Use of 18F-FDG PET/CT to Differentiate Ectopic Adrenocorticotropic Hormone-Secreting Lung Tumors From Tumor-Like Pulmonary Infections in Patients With Ectopic Cushing Syndrome

BackgroundEctopic adrenocorticotropic hormone (ACTH)-secreting lung tumors represent the most common cause of ectopic Cushing syndrome (ECS). Pulmonary opportunistic infections are associated with ECS. The present study aimed to evaluate the usefulness of 18F-FDG PET/CT for differentiating ectopic ACTH-secreting lung tumors from tumor-like pulmonary infections in patients with ECS.MethodsWe retrospectively reviewed the imaging data of 24 patients with ECS who were suspected to have ACTH-secreting lung tumors and underwent 18F-FDG PET/CT between 2008 and 2019. Eleven patients with lung tumors and 4 with pulmonary infections also had additional somatostatin receptor imaging (99mTc-HYNIC-TOC SPECT/CT or 68Ga-DOTATATE PET/CT).ResultsIn total, 18 patients had lung tumors and six had pulmonary infections. The primary source of ECS remained occult in the six patients with pulmonary infections. The maximum standardized uptake value (SUVmax) for pulmonary infections was significantly higher than that for tumors (P = 0.008). Receiver operating characteristic analysis revealed that a cut-off SUVmax of 4.95 helped in differentiating ACTH-secreting lung tumors from infections with 75% sensitivity and 94.4% specificity. For the 11 patients with ACTH-lung tumors, somatostatin receptor imaging (SRI) was positive in 6; while for the 4 with pulmonary infections, SRI was positive in 2. The sensitivity and specificity of somatostatin receptor imaging (SRI) for detecting ACTH-secreting lung tumor was 54.5% and 50%.ConclusionsOur findings suggest that pulmonary infections exhibit significantly higher FDG uptake than ACTH-secreting lung tumors in 18F-FDG PET/CT. An SUVmax cut-off value of 4.95 may be useful for differentiating the two conditions. Our results also suggested that SRI may not be an effective tool for differentiating the two conditions given the relatively low specificity.

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Use of 18F-FDG PET/CT to differentiate ectopic adrenocorticotropic hormone-secreting lung tumors from tumor-like pulmonary infections in patients with ectopic Cushing syndrome

10.21203/rs.3.rs-403749/v1 ◽

2021 ◽

Author(s):

Guozhu Hou ◽

Yuanyuan Jiang ◽

Fang Li ◽

Xin Cheng

Keyword(s):

