title: Tomographic evaluation of [131I] 6beta-iodomethyl-norcholesterol standardised uptake trend in clinically silent monolateral and bilateral adrenocortical incidentalomas.
abstract: OBJECTIVE
  The aim of this study was three-fold: 1) to quantify [131I]-6beta-iodomethyl-norcholesterol ([131I]-NP-59) adrenal uptake trend in patients with incidentalomas, 2) to identify a specific uptake trend (TREND) capable of characterising pre-clinical Cushing syndrome (PC-CS) patients, 3) to assess the clinical availability of TREND as a prognostic factor of late clinical outcome in a cohort of patients with bilateral adrenal adenomas.
  
  
  METHODS
  Fifty-seven consecutive patients were examined using three-head SPECT at 24, 48, 72 hours following intravenous injection of [131I ]-NP-59. On the basis of the absence or presence of hormonal abnormalities, the selected population was classified as GR1 or GR2, respectively. Adrenal glands were classified into 4 groups taking into account both the patient group (GR1, GR2) and the presence (+) or absence (-) of the adenoma (AD) on CT scan. Using ROI technique, adrenal-liver uptake ratio (A/L) was estimated bilaterally at 24, 48 and 72 hours. For each adrenal group, mean [131I]-NP-59 uptake trends were derived.
  
  
  RESULTS
  TREND was significantly different between GR1/AD+ and GR2/AD+. Among GR2/AD+ patients, TREND correctly identified PC-CS with a global accuracy of 74%. Two patients with bilateral incidentaloma developed an overt CS. In both patients, TREND correctly identified the hyperfunctioning adrenal, thus permitting an effective sparing adrenalectomy.
  
  
  CONCLUSIONS
  TREND seems to be a parameter which closely reflects adrenal physiological behaviour, especially in the case of bilateral adrenal involving. The possibility to quantify even contralateral adrenal uptake as standardised index provides additional useful information about normal adrenal parenchyma and, indirectly, about adenoma functional autonomy.
authors.affiliation: Nuclear Medicine Unit, Department of Clinical Pathophysiology, University of Florence, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Imperiale
authors.forename: C
authors.initials: C
authors.lastname: Olianti
authors.forename: M
authors.initials: M
authors.lastname: Mannelli
authors.forename: G
authors.initials: G
authors.lastname: La Cava
authors.forename: A
authors.initials: A
authors.lastname: Pupi
mesh_terms: D015071:19-Iodocholesterol / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism*; D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism*; D003480:Cushing Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000592:standards
chemical_list: D019275:Radiopharmaceuticals; D015071:19-Iodocholesterol; C035501:6-iodomethylcholesterol