He Limeng, Yang Yan, Cao Xu, Zhu Xianjun, Liu Nan, Chen Xiaoyuan, Zhang Jingjing, Zhang Wei
Department of Nuclear Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China.
Department of Endocrinology & Metabolism, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China.
Theranostics. 2024 Oct 28;14(19):7281-7291. doi: 10.7150/thno.100848. eCollection 2024.
Distinguishing unilateral aldosterone-producing adenomas (APA) from idiopathic hyperaldosteronism (IHA), nonfunctional adrenal adenoma (NFA), and pheochromocytoma (PHEO) within primary aldosteronism (PA) presents a significant challenge. Studies have demonstrated high levels of chemokine receptor (CXCR) 4 expression in APA, thereby validating the use of Ga-labeled CXCR4 PET/CT for detecting APA. This study evaluates the efficacy of [F]AlF-NOTA-pentixather PET/CT in distinguishing APA from other PA types. In the initial experiment, a comparative analysis was conducted to evaluate the diagnostic efficacy of [F]AlF-NOTA-T140 PET/CT and [F]AlF-NOTA-pentixather PET/CT for APA in 3 patients with PA. Based on the preliminary findings, [F]AlF-NOTA-pentixather PET/CT was subsequently performed on 45 patients with suspected PA and 5 controls. Lesions exhibiting higher tracer uptake than normal adrenal glands were considered positive and referred for adrenalectomy. Prior to surgery, adrenal venous sampling (AVS) was performed in 71.1% of patients to assess laterality. Postoperative follow-up was conducted in 91.1% of patients. The semi-quantitative analysis involved assessing maximum standardized uptake value (SUVmax), LLR (lesion-to-liver ratio), and lesion-to-contralateral ratio (LCR). Correlations were made between PET/CT findings, histopathology results, outcomes, and AVS. In terms of diagnosing APA, [F]AlF-NOTA-pentixather PET/CT demonstrated a sensitivity of 100%, specificity of 91.7%, and accuracy of 95.8%. The mean SUVmax for APAs (25.62 ± 12.71, n = 24) was significantly higher compared to non-APA cases (7.24 ± 3.27, n = 24, < 0.0001). An optimal SUVmax threshold of 11.60 accurately predicted the presence of APA with a sensitivity of 95.8%, specificity of 96.0%, and accuracy of 93.9%. A cutoff value for LCR at 1.38 provided 95.8% sensitivity and 92.0% specificity, while an LLR cutoff at 5.28 yielded a sensitivity rate of 91.7% and a specificity rate of 92.0%. Positive findings on PET/CT scans were completely consistent with AVS results. All patients with positive lesions derived significant benefits from surgical intervention. [F]AlF-NOTA-pentixather PET/CT seems to be highly related to AVS and could be a noninvasive method for diagnosing APA in patients with PA.
在原发性醛固酮增多症（PA）中，区分单侧醛固酮瘤（APA）与特发性醛固酮增多症（IHA）、无功能肾上腺腺瘤（NFA）和嗜铬细胞瘤（PHEO）是一项重大挑战。研究表明，APA中趋化因子受体（CXCR）4表达水平较高，从而验证了使用镓标记的CXCR4 PET/CT检测APA的可行性。本研究评估了[F]AlF-NOTA-喷替沙 PET/CT在区分APA与其他PA类型方面的有效性。在初始实验中，进行了一项对比分析，以评估[F]AlF-NOTA-T140 PET/CT和[F]AlF-NOTA-喷替沙 PET/CT对3例PA患者APA的诊断有效性。基于初步研究结果，随后对45例疑似PA患者和5例对照者进行了[F]AlF-NOTA-喷替沙 PET/CT检查。示踪剂摄取高于正常肾上腺的病变被视为阳性，并转诊进行肾上腺切除术。手术前，71.1%的患者进行了肾上腺静脉采血（AVS）以评估病变侧别。91.1%的患者进行了术后随访。半定量分析包括评估最大标准化摄取值（SUVmax）、病变与肝脏比值（LLR）和病变与对侧比值（LCR）。对PET/CT检查结果、组织病理学结果、手术效果和AVS结果进行了相关性分析。在诊断APA方面，[F]AlF-NOTA-喷替沙 PET/CT的敏感性为100%，特异性为91.7%，准确性为95.8%。APA的平均SUVmax（25.62±12.71，n = 24）显著高于非APA病例（7.24±3.27，n = 24，P < 0.0001）。最佳SUVmax阈值为11.60，预测APA存在的敏感性为95.8%，特异性为96.0%，准确性为93.9%。LCR的截断值为1.38时，敏感性为95.8%，特异性为92.0%；LLR截断值为5.28时，敏感性为91.7%，特异性为92.0%。PET/CT扫描的阳性结果与AVS结果完全一致。所有有阳性病变的患者均从手术干预中获得了显著益处。[F]AlF-NOTA-喷替沙 PET/CT似乎与AVS高度相关，可能是诊断PA患者APA的一种非侵入性方法。
