Abstract
Increased glucose metabolism through the activation of aerobic glycolysis is a central feature of malignant transformation and progression (the Warburg effect) [1]. Malignant tumors can be detected with high sensitivity and specificity by imaging their increased metabolic rate for glucose; and positron emission tomography (PET) using the glucose analog fluorine-18 labeled fluoro-deoxyglucose ([18F]-FDG) has become a routine clinical imaging strategy for staging and restaging most solid tumors. In recent years, metabolic imaging has been increasingly combined with computed tomography (CT) imaging for precise anatomic localization resulting in fusion PET-CT. After intravenous injection [18F]-FDG is transported across cell membrane by sodium-independent, facilitative glucose transporters (GLUTs), and in most malignant tumors GLUT1 is frequently highly expressed. Intracellularly, [18F]-FDG is phosphorylated by hexokinase to [18F]-FDG-6 phosphate, which cannot be further metabolized in the glycolytic pathway and becomes trapped within the cell steadily accumulating in metabolically active cells [2]. This process has enabled accurate metabolic imaging of malignant tumors based on their increased rate of metabolism and glucose utilization as compared to surrounding normal tissues.
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Gillies RJ et al (2008) Causes and consequences of increased glucose metabolism of cancers. J Nucl Med 49(Suppl 2):24S–42S
Plathow C, Weber WA (2008) Tumor cell metabolism imaging. J Nucl Med 49 (Suppl 2):43S–63S
Hedeland H et al (1968) On the prevalence of adrenocortical adenomas in an autopsy material in relation to hypertension and diabetes. Acta Med Scand 184:211–214
Abrams HL et al (1950) Metastases in carcinoma: analysis of 1000 autopsied cases. Cancer 3:74–85
Boland GW et al (1995) Indeterminate adrenal mass in patients with cancer: evaluation at PET with 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology. 194(1):131–134.
Kumar R et al (2004) 18F-FDG PET in evaluation of adrenal lesions in patients with lung cancer. J Nucl Med 45(12):2058–2062
Jana S et al (2006) FDG-PET and CT characterization of adrenal lesions in cancer patients. Eur J Nucl Med Mol Imaging 33(1):29–35
Metser U et al (2006) 18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med 47(1):32–37
Kim HK et al (2007) Preoperative evaluation of adrenal lesions based on imaging studies and laparoscopic adrenalectomy in patients with otherwise operable lung cancer. Lung Cancer 58(3):342–347
Brady MJ et al (2009) Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer: a proposal for an efficient diagnostic algorithm. Radiology 250(2):523–530
Boland GW et al (1998) Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol 171:201–204
Blake MA et al (2006) Adrenal lesions: characterization with fused PET/CT image in patients with proved or suspected malignancy – initial experience. Radiology 238(3):970–977
Han SJ et al (2007) Analysis of adrenal masses by 18F-FDG positron emission tomography scanning. Int J Clin Pract 61(5):802–809
Shimizu A et al (2003) High [18F] 2-fluoro-2-deoxy-D-glucose (FDG) uptake of adrenocortical adenoma showing subclinical Cushing’s syndrome. Ann Nucl Med 17(5):403–406
Rao SK et al (2004) F-18 fluorodeoxyglucose positron emission tomography-positive benign adrenal cortical adenoma: imaging features and pathologic correlation. Clin Nucl Med 29(5):300–302
Yun M et al (2001) 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med 42(12):1795–1799
Maurea S et al (1999) Imaging of adrenal tumors using FDG PET: comparison of benign and malignant lesions. AJR Am J Roentgenol.173(1):25–29
Shulkin BL et al (1999) Pheochromocytomas: imaging with 2-[fluorine-18]fluoro-2-deoxy-D-glucose PET. Radiology. 212:35–41
Chong S et al (2006) Integrated PET-CT for the characterization of adrenal gland lesions in cancer patients: diagnostic efficacy and interpretation pitfalls. Radiographics 26(6):1811–1824; discussion 1824–1826
