11 C-metomidate PET in the diagnosis of adrenal masses and primary aldosteronism: a review of the literature
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REVIEW
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C-metomidate PET in the diagnosis of adrenal masses and primary aldosteronism: a review of the literature
Stanley M. Chen Cardenas
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Prasanna Santhanam
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Received: 27 July 2020 / Accepted: 23 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Adrenal masses are commonly encountered in clinical practice, many of whom are incidental. Identifying malignancy, and excess hormone production is essential for appropriate management. Biochemical workup and imaging tests (dedicated adrenal CT and/or MRI) are used to determine the likelihood of excessive hormone function and malignancy, respectively. However, imaging cannot provide information about function and biochemical workup cannot localize the source. Furthermore, in primary aldosteronism, adrenal vein sampling, the gold standard for lateralization, has important limitations such as the technical expertise required, the elevated costs, and potential complications. Over the last decades, there has been a renewed interest in alternative noninvasive imaging techniques that provide information about adrenal function without the need for invasive procedures. In this review, we will evaluate the evidence and the potential role of 11Cmetomidate as a promising positron emission tomography (PET) tracer in clinical practice. Methods A review of the English literature for articles describing the use of the tracer 11C-metomidate in adrenal disorders. Results A total of 12 studies were included in the systematic review, which altogether addressed the use of 11C-metomidate in adrenal masses and the application of this tracer in primary aldosteronism. Conclusions 11C-metomidate, a selective inhibitor of 11-β-hydroxylase, demonstrated a high specificity for adrenocortical tissue. In addition, 11C-metomidate is correlated with this enzyme activity making it a potentially useful PET tracer for the identification primary aldosteronism, in addition to detection of adrenocortical masses. Keywords
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C-metomidate Positron emission tomography Adrenal masses Primary aldosteronism Adrenal tracer ●
Introduction Adrenal masses are relatively common with an estimated prevalence of about 4% based on abdominal CT and 6% on autopsy series [1]. Approximately 80% are benign and the majority nonfunctioning [2]. However, malignant conditions such as adrenocortical carcinoma (ACC) and adrenal metastasis are seen in a small number of cases (60% and a relative washout of >40% is suggestive of a benign lesion [5, 6]. MRI provide similar diagnostic accuracy compared to CT and does not involved radiation; however, it is costly, and not as widely available making it a second choice for adrenal imaging. MRI of a benign adrenal nodule shows a homogenous lesion, with low-intermediate intensity in T2weighted images compared to the liver, and loss of signal
Endocrine
intensity in out-of-phase images [7]. Both CT and MRI are reasonable options; however, none of them can determine functionality which could h
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