11C-美替拉酮 PET-CT 与肾上腺静脉取样对原发性醛固酮增多症进行亚型分类：一项前瞻性临床试验。
11C-Metomidate PET-CT versus adrenal vein sampling to subtype primary aldosteronism: a prospective clinical trial.
机构信息
Department of Endocrinology, Changi General Hospital (CGH).
Duke-NUS Medical School.
出版信息
J Hypertens. 2022 Jun 1;40(6):1179-1188. doi: 10.1097/HJH.0000000000003132.
OBJECTIVE
Adrenal vein sampling (AVS) is recommended to subtype primary aldosteronism, but it is technically challenging. We compared 11C-Metomidate-PET-computed tomography (PET-CT) and AVS for subtyping of primary aldosteronism.
METHODS
Patients with confirmed primary aldosteronism underwent both AVS and 11C-Metomidate PET-CT (post-dexamethasone). All results were reviewed at a multidisciplinary meeting to decide on final subtype diagnosis. Primary outcome was accuracy of PET versus AVS to diagnosis of unilateral primary aldosteronism based on post-surgical biochemical cure. Secondary outcome was accuracy of both tests to final subtype diagnosis.
RESULTS
All 25 patients recruited underwent PET and successful AVS (100%). Final diagnosis was unilateral in 22 patients, bilateral in two and indeterminate in one due to discordant lateralization. Twenty patients with unilateral primary aldosteronism underwent surgery, with 100% complete biochemical success, and 75% complete/partial clinical success. For the primary outcome, sensitivity of PET was 80% [95% confidence interval (95% CI): 56.3-94.3] and AVS was 75% (95% CI: 50.9-91.3). For the secondary outcome, sensitivity and specificity of PET was 81.9% (95% CI: 59.7-94.8) and 100% (95% CI: 15.8-100), and AVS was 68.2% (95% CI: 45.1-86.1) and 100% (95% CI: 15.8-100), respectively. Twelve out of 20 (60%) patients had both PET and AVS lateralization, four (20%) PET-only, three (15%) AVS-only, while one patient did not lateralize on PET or AVS. Post-surgery outcomes did not differ between patients identified by either test.
CONCLUSION
In our pilot study, 11C-Metomidate PET-CT performed comparably to AVS, and this should be validated in larger studies. PET identified patients with unilateral primary aldosteronism missed on AVS, and these tests could be used together to identify more patients with unilateral primary aldosteronism.
VIDEO ABSTRACT
目的
推荐使用肾上腺静脉取样（AVS）对原发性醛固酮增多症进行亚型分类，但该方法具有一定技术挑战性。我们比较了 11C-美替拉酮-正电子发射断层扫描（PET-CT）和 AVS 对原发性醛固酮增多症的亚型分类。
方法
经确诊患有原发性醛固酮增多症的患者同时接受 AVS 和 11C-美替拉酮 PET-CT（地塞米松后）检查。所有结果均在多学科会议上进行审查，以确定最终的亚型诊断。主要结局是基于术后生化缓解，比较 PET 与 AVS 对单侧原发性醛固酮增多症的诊断准确性。次要结局是比较两种检测方法对最终亚型诊断的准确性。
结果
所有入组的 25 例患者均成功完成了 PET 和 AVS（100%）。最终诊断为单侧 22 例，双侧 2 例，1 例因侧化不一致而不确定。20 例单侧原发性醛固酮增多症患者接受了手术，100%完全生化缓解，75%完全/部分临床缓解。主要结局方面，PET 的敏感性为 80%（95%置信区间[95%CI]：56.3-94.3），AVS 为 75%（95%CI：50.9-91.3）。次要结局方面，PET 的敏感性和特异性分别为 81.9%（95%CI：59.7-94.8）和 100%（95%CI：15.8-100），AVS 为 68.2%（95%CI：45.1-86.1）和 100%（95%CI：15.8-100）。20 例患者中，12 例（60%）患者的 PET 和 AVS 均有侧化，4 例（20%）仅 PET 有侧化，3 例（15%）仅 AVS 有侧化，1 例患者 PET 和 AVS 均未侧化。手术结果在两种检测方法确定的患者之间没有差异。
结论
在我们的初步研究中，11C-美替拉酮 PET-CT 与 AVS 具有可比性，应在更大规模的研究中进行验证。PET 识别出了 AVS 漏诊的单侧原发性醛固酮增多症患者，这两种检测方法可以一起使用，以识别更多单侧原发性醛固酮增多症患者。
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