Introduction: Our previous sequencing data revealed that in Cushing’s disease, tumors exhibit higher CXCR4 expression and reduced blood supply compared to normal pituitary tissue. These findings led to the development of a preoperative CXCR4 PET-MRI strategy and an intraoperative ICG fluorescence-guided endoscopy approach.
Methods: In this study, 70 patients with Cushing’s disease underwent CXCR4-targeted PET-MRI, including 62 patients with newly diagnosed cases. Additionally, 26 patients received intraoperative fluorescence endoscopy to enhance tumor margin visualization.
Results: Among the 70 diagnosed CD cases from 2023 to 2024, 66 (94.3%) achieved precise tumor localization with a combinate of PET-MRI and enhanced MRI, and in 62 (88.6%) of these cases, the preoperative PET-MRI localization matched the intraoperative findings. Of the 26 patients who underwent intraoperative fluorescence endoscopy, 24 (92.3%) demonstrated clear tumor margin visualization. This combined approach improved the post-operative remission rate from 84.3% in 2020 to 94.7% in 2024.
Conclusion : CXCR4 PET-MRI combined with intraoperative fluorescence endoscopy enhances remission rate in Cushing’s disease, significantly improving the precision of tumor localization and the rate of complete resections.
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