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

Olympia Koulouri; Andrea Steuwe; Daniel Gillett; Andrew C Hoole; Andrew S Powlson; Neil A Donnelly; Neil G Burnet; Nagui M Antoun; Heok Cheow; Richard J Mannion; John D Pickard; Mark Gurnell

doi:10.1530/EJE-15-0616

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

Olympia Koulouri, Andrea Steuwe, Daniel Gillett, Andrew C Hoole, Andrew S Powlson, Neil A Donnelly, Neil G Burnet, Nagui M Antoun, Heok Cheow, Richard J Mannion, John D Pickard, Mark Gurnell

Division of Cancer Sciences (L5)

Research output: Contribution to journal › Article › peer-review

Abstract

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-methionine uptake that correlated with a suspected abnormality on pituitary MRI was seen in five of eight patients with residual or recurrent Cushing's syndrome following first TSS (and pituitary radiotherapy in two cases). Two patients elected to undergo repeat TSS with histology confirming a corticotroph tumour in each case. In two patients with the ectopic ACTH syndrome, (11)C-methionine was concentrated in sites of distant metastases, with minimal uptake in the sellar region.

CONCLUSIONS: (11)C-methionine PET-CT can aid the detection of ACTH-secreting tumours in Cushing's syndrome and facilitate targeted therapy.

Original language	English
Pages (from-to)	M107-20
Journal	European Journal of Endocrinology
Volume	173
Issue number	4
DOIs	https://doi.org/10.1530/EJE-15-0616
Publication status	Published - Oct 2015

Keywords

ACTH Syndrome, Ectopic
ACTH-Secreting Pituitary Adenoma
Adenoma
Adolescent
Adult
Aged
Carbon Radioisotopes
Cohort Studies
Female
Humans
Image Processing, Computer-Assisted
Magnetic Resonance Imaging
Male
Methionine
Middle Aged
Pituitary ACTH Hypersecretion
Positron-Emission Tomography
Young Adult
Journal Article
Research Support, Non-U.S. Gov't

Research Beacons, Institutes and Platforms

Manchester Cancer Research Centre

Access to Document

10.1530/EJE-15-0616

Cite this

@article{20f700c9579f40c887083b6f55818fba,

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

abstract = "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-methionine uptake that correlated with a suspected abnormality on pituitary MRI was seen in five of eight patients with residual or recurrent Cushing's syndrome following first TSS (and pituitary radiotherapy in two cases). Two patients elected to undergo repeat TSS with histology confirming a corticotroph tumour in each case. In two patients with the ectopic ACTH syndrome, (11)C-methionine was concentrated in sites of distant metastases, with minimal uptake in the sellar region.CONCLUSIONS: (11)C-methionine PET-CT can aid the detection of ACTH-secreting tumours in Cushing's syndrome and facilitate targeted therapy.",

keywords = "ACTH Syndrome, Ectopic, ACTH-Secreting Pituitary Adenoma, Adenoma, Adolescent, Adult, Aged, Carbon Radioisotopes, Cohort Studies, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Methionine, Middle Aged, Pituitary ACTH Hypersecretion, Positron-Emission Tomography, Young Adult, Journal Article, Research Support, Non-U.S. Gov't",

author = "Olympia Koulouri and Andrea Steuwe and Daniel Gillett and Hoole, {Andrew C} and Powlson, {Andrew S} and Donnelly, {Neil A} and Burnet, {Neil G} and Antoun, {Nagui M} and Heok Cheow and Mannion, {Richard J} and Pickard, {John D} and Mark Gurnell",

note = "{\textcopyright} 2015 European Society of Endocrinology.",

year = "2015",

month = oct,

doi = "10.1530/EJE-15-0616",

language = "English",

volume = "173",

pages = "M107--20",

journal = "European Journal of Endocrinology",

issn = "0804-4643",

publisher = "BioScientifica",

number = "4",

}

TY - JOUR

T1 - A role for 11C-methionine PET imaging in ACTH-dependent Cushing's syndrome

AU - Koulouri, Olympia

AU - Steuwe, Andrea

AU - Gillett, Daniel

AU - Hoole, Andrew C

AU - Powlson, Andrew S

AU - Donnelly, Neil A

AU - Burnet, Neil G

AU - Antoun, Nagui M

AU - Cheow, Heok

AU - Mannion, Richard J

AU - Pickard, John D

AU - Gurnell, Mark

PY - 2015/10

Y1 - 2015/10

N2 - 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-methionine uptake that correlated with a suspected abnormality on pituitary MRI was seen in five of eight patients with residual or recurrent Cushing's syndrome following first TSS (and pituitary radiotherapy in two cases). Two patients elected to undergo repeat TSS with histology confirming a corticotroph tumour in each case. In two patients with the ectopic ACTH syndrome, (11)C-methionine was concentrated in sites of distant metastases, with minimal uptake in the sellar region.CONCLUSIONS: (11)C-methionine PET-CT can aid the detection of ACTH-secreting tumours in Cushing's syndrome and facilitate targeted therapy.

AB - 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-methionine uptake that correlated with a suspected abnormality on pituitary MRI was seen in five of eight patients with residual or recurrent Cushing's syndrome following first TSS (and pituitary radiotherapy in two cases). Two patients elected to undergo repeat TSS with histology confirming a corticotroph tumour in each case. In two patients with the ectopic ACTH syndrome, (11)C-methionine was concentrated in sites of distant metastases, with minimal uptake in the sellar region.CONCLUSIONS: (11)C-methionine PET-CT can aid the detection of ACTH-secreting tumours in Cushing's syndrome and facilitate targeted therapy.

KW - ACTH Syndrome, Ectopic

KW - ACTH-Secreting Pituitary Adenoma

KW - Adenoma

KW - Adolescent

KW - Adult

KW - Aged

KW - Carbon Radioisotopes

KW - Cohort Studies

KW - Female

KW - Humans

KW - Image Processing, Computer-Assisted

KW - Magnetic Resonance Imaging

KW - Male

KW - Methionine

KW - Middle Aged

KW - Pituitary ACTH Hypersecretion

KW - Positron-Emission Tomography

KW - Young Adult

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1530/EJE-15-0616

DO - 10.1530/EJE-15-0616

M3 - Article

C2 - 26245763

SN - 0804-4643

VL - 173

SP - M107-20

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

IS - 4

ER -

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

Abstract

Keywords

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