Caoili EM et al (2007) Differentiating adrenal adenomas from nonadenomas using (18)F-FDG PET/CT: quantitative and qualitative evaluation. Acad Radiol 14(4):468–475
Vikram R et al (2008) Utility of PET/CT in differentiating benign from malignant adrenal nodules in patients with cancer. AJR Am J Roentgenol 191(5):1545–1551
Blake MA et al (2004) Collision adrenal tumors on PET/CT. AJR Am J Roentgenol 183(3):864–865
Boland GW et al (2009) PET/CT for the characterization of adrenal masses in patients with cancer: qualitative versus quantitative accuracy in 150 consecutive patients. AJR Am J Roentgenol 192(4):956–962
Cook DM, Loriaux LD (1996) The incidental adrenal mass. Am J Med 101:88–94
Herrera MF et al (1991) Incidentally discovered adrenal tumors: an institutional perspective. Surgery 110:1014–1021
Han SJ et al (2007) Analysis of adrenal masses by 18F-FDG positron emission tomography scanning. Int J Clin Pract 61(5):802–809
Tessonnier L et al (2008) Does 18FFDG PET/CT add diagnostic accuracy in incidentally identified non-secreting adrenal tumours? Eur J Nucl Med Mol Imaging 35(11):2018–2025
Tenenbaum F et al (2004) 18F-fluorodeoxyglucose Adrenocortical tumours? Preliminary results in 13 consecutive patients. Eur J Endocrinol 150:789–792
Zettinig G et al (2004) Positron emission tomography imaging of adrenal masses: (18)F-fluorodeoxyglucose and the 11_-hydroxylase tracer (11)C-metomidate. Eur J Nucl Med Mol Imaging 31:1224–1230
Luton JP et al (1990) Clinical features of ACC, prognostic factors, and the effect of mitotane therapy. N Engl J Med 322:1195
Icard P et al (2001) ACCs: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons Study Group. World J Surg 25:891–897
Kendrick ML et al (2001) ACC: surgical progress or status quo? Arch Surg 136:543–549
Schulick RD, Brennan MF (1999) Long-term survival after complete resection and repeat resection in patients with ACC. Ann Surg Oncol 6:719–726
Weiss LM et al (1989) Pathologic features of prognostic significance in ACC. Am J Surg Pathol 13:202–206
Gross MD et al (2007) PET in the diagnostic evaluation of adrenal tumors. Q J Nucl Med Mol Imaging 51:272–283
Becherer A et al (2001) FDG-PET in ACC. Cancer Biother Radiopharm 16(4):289–295
Leboulleux S et al (2006) Diagnostic and prognostic value of 18-fluorodeoxyglucose positron emission tomography in ACC: a prospective comparison with computed tomography. J Clin Endocrinol Metab 91(3):920–925
Mackie GC et al (2006) Use of [18F]fluorodeoxyglucose positron emission tomography in evaluating locally recurrent and metastatic ACC. J Clin Endocrinol Metab 91(7):2665–2671. Epub 2006 Apr 18. PubMed PMID: 16621901
Groussin L et al (2009) 18F-Fluorodeoxyglucose positron emission tomography for the diagnosis of Adrenocortical tumors: a prospective study in 77 operated patients. J Clin Endocrinol Metab 94(5):1713–1722
Kreissig R et al (2000) The use of FDG-PET and CT for the staging of ACC in children. Pediatr Radiol 30(5):306
Binkovitz I et al (2008) Early detection of recurrent pediatric adrenal cortical carcinoma using FDG-PET. Clin Nucl Med 33(3):186–188
Lieberman LM et al (1971) Diagnosis of adrenal disease by visualization of human adrenal glands with 131 I-19-iodocholesterol. N Engl J Med 285:1387–1393
Beierwaltes WH et al (1971) Visualization of human adrenal glands in vivo by scintillation scanning. JAMA 216:275–277
Sarkar SD et al (1975) A new and superior adrenal scanning agent, NP-59. J Nucl Med 16:1038–1042
Sarkar SD et al (1977) A new and superior adrenal imaging agent, 131I-6beta-iodomethyl-19-nor-cholesterol (NP-59): evaluation in humans. J Clin Endocrinol Metab 45:353–362
Rizza RA et al (1978) Visualization of nonfunctioning adrenal adenomas with iodocholesterol: possible relationship to subcellular distribution of tracer. J Nucl Med 19:458–463
Gross MD et al (1981) The role of pharmacologic manipulation in adrenal cortical scintigraphy. Semin Nucl Med 11:128–148
