X-ray and Radionuclide Imaging in the Diagnosis of ACTH-Producing Neuroendocrine Tumors

Golounina, O.O.; Slashchuk, K.Yu.; Khairieva, A.V.; Tarbaeva, N.V.; Degtyarev, M.V.; Belaya, Zhanna

doi:10.33266/1024-6177-2022-67-4-80-88

Cited by 4 publications

(3 citation statements)

References 47 publications

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“…Важно отметить, что процедура должна выполняться только у пациентов с лабораторно подтвержденным АКТГ-зависимым эндогенным гиперкортицизмом на момент проведения селективного забора крови. Ремиссия гиперкортицизма, в том числе медикаментозная, делает результаты селективного забора неинформативными [ 12 ].…”

Section: Discussionunclassified

“…На сегодняшний день метод двустороннего селективного забора крови из НКС с определением градиента АКТГ центр/периферия до и после введения стимуляционного агента признан «золотым стандартом» среди всех методов дифференциальной диагностики АКТГ-зависимых форм эндогенного гиперкортицизма [ 12 ][ 13 ]. С момента внедрения метод претерпел значительные изменения и усовершенствования с целью повышения диагностической точности.…”

Section: обоснованиеunclassified

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Diagnostic value of bilateral inferior petrosal sinus sampling in various modifications and methods of radiation and radionuclide imaging in the diagnosis and differential diagnosis of ACTH-dependent endogenous hypercortisolism

Belaya,

Golounina,

Sitkin

et al. 2024

Probl Endokrinol (Mosk)

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AIM: To analyze the diagnostic performance of bilateral inferior petrosal sinus sampling (BIPSS) with desmopressin as a stimulation agent and prolactin measurements to control catheter position with or without the ACTH/prolactin normalized ratio calculation in the differential diagnosis of ACTH-dependent endogenous hypercortisolism, and the diagnostics performance of ectopic ACTH-syndrome (EAS) visualization.MATERIALS AND METHODS: A single-center diagnostic study with a retrospective analysis of the data was carried out. The study included patients with ACTH-dependent endogenous hypercorticism with no visualization of pituitary adenoma on MRI or adenoma sizes less than 6 mm. All patients underwent BIPSS with and without calculation of the ACTH/prolactin normalized ratio. Visualization of an EAS included pituitary MRI (to exclude EAS), whole-body CT scan with contrast, and somatostatin receptor scintigraphy with 99mTc-Tectrotide and CT (99mTc-Tectrotide SPECT). The final verification was based on immunohistochemical confirmation of the tumor or stable remission of Cushing’s disease (CD) after surgical treatment. Statistical data processing was carried out by using IBM SPSS Statistics 23. Confidence intervals were calculated using the JavaStat online calculator.RESULTS: 230 BIPSS were performed in 228 patients (166 women, 62 men), of which 178 patients were verified as CD and 50 cases were EAS of various localization. The effectiveness of catheterization of petrosal sinuses was 96.9%. The sensitivity of BIPSS without ACTH/prolactin ratio calculation (n=70) was 95.9% (95% CI 86.3–98.9), specificity was 92% (95% CI 75.0–97.8), for the BIPSS with additional determination of ACTH/prolactin-normalized ratio (n=51) — 97.3% (95% CI 86.2–99.5) and 93.8% (95% CI 71.7–98.9), respectively. The use of the MRI method for this sample of patients had a sensitivity of 60.2% (95% CI 52.6–67.5), specificity of 59.2% (95% CI 44.2–73.0), the total body CT with contrast has a sensitivity of 74% (95% CI 59.7–85.4), specificity of 100% (95% CI 97.95–100). The diagnostic accuracy for 99mTc-Tectrotide SPECT in NET visualization has a sensitivity of 73.3% (95% CI 44.9–92.2), specificity of 100% (95% CI 95.3–100).CONCLUSION: BIPSS with desmopressin stimulation and prolactin measurements to control catheter position, as well as the additional calculation of the ACTH/prolactin-normalized ratio, is an optimal method for the differential diagnosis of EAS. Patients who are identified an EAS on BIPSS may be further referred for 99mTc-Tectrotide SPECT and CT for tumor visualization.

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Section: Discussionunclassified

Section: обоснованиеunclassified

Diagnostic value of bilateral inferior petrosal sinus sampling in various modifications and methods of radiation and radionuclide imaging in the diagnosis and differential diagnosis of ACTH-dependent endogenous hypercortisolism

Belaya,

Golounina,

Sitkin

et al. 2024

Probl Endokrinol (Mosk)

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“…Дифференциальная диагностика БИК и АКТГ-ЭС представляет наибольшую сложность, особенно у пациентов без визуализации аденомы или с микроаденомами гипофиза менее 6 мм в диаметре и/или отрицательными результатами топической диагностики НЭО, по данным методов лучевой диагностики, функциональной и рецепторной визуализации [ 3 ].…”

