18F-CETO in adrenocortical carcinoma: first clinical-translational study of an adrenocortical-targeting PET tracer.
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Edholm A, Zhang L, MacFarlane J, Åkerström T, Senanayake R, Welin S, Hegedus A, Cheow HK, Lase I, Stålberg P, Monazzam A, Gillett D, Aloj L, Hellman P, Wargelius H, Tadross JA, Antoni G, Aigbirhio F, Skogseid B, Gurnell M, Backman S, Sundin A, Casey RT, Crona J
Endocr. Relat. Cancer 33 (10) - [2026-10-01; online 2026-09-23]
The adrenocortical-specific PET tracer [11C]metomidate (11C-MTO) shows high diagnostic accuracy in adrenocortical carcinoma (ACC), but complex radiochemistry and short half-life limit clinical implementation. The novel tracer para-chloro-2-[18F]fluoroethyletomidate (18F-CETO) may enable broader use. In this bicentric study, 20 ACC patients underwent PET/CT with 18F-CETO and [18F]fluoro-2-deoxy-D-glucose (18F-FDG), with 235 lesions identified. 18F-CETO detected more lesions than 18F-FDG at initial staging in 5/13 patients, whereas fewer lesions were detected at re-staging in 5/7 patients (P = 0.002). A further 70 patients with 18F-CETO or 11C-MTO-PET/CT and an anatomical imaging reference were used to explore the utility of adrenocortical imaging. Three adrenocortical imaging phenotypes were defined: homogeneous-high (n = 71), homogeneous-low (n = 11), and heterogeneous (n = 8), which showed differences in overall survival in exploratory analyses. Tumors were characterized by RNA sequencing and immunohistochemistry showing correlation between tracer-uptake to CYP11B1 expression and adrenocortical differentiation. These findings suggest a potential role for 18F-CETO in ACC phenotyping and initial staging.
NGI Uppsala (SNP&SEQ Technology Platform) [Service]
National Genomics Infrastructure [Service]
PubMed 42775908
DOI 10.1530/ERC-26-0314
Crossref 10.1530/ERC-26-0314
pmc: PMC13663316
pii: 78256