肾上腺皮质癌（ACC）是一种极为罕见的内分泌恶性肿瘤，常规影像和激素检查无法诊断。18F-FDG PET可以帮助预测恶性程度，但需要更多数据以支持未来的指南。该研究共纳入63例经组织学证实的ACC患者（n=55）或具有类固醇过量分泌的肾上腺皮质癌转移患者（n=8）。所有患者都接受了18F-FDG PET检查，计算出SUVmax和肾上腺/肝SUVmax比值。将18F-FDG PET参数与临床、病理和预后数据进行比较。结果显示，56例患者（89%）的ACC具有肾上腺/肝SUVmax比值>1.45，这是预测恶性程度100%敏感性的先前定义的截止值。其中7例ACC（11%）没有良好的FDG摄取（肾上腺/肝SUVmax <1.45），其中大多数的增殖标记Ki-67表达水平<10%。发现18F-FDG PET参数（SUVmax和肾上腺/肝SUVmax比值）与肿瘤大小、ENSAT（欧洲肾上腺瘤研究网络）分期、总Weiss评分和Ki- 67之间有强相关性。SUVmax和Ki-67之间的明显相关性（r = 0.47，P = 0.0009）暗示着18F-FDG摄取水平与肿瘤增殖之间的关系。未发现18F-FDG PET参数与预后指标（无进展生存或总生存）之间的统计学显著性关联。这项大型队列研究显示，大多数的ACC表现出高的18F-FDG摄取。然而，观察到的SUVmax和Ki-67表达水平之间的正相关似乎解释了发现一些18F-FDG摄取较低或不存在的ACC的可能性。这些发现对于处理肾上腺占位患者具有实际意义。©2023 Wolters Kluwer Health，Inc.保留所有权利。

Adrenocortical carcinoma (ACC) is an extremely rare endocrine malignancy, which cannot always be diagnosed during conventional radiology and hormonal investigations. 18F-FDG PET could help predict malignancy, but more data are necessary to support future guidelines.A cohort of 63 patients with histologically proven ACC (n = 55) or metastatic ACC with steroid oversecretion (n = 8) was assembled. All patients underwent an 18F-FDG PET, and the SUVmax and the adrenal-to-liver SUVmax ratio were calculated. The 18F-FDG PET parameters were compared with clinical, pathological, and outcome data.Fifty-six of 63 patients (89%) had an ACC with an adrenal-to-liver SUVmax ratio >1.45, which was a previously defined cutoff value to predict malignancy with 100% sensitivity. Seven ACCs (11%) had a lower uptake (adrenal-to-liver SUVmax <1.45), most of them with a proliferation marker Ki-67 expression level <10%. A positive correlation between 18F-FDG PET parameters (SUVmax and adrenal-to-liver SUVmax ratio) and tumor size, ENSAT (European Network for the Study of Adrenal Tumors) staging, total Weiss score, and the Ki-67 was found. The strong correlation between SUVmax and Ki-67 (r = 0.47, P = 0.0009) suggests a relationship between 18F-FDG uptake levels and tumor proliferation. No statistically significant associations between outcome parameters (progression-free or overall survival) and 18F-FDG PET parameters were found.This large cohort study shows that most cases of ACC demonstrate high 18F-FDG uptake. However, the positive correlation observed between SUVmax and Ki-67 expression levels seems to explain the possibility of identifying some ACC with a low or inexistent 18F-FDG uptake. These findings have practical implications for the management of patients with an adrenal mass.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.