Fdg Pet ◽

Adrenocorticotropic Hormone ◽

Cushing Syndrome ◽

Lung Tumors ◽

Pulmonary Infections ◽

Pet Ct ◽

Ectopic Adrenocorticotropic Hormone ◽

Well Differentiated ◽

Fdg Pet Ct ◽

Acth Secreting

Abstract Background: Ectopic adrenocorticotropic hormone (ACTH)-secreting lung tumors represent the most common cause of ectopic Cushing syndrome (ECS). Pulmonary opportunistic infections are associated with ECS and occasionally difficult to differentiate from tumors by using computed tomography (CT) alone. The present study aimed to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT (18F-FDG PET/CT) for differentiating ectopic ACTH-secreting lung tumors from tumor-like pulmonary infections in patients with ECS.Methods: We retrospectively reviewed the imaging data for 24 patients with ECS who were suspected to have ACTH-secreting lung tumors and underwent 18F-FDG PET/CT between 2008 and 2019. Part of the 24 patients underwent 99mTc-HYNIC-TOC scintigraphy and 68Ga-DOTA-TATE PET/CT.Results: In total, 18 patients had lung tumors and six had pulmonary infections. The primary source of ECS remained occult in the six patients with pulmonary infections. The maximum standardized uptake value (SUVmax) for pulmonary infections was significantly higher than that for tumors (P = 0.008). Receiver operating characteristic analysis was performed, and it was found that a cut-off SUVmax of 4.95 helped in differentiating lung tumors from infections with 75% sensitivity and 94.4% specificity. In a subgroup analysis of 12 typical and five atypical carcinoids, there was no significant between-group difference with respect to SUVmax, the lesion size, the ACTH level, and the prevalence of regional lymph node metastasis. Four out of 6 patients with 5 infectious lesions and 16 out of 18 patients with 16 ACTH-secreting tumors underwent 99mTc-HYNIC-TOC scintigraphy, and 1/6 patients with 1 infectious lesion, and 6 out of 18 patients with 6 ACTH-secreting tumors underwent 68Ga-DOTA-TATE PET/CT. There is no significant difference in sensitivity between tumor lesions and infections using 99mTc-HYNIC-TOC scintigraphy. Conclusions: Our findings suggest that pulmonary infections exhibit significantly higher FDG uptake than do well-differentiated ACTH-secreting lung tumors in 18F-FDG PET/CT. Therefore, SUVmax (cut-off 4.95) may be useful for differentiating the two conditions. However, 99mTc-HYNIC-TOC scintigraphy is of no value in distinguishing the focus of well-differentiated ACTH-secreting lung tumors from that of infection. Typical and atypical ACTH-secreting lung carcinoids may show similar clinical behavior and appearance on 18F-FDG PET/CT.

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Use of 18F-FDG PET/CT to differentiate ectopic adrenocorticotropic hormone-secreting lung tumours from tumour-like pulmonary infections in patients with ectopic Cushing syndrome

10.21203/rs.3.rs-16145/v1 ◽

2020 ◽

Author(s):

Guozhu Hou ◽

Yuanyuan Jiang ◽

Fang Li ◽

Xin Cheng

Keyword(s):

Fdg Pet ◽

Adrenocorticotropic Hormone ◽

Cushing Syndrome ◽

Pulmonary Infections ◽

Lung Tumours ◽

Pet Ct ◽

18F Fdg ◽

Ectopic Adrenocorticotropic Hormone ◽

Fdg Pet Ct ◽

Acth Secreting

Abstract Purpose: Ectopic adrenocorticotropic hormone (ACTH)-secreting lung tumours represent the most common cause of ectopic Cushing syndrome (ECS). Pulmonary opportunistic infections are associated with ECS and occasionally difficult to differentiate from tumours by using computed tomography (CT) alone. The aim of the present study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT (18F-FDG PET/CT) for differentiating ectopic ACTH-secreting lung tumours from tumour-like pulmonary infections in patients with ECS.Methods: We retrospectively reviewed the imaging data for 24 patients with ECS who were suspected to have ACTH-secreting lung tumours and underwent 18F-FDG PET/CT between 2008 and 2019.Results: In total, 18 patients had lung tumours (17 carcinoids and 1 small cell lung cancer) and six had pulmonary infections (cryptococcosis, n = 3; aspergillosis, n = 4; pulmonary abscess, n = 1). The primary source of ECS remained occult in the six patients with pulmonary infections. The maximum standardized uptake value (SUVmax) for pulmonary infections was significantly higher than that for tumours (P = 0.008). Receiver operating characteristic analysis was performed, and it was found that a cut-off SUVmax of 4.95 helped in differentiating lung tumours from infections with 75% sensitivity and 94.4% specificity. In subgroup analysis of 12 typical and five atypical carcinoids, there was no significant between-group difference with respect to SUVmax, the lesion size, the ACTH level, and the prevalence of regional lymph node metastasis.Conclusions: Our findings suggest that pulmonary infections exhibit significantly higher FDG uptake than do ACTH-secreting lung tumours in 18F-FDG PET/CT. Therefore, SUVmax (cut-off 4.95) may be useful for differentiating the two conditions. Typical and atypical ACTH-secreting lung carcinoids may show a similar clinical behaviour and appearance on 18F-FDG PET/CT.

