MET PET/CT的敏感性分别为100%、59%和24%，特异性分别为100%、75%和13%。随后，我们回顾性比较了促肾上腺皮质激素垂体腺瘤患者（n=18）与无垂体病变者（n=18）的PET/CT结果，显示研究组的SUVmax显著更高（3.74±0.90 vs. 1.87±1.17；p<0.001）。ROC曲线分析显示曲线下面积（AUC）为0.889（p<0.001；95% CI 0.784–0.994）。当SUVmax阈值为2.60时，计算的敏感性和特异性分别为89%和78%；阈值为3.56时，敏感性和特异性分别为67%和89%。 结论：[11C]C-MET PET/CT似乎不是诊断促肾上腺皮质激素垂体腺瘤的可靠选择。BIPSS仍被证明是CD的最佳诊断方案。然而，放射性示踪剂在垂体的积累高于正常水平可能提示氨基酸代谢增强，进而提示腺瘤存在。
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