Gordon L et al (1980) Failure to visualize adrenal glands in a patient with bilateral adrenal hyperplasia. J Nucl Med 21:49–51
Lynn MD et al (1986) The influence of hypercholesterolaemia on the adrenal uptake and metabolic handling of 131I-6 beta-iodomethyl-19-norcholesterol (NP-59). Nucl Med Commun 7:631–637
Counsell RE et al (1980) Tissue distribution of high-density lipoprotein labeled with radioiodinated cholesterol. J Nucl Med 21:852–858
Nordblom GD et al (1980) A comparison of cholesteryl oleate and 19-iodocholesteryl oleate as substrates for adrenal cholesterol esterase. J Steroid Biochem 13:463–466
Lynn MD et al (1986) Enterohepatic circulation and distribution of 131I-6 beta-iodomethyl-19-norcholesterol (NP-59). Nucl Med Commun 7:625–630
Rubello D et al (2002) Functional scintigraphy of the adrenal gland. Eur J Endocrinol 147:13–28
Shapiro B et al (1983) Value of bowel preparation in adrenocortical scintigraphy with NP-59. J Nucl Med 24:732–734
Kampen WU (2003) Significance of 131I-Norvholesterol Scintigraphy for Diagnosis of Adrenal Dysfunction. Der Nuklearmediziner 26:21–24
Gross MD et al (1984) Scintigraphic localization of adrenal lesions in primary aldosteronism. Am J Med 77:839–844
Yen RF et al (2009) 131I-6beta-iodomethyl-19-norcholesterol SPECT/CT for primary aldosteronism patients with inconclusive adrenal venous sampling and CT results. J Nucl Med 50:1631–1637
Avram AM et al (2006) Adrenal gland scintigraphy. Semin Nucl Med 36:212–227
Gross MD et al (1987) Functional and scintigraphic evaluation of the silent adrenal mass. J Nucl Med 28:1401–1407
Kazerooni EA et al (1990) Diagnostic accuracy and pitfalls of [iodine-131]6-beta-iodomethyl-19-norcholesterol (NP-59) imaging. J Nucl Med 31:526–534
Maurea S et al (2001) The diagnostic role of radionuclide imaging in evaluation of patients with nonhypersecreting adrenal masses. J Nucl Med 42:884–892
Gross MD et al (1984) The relationship of I-131 6 beta-iodomethyl-619-norcholesterol (NP-59) adrenal cortical uptake to indices of androgen secretion in women with hyperandrogenism. Clin Nucl Med 9:264–270
Gross MD et al (1999) Radionuclide imaging of the adrenal cortex. Q J Nucl Med 43:224–232
Kloos RT et al (1995) Incidentally discovered adrenal masses. Endocr Rev 16:460–484
Thompson GB, Young WF Jr. (2003) Adrenal incidentaloma. Curr Opin Oncol 15:84–90
Kloos RT et al (1997) Diagnostic dilemma of small incidentally discovered adrenal masses: role for 131I-6beta-iodomethyl-norcholesterol scintigraphy. World J Surg 21:36–40
Rifai A et al (1978) Adrenal scintigraphy in low renin essential hypertension. Clin Nucl Med 3:282–286
Chen YC et al (2009) Seeking the invisible: I-131 NP-59 SPECT/CT for primary hyperaldosteronism. Kidney Int 75:663
Volpe C et al (2008) The role of adrenal scintigraphy in the preoperative management of primary aldosteronism. Scand J Surg 97:248–253
Simon DR. Palese MA (2008) Noninvasive adrenal imaging in hyperaldosteronism. Curr Urol Rep 9:80–87
Moses DC et al (1974) Efficacy of radiocholesterol imaging of the adrenal glands in Cushing’s syndrome. Surg Gynecol Obstet 139:201–204
Gross MD et al (1983) The relationship of adrenal gland iodomethylnorcholesterol uptake to zona glomerulosa function in primary aldosteronism. J Clin Endocrinol Metab 57:477–481
Barzon L et al (1998) Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates. J Clin Endocrinol Metab 83:55–62
La Cava G et al (2003) SPECT semiquantitative analysis of adrenocortical (131)I-6 beta iodomethyl-norcholesterol uptake to discriminate subclinical and preclinical functioning adrenal incidentaloma. J Nucl Med 44:1057–1064
Donadio F et al (2009) Role of adrenal gland scintigraphy in patients with subclinical hypercortisolism and incidentally discovered adrenal mass. J Endocrinol Invest 32:576–580
Barzon L et al (2001) Overnight dexamethasone suppression of cortisol is associated with radiocholesterol uptake patterns in adrenal incidentalomas. Eur J Endocrinol 145:223–224