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Hybrid SPECT/CT Somatostatin Receptor Imaging of Neuroendocrine Tumours

Medicina Fluminensis ◽

10.21860/medflum2021_365323 ◽

2021 ◽

Vol 57 (1) ◽

pp. 73-80

Author(s):

Matej Maršić ◽

Svjetlana Grbac-Ivanković ◽

Tatjana Bogović Crnčić ◽

Ivan Pribanić ◽

Neva Girotto ◽

...

Keyword(s):

Fdg Pet ◽

Neuroendocrine Tumours ◽

Somatostatin Receptor ◽

Receptor Imaging ◽

Somatostatin Receptor Imaging ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Cilj: Cilj rada bio je procijeniti doprinos jednofotonske emisijske tomografije / kompjutorizirane tomografije somatostatinskih receptora (SR SPECT/CT) s 99mTc-EDDA/HYNIC-Tyr3-oktreotidom (99mTc-Tektrotyd) u dijagnostici i procjeni proširenosti bolesti kod pacijenata oboljelih od neuroendokrinih tumora (NET-ova). Ispitanici i metode: Retrospektivno je analizirano 120 SR SPECT/CT snimanja pacijenata s patohistološki dokazanim NET-om s obzirom na vizualizaciju primarnih lezija i metastaza. U 45 pacijenata učinjena je i pozitronska emisijska tomografija 18F-fluorodeoksiglukozom (18F-FDG PET/CT) te su nalazi uspoređeni s nalazima SR SPECT/CT-a i vrijednostima kromogranina A. Rezultati: Od 120 pacijenata 47 (39 %) je na SR SPECT/CT upućeno nakon odstranjenja primarne lezije. Od preostala 73 pacijenta (61 %), u 56 (77 %) primarni je tumor bio vidljiv SR SPECT/CT-om, a u 9 (12 %) poznata lezija nije akumulirala radiofarmak. U 8 (11 %) pacijenata s NET-om nepoznatog primarnog sijela nalaz je bio negativan. Od 68 (57 %) pacijenta s dokazanim metastazama, u njih 57 (84 %) bile su vidljive SR SPECT/CT-om, a u 11 (16 %) nisu akumulirale radiofarmak. Od 45 (38 %) pacijenata kojima je učinjen i 18F-FDG PET/CT, u 27 (60 %) detekcija primarnih lezija i metastaza bila je sukladna nalazu SR SPECT/CT-a. Osjetljivost SR SPECT/CT-a bila je 77 % za primarne lezije i 84 % za metastaze, a 18F-FDG PET/CT-a 75 % za primarne lezije i 76 % za metastaze. Vrijednosti kromogranina A nisu pokazale statistički signifikantnu korelaciju s nalazima slikovne dijagnostike. Zaključci: SR SPECT/CT ima visoku osjetljivost za detekciju NET-ova. Osim toga, potvrđena je komplementarnost s 18F-FDG PET/CT-om te kod pacijenata s negativnim nalazom SR SPECT/CT-a treba učiniti 18F-FDG PET/CT i obrnuto.

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Role of Combined [68Ga]Ga-DOTA-SST Analogues and [18F]FDG PET/CT in the Management of GEP-NENs: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm8071032 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1032 ◽

Cited By ~ 11

Author(s):

Luciano Carideo ◽

Daniela Prosperi ◽

Francesco Panzuto ◽

Ludovica Magi ◽

Maria Sole Pratesi ◽

...

Keyword(s):

Fdg Pet ◽

Gamma Camera ◽

Somatostatin Receptor ◽

Clinical History ◽

Receptor Imaging ◽

Prognostic Information ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Gastro-entero-pancreatic neuroendocrine neoplasia (GEP-NENs) are rare tumors, but their frequency is increasing. Neuroendocrine tumors normally express somatostatin (SST) receptors (SSTR) on cell surface, especially G1 and G2 stage tumors, but they can show a dedifferentiation in their clinical history as they become more aggressive. Somatostatin receptor imaging has previously been performed with a gamma camera using [111In]In or [99mTc]Tc-labelled compounds, while [68Ga]Ga-labelled compounds and PET/CT imaging has recently become the gold standard for the diagnosis and management of these tumors. Moreover, in the last few years 18F-fluorodeoxyglucose ([18F]FDG) PET/CT has emerged as an important tool to define tumor aggressiveness and give relevant prognostic information, particularly when coupled with [68Ga]Ga-labelled SST analogues PET/CT. This review focuses on the importance of combined imaging with [68Ga]Ga-labelled SST analogues and [18F]FDG for the management of GEP-NENs.

