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Positron emission tomography imaging of adrenal masses: 18F-fluorodeoxyglucose and the 11β-hydroxylase tracer 11C-metomidate

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

11C-metomidate (MTO), a marker of 11β-hydroxylase, has been suggested as a novel positron emission tomography (PET) tracer for adrenocortical imaging. Up to now, experience with this very new tracer is limited. The aims of this study were (1) to evaluate this novel tracer, (2) to point out possible advantages in comparison with 18F-fluorodeoxyglucose (FDG) and (3) to investigate in vivo the expression of 11β-hydroxylase in patients with primary aldosteronism.

Methods

Sixteen patients with adrenal masses were investigated using both MTO and FDG PET imaging. All patients except one were operated on. Five patients had non-functioning adrenal masses, while 11 had functioning tumours(Cushing’s syndrome, n=4; Conn’s syndrome, n=5; phaeochromocytoma, n=2). Thirteen patients had benign disease, whereas in three cases the adrenal mass was malignant (adrenocortical cancer, n=1; malignant phaeochromocytoma, n=1; adrenal metastasis of renal cancer, n=1).

Results

MTO imaging clearly distinguished cortical from non-cortical adrenal masses (median standardised uptake values of 18.6 and 1.9, respectively, p<0.01). MTO uptake was slightly lower in patients with Cushing’s syndrome than in those with Conn’s syndrome, but the difference did not reach statistical significance. The expression of 11β-hydroxylase was not suppressed in the contralateral gland of patients with Conn’s syndrome, whereas in Cushing’s syndrome this was clearly the case. The single patient with adrenocortical carcinoma had MTO uptake in the lower range.

Conclusion

MTO could not definitely distinguish between benign and malignant disease. FDG PET, however, identified clearly all three study patients with malignant adrenal lesions. We conclude: (1) MTO is an excellent imaging tool to distinguish adrenocortical and non-cortical lesions; (2) the in vivo expression of 11β-hydroxylase is lower in Cushing’s syndrome than in Conn’s syndrome, and there is no suppression of the contralateral gland in primary aldosteronism; (3) for the purpose of discriminating between benign and malignant lesions, FDG is the tracer of choice.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Georg Zettinig, Markus Mitterhauser, Wolfgang Wadsak, Alexander Becherer, Christian Pirich, Robert Dudczak & Kurt Kletter

  2. Ludwig Boltzmann Institute for Nuclear Medicine, University of Vienna, Vienna, Austria

    Georg Zettinig, Alexander Becherer, Christian Pirich & Robert Dudczak

  3. Department of Pharmaceutic Technology and Biopharmaceutics, University of Vienna, Vienna, Austria

    Markus Mitterhauser

  4. Department of Internal Medicine III, University of Vienna, Vienna, Austria

    Heinrich Vierhapper

  5. Department of Surgery, University of Vienna, Vienna, Austria

    Bruno Niederle

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  1. Georg Zettinig
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Correspondence to Georg Zettinig.

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Zettinig, G., Mitterhauser, M., Wadsak, W. et al. Positron emission tomography imaging of adrenal masses: 18F-fluorodeoxyglucose and the 11β-hydroxylase tracer 11C-metomidate. Eur J Nucl Med Mol Imaging 31, 1224–1230 (2004). https://doi.org/10.1007/s00259-004-1575-0

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  • DOI: https://doi.org/10.1007/s00259-004-1575-0

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