Section: обоснованиеunclassified

Machine learning methods in differential diagnosis of ACTH-dependent hypercortisolism

Golounina,

Belaya,

Voronov

et al. 2024

Probl Endokrinol (Mosk)

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AIM: To develop a noninvasive method of differential diagnosis of ACTH-dependent hypercortisolism, as well as to evaluate the effectiveness of an optimal algorithm for predicting the probability of ectopic ACTH syndrome (EAS) obtained using machine learning methods based on the analysis of clinical data.MATERIALS AND METHODS: As part of a single-center, one-stage, cohort study, a retrospective prediction of the probability of EAS among patients with ACTH-dependent hypercortisolism was carried out. Patients were randomly stratified into 2 samples: training (80%) and test (20%). Eleven machine learning algorithms were used to develop predictive models: Linear Discriminant Analysis, Logistic Regression, elastic network (GLMNET), Support Vector machine (SVM Radial), k-nearest neighbors (kNN), Naive Bayes, binary decision tree (CART), C5.0 decision tree algorithms, Bagged CART, Random Forest, Gradient Boosting (Stochastic Gradient Boosting, GBM).RESULTS: The study included 223 patients (163 women, 60 men) with ACTH-dependent hypercortisolism, of which 175 patients with Cushing’s disease (CD), 48 — with EAS. As a result of preliminary data processing and selection of the most informative signs, the final variables for the classification and prediction of EAS were selected: ACTH level at 08:00 hours, potassium level (the minimum value of potassium in the active stage of the disease), 24-h urinary free cortisol, late-night serum cortisol, late-night salivary cortisol, the largest size of pituitary adenoma according to MRI of the brain. The best predictive ability in a training sample of all trained machine learning models for all three final metrics (ROC-AUC (0.867), sensitivity (90%), specificity (56.4%)) demonstrated a model of gradient boosting (Generalized Boosted Modeling, GBM). In the test sample, the AUC, sensitivity and specificity of the model in predicting EAS were 0.920; 77.8% and 97.1%, respectively.CONCLUSION: The prognostic model based on machine learning methods makes it possible to differentiate patients with EAS and CD based on basic clinical results and can be used as a primary screening of patients with ACTH-dependent hypercortisolism.

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Radioisotope diagnostics of endogenous ACTH-dependent hypercorticism: a review

Khoroshavina,

Orlova,

Ryzhkova

2024

Lučevaâ diagn. ter.

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INTRODUCTION: The literature review presents the possibilities of existing methods of radionuclide diagnosis of endogenous ACTH-dependent hypercorticism, which includes Itsenko-Cushing’s disease and ectopic ACTH syndrome. The similar clinical picture of these pathologies significantly complicates their differential diagnosis. Localization of corticotropinoma, especially in patients with persistent Cushing’s disease, and ectopic focus of ACTH hyperproduction also causes difficulties.OBJECTIVE: To analyze the available foreign and domestic literature to determine the possibilities of radionuclide imaging methods in the diagnosis of endogenous ACTH-dependent hypercorticism.MATERIALS AND METHODS: A search of scientifiс publications and clinical recommendations in the information and analytical systems PudMed and elibrary over the past twenty years, dedicated to the diagnosis of Itsenko-Cushing’s disease and ectopic ACTH syndrome using radioisotope diagnostic methods by keywords «Itsenko-Cushing’s disease», «ectopic ACTH syndrome», «radionuclide diagnostics», «scintigraphy», «SPECT», «PET».RESULTS: The presented review demonstrated the broad possibilities and prospects of using modern radioisotope imaging methods in the diagnosis of endogenous ACTH-dependent hypercorticism. Radionuclide imaging methods make it possible to conduct a study in the «whole body» mode, which makes it possible to detect not only the primary tumor focus, but also metastases in patients with ectopic ACTH syndrome in one study. In addition, the use of scintigraphy or positron emission tomography with labeled somatostatin analogues makes it possible to predict the effectiveness of treatment of formations producing adrenocorticotropic hormone with somatostatin analogues, which is important when planning antitumor therapy.CONCLUSION: The use of radioisotope diagnostic methods significantly increases the accuracy of topical diagnosis of a tumor focus, allows for an assessment of the prevalence of the tumor process and the selection of patients for antitumor therapy using somatostatin analogues.

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X-ray and Radionuclide Imaging in the Diagnosis of ACTH-Producing Neuroendocrine Tumors

Cited by 4 publications

References 47 publications

Diagnostic value of bilateral inferior petrosal sinus sampling in various modifications and methods of radiation and radionuclide imaging in the diagnosis and differential diagnosis of ACTH-dependent endogenous hypercortisolism

Diagnostic value of bilateral inferior petrosal sinus sampling in various modifications and methods of radiation and radionuclide imaging in the diagnosis and differential diagnosis of ACTH-dependent endogenous hypercortisolism

Machine learning methods in differential diagnosis of ACTH-dependent hypercortisolism

Radioisotope diagnostics of endogenous ACTH-dependent hypercorticism: a review

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