Barzon L et al (1999) Risk factors and long-term follow-up of adrenal incidentalomas. J Clin Endocrinol Metab 84:520–526
Yoh T et al (2008) Quantitative evaluation of norcholesterol scintigraphy, CT attenuation value, and chemical-shift MR imaging for characterizing adrenal adenomas. Ann Nucl Med 22:513–519
Maurea S et al (2002) Diagnostic accuracy of radionuclide imaging using 131I nor-cholesterol or meta-iodobenzylguanidine in patients with hypersecreting or non-hypersecreting adrenal tumours. Nucl Med Commun 23:951–960
Lumachi F et al (2003) Non-invasive adrenal imaging in primary aldosteronism. Sensitivity and positive predictive value of radiocholesterol scintigraphy, CT scan and MRI. Nucl Med Commun 24:683–688
Lumachi F et al (2002) Usefulness of CT scan, MRI and radiocholesterol scintigraphy for adrenal imaging in Cushing’s syndrome. Nucl Med Commun 23:469–473
Maurea S et al (2004) Imaging characterization of non-hypersecreting adrenal masses. Comparison between MR and radionuclide techniques. Q J Nucl Med Mol Imaging 48:188–197
Reschini E et al (1984) Uptake of 75Se-selenomethylcholesterol by a nonfunctioning adrenocortical adenoma. J Nucl Med Allied Sci 28:221–224
Fig LM et al (1988) Adrenal localization in the adrenocorticotropic hormone-independent Cushing syndrome. Ann Intern Med 109:547–553
Barzon L et al (2001) Scintigraphic patterns of ACC: morpho-functional correlates. Eur J Endocrinol 145:743–748
Schteingart DE et al (1981) Iodocholesterol adrenal tissue uptake and imaging adrenal neoplasms. J Clin Endocrinol Metab 52:1156–1161
Drane WE et al (1983) Imaging of an adrenal cortical carcinoma and its skeletal metastasis. J Nucl Med 24:710–712
Chatal JF et al (1976) Uptake of 131I-19-iodocholesterol by an adrenal cortical carcinoma and its metastases. J Clin Endocrinol Metab 43:248–251
Pasieka JL et al (1992) Adrenal scintigraphy of well-differentiated (functioning) ACCs: potential surgical pitfalls. Surgery 112:884–890
Greathouse DJ et al (1984) Pure primary hyperaldosteronism due to adrenal cortical carcinoma. Am J Med 76:1132–1136
Sakashita S et al (1984) Primary aldosteronism due to adrenal cortical carcinoma. J Urol 132:959–961
Shenker Y et al (1986) The scintigraphic localization of mineralocorticoid-producing ACC. J Endocrinol Invest 9:115–120
Scott HW Jr. et al (1986) Primary hyperaldosteronism caused by ACC. World J Surg 10:646–653
Bossuyt A, Somers G (1975) 131I-19-iodocholesterol visualization of an ACC without clinical manifestations. J Nucl Biol Med 19:225–227
Wang FF et al (2006) Unusual visualization of an ACC on NP-59 scintiscan. J Formos Med Assoc 105:340–345
Jonson SD, Welch MJ (1999) Synthesis, biological evaluation, and baboon PET imaging of the potential adrenal imaging agent cholesteryl-p-[18F]fluorobenzoate. Nucl Med Biol 26:131–138
Beierwaltes WH et al (1978) Imaging the adrenal glands with radiolabeled inhibitors of enzymes: concise communication. J Nucl Med 19:200–203
Zolle IM et al (2008) New selective inhibitors of steroid 11beta-hydroxylation in the adrenal cortex. Synthesis and structure-activity relationship of potent etomidate analogues. J Med Chem 51:2244–2253
Beierwaltes WH et al (1976) Localization of radiolabeled enzyme inhibitors in the adrenal gland. J Nucl Med 17:998–1002
Hillidge CJ et al (1973) Investigations of azaperone-metomidate anaesthesia in the horse. Vet Rec 93:307–311
Ryder-Davies P (1973) The use of Metomidate, and intramuscular narcotic for birds. Vet Rec 92:507–509
Biver A et al (1976) Combined azaperone and metomidate anaesthesia in liver transplantation in the pig. Eur Surg Res 8:81–88
Cadle DR, Martin GR (1976) Metomidate as sole anaesthetic agent in tawny owls. Vet Rec 98:91–92
Green CJ et al (1981) Metomidate etomidate and fentanyl as injectable anaesthetic agents in mice. Lab Anim 15:171–175
Hansen MK et al (2003) Pharmacokinetic and pharmacodynamic properties of metomidate in turbot (Scophthalmus maximus) and halibut (Hippoglossus hippoglossus). J Vet Pharmacol Ther 26:95–103
