Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
J Clin Endocrinol Metab. 2023 Dec 21;109(1):171-182. doi: 10.1210/clinem/dgad421.
Primary aldosteronism (PA) is one of the leading causes of secondary hypertension, and its diagnostic subtyping consistently presents a clinical challenge.
This study aimed to investigate the potential of 68Ga-Pentixafor positron emission tomography/computed tomography (PET/CT) in PA classification and its applicability in guiding the development of clinical treatment plans by increasing the sample size.
We prospectively enrolled 120 patients with either PA or nonfunctional adenoma (NFA) for analysis. All patients underwent 68Ga-Pentixafor PET/CT. Of these, 11 patients underwent adrenal venous sampling (AVS), 77 underwent adrenalectomy, 76 received pathological diagnoses, and 71 underwent immunohistochemical detection of aldosterone synthase (CYP11B2). Immunohistochemistry for C-X-C chemokine receptor 4 (CXCR4) was performed in 62 cases. Follow-up was conducted for all patients.
Among the 120 patients, 66 were diagnosed with aldosterone-producing adenoma (APA), 33 with idiopathic hyperaldosteronism (IHA), and 21 with NFA. For APA patients, the sensitivity, specificity, and accuracy of visual analysis using 68Ga-Pentixafor PET/CT were 92.40%, 94.40%, and 93.33%, respectively. Furthermore, for APA patients with a nodule greater than 1 cm in diameter, when the maximum standard uptake value was 7.3 or greater, the specificity was 100%; and for APA patients with a nodule less than 1 cm in diameter, 68Ga-Pentixafor PET/CT also exhibited high sensitivity. AVS was successfully performed in 5 patients. Among the 5 patients, the concordance rate between the AVS and 68Ga-Pentixafor PET/CT for PA subtyping was 60%. In the 77 patients who underwent adrenalectomy, 61 PET/CT scans displayed positive lesions, all of which benefited from the surgery. Additionally, the concordance rate between 68Ga-Pentixafor PET/CT imaging and CYP11B2 was 81.69%.
68Ga-Pentixafor PET/CT is a reliable and noninvasive functional imaging technique that demonstrates high accuracy in classifying PA and provides valuable guidance for clinical treatment decision-making.
原发性醛固酮增多症（PA）是继发性高血压的主要病因之一，其诊断亚类一直是临床挑战。
本研究旨在通过增加样本量，探讨 68Ga-环五聚体正电子发射断层扫描/计算机断层扫描（PET/CT）在 PA 分类中的应用潜力及其在指导临床治疗方案制定中的适用性。
前瞻性纳入 120 例 PA 或无功能腺瘤（NFA）患者进行分析。所有患者均行 68Ga-环五聚体 PET/CT 检查。其中 11 例行肾上腺静脉采样（AVS），77 例行肾上腺切除术，76 例获得病理诊断，71 例行醛固酮合酶（CYP11B2）免疫组化检测。62 例行 C-X-C 趋化因子受体 4（CXCR4）免疫组化检查。所有患者均进行随访。
120 例患者中，诊断为醛固酮瘤（APA）66 例、特发性醛固酮增多症（IHA）33 例、NFA 21 例。对于 APA 患者，68Ga-环五聚体 PET/CT 视觉分析的敏感性、特异性和准确性分别为 92.40%、94.40%和 93.33%。此外，对于直径大于 1cm 的结节，当最大标准摄取值为 7.3 或更高时，APA 患者的特异性为 100%；对于直径小于 1cm 的结节，68Ga-环五聚体 PET/CT 也具有较高的敏感性。5 例患者成功进行 AVS。5 例患者中，AVS 与 68Ga-环五聚体 PET/CT 对 PA 亚型分类的一致性率为 60%。在 77 例行肾上腺切除术的患者中，61 例 PET/CT 扫描显示阳性病变，均从手术中获益。此外，68Ga-环五聚体 PET/CT 成像与 CYP11B2 的一致性率为 81.69%。
68Ga-环五聚体 PET/CT 是一种可靠的、非侵入性的功能成像技术，在 PA 分类中具有较高的准确性，可为临床治疗决策提供有价值的指导。
