NHC Key Laboratory of Endocrinology (Peking Union Medical College Hospital); Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongcheng, Beijing, 100730, China.
Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine and State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Science and PUMC, Beijing, 100730, China.
Eur Radiol. 2023 Feb;33(2):996-1003. doi: 10.1007/s00330-022-09058-x. Epub 2022 Sep 7.
We analyzed the diagnostic efficiency of Ga-pentixafor PET/CT for functional nodules in primary aldosteronism (PA). Furthermore, we compared the correlation of CXCR4 expression with aldosterone synthase (CYP11B2) expression and PET/CT uptake in these patients.
We prospectively assessed 50 patients diagnosed with PA and 10 patients with non-functional adrenal adenoma (NFA). All patients underwent Ga-pentixafor PET/CT before adrenalectomy. Immunohistochemistry (IHC) was performed to detect the protein expression of CYP11B2 and the G-protein-coupled receptor CXCR4.
CYP11B2 IHC revealed the presence of 43 functional nodules. Subsequently, 40/43 functional nodules could be detected on Ga-pentixafor PET/CT, while negative imaging findings were noted for 11/13 non-functional nodules (sensitivity, 93.0%; specificity, 84.6%). The optimum SUV cut-off for the identification of functional nodules was 8.95 (AUC 0.914 [0.828-1.000], p < 0.001). Regarding the size of functional nodules, diagnostic efficiency appeared to be much higher for nodules greater than 1 cm in size (sensitivity, up to 97.3%). Moreover, we examined the relationship between CXCR4 and CYP11B2 expression in 56 lesions. All 43 CYP11B2-positive nodules were CXCR4-positive, but one of the 13 CYP11B2-negative nodules (7.7%) showed false-positive staining for CXCR4. Moreover, the consistency between PET/CT uptake and CXCR4 staining results was 92.9% (52/56).
At least 90% of functional nodules show positive uptake on Ga-pentixafor PET/CT, and the detection ability is much better for nodules with a diameter ≥ 1 cm. With its high sensitivity and specificity, Ga-pentixafor PET/CT can be considered a promising surgical decision-making tool for patients with PA.
• Ga-pentixafor PET/CT could be a useful tool for the identification of functional adrenal nodules in APAs and even IHAs. • The diagnostic efficiency appears to be much higher for nodules ≥ 1 cm in size. • There is high consistency between the results of 68Ga-pentixafor PET/CT imaging and CXCR4 immunohistochemistry.
我们分析了 Ga-戊曲肽 PET/CT 对原发性醛固酮增多症（PA）功能性结节的诊断效率。此外，我们比较了这些患者中 CXCR4 表达与醛固酮合酶（CYP11B2）表达和 PET/CT 摄取的相关性。
我们前瞻性评估了 50 例诊断为 PA 的患者和 10 例无功能性肾上腺腺瘤（NFA）患者。所有患者在肾上腺切除术前行 Ga-戊曲肽 PET/CT 检查。进行免疫组织化学（IHC）检测以检测 CYP11B2 和 G 蛋白偶联受体 CXCR4 的蛋白表达。
CYP11B2 IHC 显示存在 43 个功能性结节。随后，在 Ga-戊曲肽 PET/CT 上检测到 40/43 个功能性结节，而在 13/13 个无功能性结节中则未见阴性影像学结果（灵敏度，93.0%；特异性，84.6%）。用于识别功能性结节的最佳 SUV 截止值为 8.95（AUC 0.914 [0.828-1.000]，p < 0.001）。关于功能性结节的大小，大于 1cm 大小的结节的诊断效率似乎更高（灵敏度高达 97.3%）。此外，我们在 56 个病变中检查了 CXCR4 与 CYP11B2 表达之间的关系。所有 43 个 CYP11B2 阳性结节均为 CXCR4 阳性，但 13 个 CYP11B2 阴性结节中有 1 个（7.7%）显示 CXCR4 假阳性染色。此外，PET/CT 摄取与 CXCR4 染色结果之间的一致性为 92.9%（52/56）。
至少 90%的功能性结节在 Ga-戊曲肽 PET/CT 上显示阳性摄取，并且直径≥1cm 的结节的检测能力更好。Ga-戊曲肽 PET/CT 具有较高的灵敏度和特异性，可作为 PA 患者手术决策的有前途的工具。
Ga-戊曲肽 PET/CT 可能是识别 APA 和甚至 IHA 中功能性肾上腺结节的有用工具。
对于直径≥1cm 的结节，诊断效率似乎更高。
Ga-戊曲肽 PET/CT 成像和 CXCR4 免疫组化结果之间具有高度一致性。
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