Yi Tieci, Lu Difei, Cui Yonggang, Zhang Zheng, Yang Xing, Zhang Jianhua, Qiu Lin, Weng Haoyu, Liu Lin, Duan Xiaojiang, Zhao Guangyu, Ma Wei, Gao Ying, Fan Yan
Department of Cardiology, Peking University First Hospital, Beijing, China.
Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China.
Mol Imaging Biol. 2025 Feb;27(1):142-150. doi: 10.1007/s11307-024-01976-0. Epub 2024 Dec 23.
To investigate the diagnostic efficacy of Ga-pentixafor positron emission tomography/computed tomography (PET/CT) in primary aldosteronism (PA) subtyping and lateralization of aldosterone secretion in PA patients.
37 patients who were diagnosed with PA, were prospectively enrolled in the study, and underwent adrenal vein sampling (AVS) after Ga-pentixafor PET/CT was conducted. Lateralization index (LI), defined as aldosterone/cortisol ratio in the dominant side to the contralateral adrenal vein when bilateral adrenal vein catheterization succeeded, and the aldosterone/cortisol ratio in the left adrenal vein to IVC (LAV/IVC) when the catheterization of right adrenal vein failed, were applied to determine lateralization side. Statistical analysis was performed using SPSS 21.0.
The female proportion of all patients with PA was 32.4% (12/37), and the mean age was 51.3 ± 10.9 years. Patients with bilateral adrenal mass accounted for 54.1% (20/37), and 10 of them (27.0%) had adrenal hyperplasia or adrenal nodules ≤ 1.0 cm. In all 37 patients, the sensitivity, specificity and accuracy of Ga-pentixafor PET/CT in distinguishing lateralization by visualization were 89.3%, 77.8% and 86.5%, respectively. The area under the ROC curve for detecting positive lateralization based on the value of Ga-pentixafor SUV was 0.750 (95%CI 0.578-0.922, p = 0.026). The optimum SUV cut-off value was 6.86, with the sensitivity of 78.6%, specificity of 66.7%, and accuracy of 78.4%. Defining SUV ratio as SUV/SUV of contralateral adrenal gland, the area under the ROC curve for identifying lateralization based on the SUV ratio was 0.710 (95%CI 0.500-0.921, p = 0.061). The optimum SUV ratio cut-off was 2.40, with the sensitivity of 60.7%, specificity of 88.9%, and accuracy of 67.6%. The consistency of Ga-pentixafor PET/CT with AVS was of no significant difference between patients with bilateral adrenal lesions (80.0%, 16/20) and unilateral lesion (94.1%, 16/17; p = 0.737), and no significance was revealed in the consistency between patients with adrenal hyperplasia or adrenal lesion of diameter ≤ 1 cm (81.8%, 9/11) and those with adrenal lesions > 1 cm (88.5%, 23/26; p = 0.884).
Ga-pentixafor PET/CT showed at least 80% consistency for the lateralization in patients with PA compared with AVS, even in those presented with bilateral adrenal hyperplasia. Visual analysis exhibited better diagnostic efficacy compared with SUV or SUV/SUV of the contralateral adrenal gland.( ChiCTR2300073049. Registered 30 June 2023. Retrospectively registered).
探讨镓喷替酸正电子发射断层扫描/计算机断层扫描（PET/CT）在原发性醛固酮增多症（PA）亚型诊断及PA患者醛固酮分泌侧别定位中的诊断效能。
37例确诊为PA的患者前瞻性纳入本研究，在进行镓喷替酸PET/CT后接受肾上腺静脉采血（AVS）。侧别指数（LI）定义为双侧肾上腺静脉插管成功时优势侧肾上腺静脉与对侧肾上腺静脉的醛固酮/皮质醇比值，以及右侧肾上腺静脉插管失败时左肾上腺静脉与下腔静脉的醛固酮/皮质醇比值（LAV/IVC），用于确定侧别。使用SPSS 21.0进行统计分析。
所有PA患者中女性占32.4%（12/37），平均年龄为51.3±10.9岁。双侧肾上腺肿块患者占54.1%（20/37），其中10例（27.0%）有肾上腺增生或肾上腺结节≤1.0 cm。在所有37例患者中，镓喷替酸PET/CT通过可视化鉴别侧别的敏感性、特异性和准确性分别为89.3%、77.8%和86.5%。基于镓喷替酸SUV值检测阳性侧别的ROC曲线下面积为0.750（95%CI 0.578 - 0.922，p = 0.026）。最佳SUV截断值为6.86，敏感性为78.6%，特异性为66.7%，准确性为78.4%。将SUV比值定义为SUV/对侧肾上腺SUV，基于SUV比值识别侧别的ROC曲线下面积为0.710（95%CI 0.500 - 0.921，p = 0.061）。最佳SUV比值截断值为2.40，敏感性为60.7%，特异性为88.9%，准确性为67.6%。镓喷替酸PET/CT与AVS的一致性在双侧肾上腺病变患者（80.0%，16/20）和单侧病变患者（94.1%，16/17；p = 0.737）之间无显著差异，肾上腺增生或直径≤1 cm肾上腺病变患者（81.8%，9/11）与肾上腺病变>1 cm患者（88.5%，23/26；p = 0.884）之间的一致性也无显著差异。
与AVS相比，镓喷替酸PET/CT在PA患者侧别定位中显示出至少80%的一致性，即使在双侧肾上腺增生患者中也是如此。视觉分析显示出比SUV或对侧肾上腺SUV/SUV更好的诊断效能。（ChiCTR2300073049。2023年6月30日注册。回顾性注册）