Atucha E et al (2009) Structure-activity relationship of etomidate derivatives at the GABA(A) receptor: Comparison with binding to 11beta-hydroxylase. Bioorg Med Chem Lett 19:4284–4287
Evans RH, Hill RG (1977) The GABA-mimetic action of etomidate [proceedings]. Br J Pharmacol 61:484P
Weber MM et al (1993) Different inhibitory effect of etomidate and ketoconazole on the human adrenal steroid biosynthesis. Clin Investig 71:933–938
Fassnacht M (2000) New mechanisms of adrenostatic compounds in a human adrenocortical cancer cell line. Eur J Clin Invest 30(Suppl 3):76–82
Hahner S et al (2008) [123 I]Iodometomidate for molecular imaging of adrenocortical cytochrome P450 family 11B enzymes. J Clin Endocrinol Metab 93:2358–2365
Ishimura K, Fujita H (1997) Light and electron microscopic immunohistochemistry of the localization of adrenal steroidogenic enzymes. Microsc Res Tech 36:445–453
Allolio B et al (1988) Nonhypnotic low-dose etomidate for rapid correction of hypercortisolaemia in Cushing’s syndrome. Klin Wochenschr 66:361–364
Schulte HM et al (1990) Infusion of low dose etomidate: correction of hypercortisolemia in patients with Cushing’s syndrome and dose-response relationship in normal subjects. J Clin Endocrinol Metab 70:1426–1430
Engelhardt D (1994) Steroid biosynthesis inhibitors in Cushing’s syndrome. Clin Investig 72:481–488
Mitterhauser M et al (2003) In vivo and in vitro evaluation of [18F]FETO with respect to the adrenocortical and GABAergic system in rats. Eur J Nucl Med Mol Imaging 30:1398–1401
Bergstrom M et al (1998) In vitro and in vivo primate evaluation of carbon-11-etomidate and carbon-11-metomidate as potential tracers for PET imaging of the adrenal cortex and its tumors. J Nucl Med 39:982–989
Juhlin C et al (1998) [Differential diagnosis in adrenal gland tumors using PET and [11C]-metomidate]. Nord Med 113:306–307
Bergstrom M et al (2000) PET imaging of adrenal cortical tumors with the 11beta-hydroxylase tracer [11C]-metomidate. J Nucl Med 41:275–282
Khan TS et al (2003) [11C]-metomidate PET imaging of adrenocortical cancer. Eur J Nucl Med Mol Imaging 30:403–410
Minn H et al (2004) Imaging of adrenal incidentalomas with PET using (11)C-metomidate and (18)F-FDG. J Nucl Med 45:972–979
Zettinig G et al (2004) Positron emission tomography imaging of adrenal masses: (18)F-fluorodeoxyglucose and the 11beta-hydroxylase tracer (11)C-metomidate. Eur J Nucl Med Mol Imaging 31:1224–1230
Hennings J et al (2009) Computed tomography, magnetic resonance imaging and [11C]-metomidate positron emission tomography for evaluation of adrenal incidentalomas. Eur J Radiol 69:314–323
Karimi F et al (2008) Synthesis of 11C-labelled metomidate analogues as adrenocortical imaging agents. J Label Compd Radiopharm 51:273–276
Wadsak W et al (2006) [18F]FETO for adrenocortical PET imaging: a pilot study in healthy volunteers. Eur J Nucl Med Mol Imaging 33:669–672
Rendl G et al (2006) Usefulness of the 11 beta-hydroxylase inhibitor 18F FETO in positron emission tomography imaging of adrenal masses. Nuklearmedizin, Abstract Band of the International Symposium of Nuclear Medicine 2006, Bad Gastein 2006 No 17
Erlandsson M et al (2009) (18)F-labelled metomidate analogues as adrenocortical imaging agents. Nucl Med Biol 36:435–445
Schirbel A et al (2004) 4-[123/131I]Iodometomidate as a radioligand for functional diagnosis of adrenal disease: synthesis, structural requirements and biodistribution. Radiochim Acta 92:297–303
Hahner S et al (2009) 131I-Iodometomidate radiotherapy for metastatic ACC – first clinical experience. Presented at European Congress of Endocrinology, ECE 2009, Istanbul, Turkey. Endocrine Abstracts (2009) 20 OC1.3
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Avram, A.M., Hahner, S. (2009). Functional Imaging of Adrenocortical Carcinoma. In: Hammer, G., Else, T. (eds) Adrenocortical Carcinoma. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77236-3_7
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