title: [¹²³I]Iodometomidate imaging in adrenocortical carcinoma.
abstract: BACKGROUND
  Imaging with [¹²³I]iodometomidate ([¹²³I]IMTO) has been shown to diagnose adrenocortical lesions with high sensitivity and specificity.
  
  
  OBJECTIVE
  Our objective was to evaluate the clinical utility of [¹²³I]IMTO imaging in adrenocortical carcinoma (ACC).
  
  
  METHODS
  We conducted a prospective monocentric diagnostic study and a prospective case series at a single tertiary referral center.
  
  
  METHODS
  Fifty-eight patients with histologically confirmed ACC, all European Network for the Study of Adrenal Tumors stage IV (with distant metastases), received 185 MBq [¹²³I]IMTO. Sequential planar whole-body scans until 24 hours post injection and single photon emission computed tomography/computed tomography (SPECT/CT) hybrid imaging 4 to 6 hours post injection were performed.
  
  
  METHODS
  Outcome measures included uptake of [¹²³I]IMTO in ACC lesions, sensitivity and specificity of [¹²³I]IMTO imaging compared with conventional imaging, and number of patients eligible for [¹³¹I]IMTO therapy.
  
  
  RESULTS
  Of 430 lesions detected by conventional imaging, 30% showed strong, 8% moderate, and 62% no tracer accumulation. [¹²³I]IMTO detected both primary and metastatic lesions of ACC. However, a substantial percentage of lesions failed to show [¹²³I]IMTO uptake. The overall sensitivity and specificity values were 38% and 100%, respectively. Thirty-four patients (59%) had at least 1 [¹²³I]IMTO-positive lesion. Cortisol and aldosterone secretion by ACC was positively correlated to [¹²³I]IMTO uptake (P = .01); cytotoxic chemotherapy and mitotane treatment presumably did not influence tracer uptake. Twenty-one patients (36.2%) had radiotracer uptake in all lesions ≥ 2 cm and therefore were potential candidates for targeted systemic radiotherapy with [¹³¹I]IMTO.
  
  
  CONCLUSIONS
  About one-third of patients with ACC show specific retention of [¹²³I]IMTO in metastatic lesions. This study provides support for the conduct of a prospective trial to determine whether the first molecular informed therapy using [¹³¹I]IMTO will be of value to patients with metastatic ACC.
authors.affiliation: Department of Nuclear Medicine, University Hospital of Wuerzburg, University of Wuerzburg, D-97080 Wuerzburg, Germany. kreissl_m@klinik.uni-wuerzburg.de
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kreissl
authors.forename: Andreas
authors.initials: A
authors.lastname: Schirbel
authors.forename: Martin
authors.initials: M
authors.lastname: Fassnacht
authors.forename: Heribert
authors.initials: H
authors.lastname: Haenscheid
authors.forename: Frederik A
authors.initials: FA
authors.lastname: Verburg
authors.forename: Stefanie
authors.initials: S
authors.lastname: Bock
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Saeger
authors.forename: Pascal
authors.initials: P
authors.lastname: Knoedler
authors.forename: Christoph
authors.initials: C
authors.lastname: Reiners
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Buck
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hahner
mesh_terms: D000302:Adrenal Cortex / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D018268:Adrenocortical Carcinoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000556:secondary; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood / Q000378:metabolism; D015331:Cohort Studies; D005045:Etomidate / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D009367:Neoplasm Staging; D010865:Pilot Projects; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; C529450:iodophenyl metomidate; D000450:Aldosterone; D006854:Hydrocortisone; D005045:Etomidate