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A pictoral review on somatostatin receptor scintigraphy in neuroendocrine tumors: The role of multimodality imaging with SRS and GLUT receptor imaging with FDG PET-CT

Indian Journal of Radiology and Imaging ◽

10.4103/0971-3026.111478 ◽

2012 ◽

Vol 22 (4) ◽

pp. 267 ◽

Cited By ~ 3

Author(s):

Venkatesh Rangarajan ◽

Sneha Shah ◽

Nilendu Purandare ◽

Archi Agrawal

Keyword(s):

Neuroendocrine Tumors ◽

Fdg Pet ◽

Multimodality Imaging ◽

Somatostatin Receptor ◽

Somatostatin Receptor Scintigraphy ◽

Receptor Imaging ◽

Pet Ct ◽

Receptor Scintigraphy ◽

Fdg Pet Ct

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18F-FDG-PET/CT findings of granulocyte colony stimulating factor (G-CSF)-producing lung tumors

Annals of Nuclear Medicine ◽

10.1007/s12149-008-0146-z ◽

2008 ◽

Vol 22 (7) ◽

pp. 635-639 ◽

Cited By ~ 25

Author(s):

Miyako Morooka ◽

Kazuo Kubota ◽

Yuji Murata ◽

Hitoshi Shibuya ◽

Kimiteru Ito ◽

...

Keyword(s):

Fdg Pet ◽

Lung Tumors ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Ct Findings ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Stimulating Factor ◽

Factor G

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Effect of Peptide Receptor Radionuclide Therapy on Somatostatin Receptor Status and Glucose Metabolism in Neuroendocrine Tumors: Intraindividual Comparison of Ga-68 DOTANOC PET/CT and F-18 FDG PET/CT

International Journal of Molecular Imaging ◽

10.1155/2011/524130 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 18

Author(s):

Sowon Oh ◽

Vikas Prasad ◽

Dong Soo Lee ◽

R. P. Baum

Keyword(s):

Glucose Metabolism ◽

Neuroendocrine Tumors ◽

Fdg Pet ◽

Radionuclide Therapy ◽

Somatostatin Receptor ◽

Peptide Receptor Radionuclide Therapy ◽

Receptor Expression ◽

Peptide Receptor ◽

Pet Ct ◽

Fdg Pet Ct

The heterogeneous nature of the neuroendocrine tumors (NET) makes it challenging to find one uniformly applicable management protocol which is especially true for diagnosis. The discovery of the overexpression of somatostatin receptors (SMS-R) on neuroendocrine tumor cells lead to the generalized and rapid acceptance of radiolabeled somatostatin receptor analogs for staging and restaging of NET as well as for Peptide Receptor Radionuclide Therapy (PRRNT) using Y-90 and Lu-177 DOTATATE/DOTATOC. In this present work we tried to look in to the effect of PRRNT on the glucose metabolism assessed by F-18 FDG PET/CT and SMS-R density assessed by Ga-68 DOTANOC PET/CT. We observed a complex relationship between the somatostatin receptor expression and glucose metabolism with only 56% (77/138) of the lesions showing match, while the others show mismatch between the receptor status and metabolism. The match between receptor expression and glucose metabolism increases with the grade of NET. In grade 3 NET, there is a concurrence between the changes in glucose metabolism and somatostatin receptor expression. PRRNT was found to be more effective in lesions with higher receptor expression.

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