Zuo Rui, Liu Shuang, Ren Xinyi, Li Wenbo, Xia Zhu, Xu Lu, Pang Hua
Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Clin Endocrinol (Oxf). 2025 May;102(5):499-509. doi: 10.1111/cen.15204. Epub 2025 Jan 26.
This study aimed to compare the clinical efficacy of dual-time Ga-pentixafor PET/CT with adrenal vein sampling (AVS) in PA lateralization.
We retrospectively analysed 161 patients with PA. We assessed the diagnostic performance of dual-time Ga-pentixafor PET/CT in diagnosing unilateral primary aldosteronism (UPA) and aldosterone-producing adenoma (APA). We also explored the relationship between Ga-pentixafor PET/CT findings, postoperative outcomes, and the presence of the KCNJ5 gene mutation.
The diagnostic accuracy of Ga-pentixafor PET at 10 and 40 min for UPA (75.2% and 76.4%, respectively) surpassed that of CT (55.3%, p < 0.01). The optimal cutoff for diagnosing APA was 10 min lesion-to-normal adrenal ratio = 1.95, yielding an AUC of 91.9%, with sensitivity, specificity, and accuracy of 76.0%, 91.3%, and 83.3%, respectively. This high diagnostic efficacy extended to subgroups with nodules ≥ 1 or < 1 cm, and the largest AUC of Ga-pentixafor PET/CT for diagnosis APA with lesions ≥ 1 and < 1 cm is 88.2% and 97.0%, respectively. The lateralization results provided by Ga-pentixafor PET/CT corroborated the surgical treatment decision in 92.0% of PA patients, and more than 95% achieved clinical and/or biochemical cure or improvement. The PET positive rate of KCNJ5 mutation was higher than that of KCNJ5 wild-type, with optimal diagnostic efficacy at 40 min lesion-to-liver ratio = 4.79 (AUC 81.3%, sensitivity 90.0%, specificity 66.7%).
Dual-time Ga-pentixafor PET/CT exhibits robust diagnostic efficacy in PA lateralization. Furthermore, Ga-pentixafor PET/CT holds promise as an imaging marker for predicting the presence of the KCNJ5 mutation in PA patients.
本研究旨在比较双时相镓喷替酸PET/CT与肾上腺静脉采血（AVS）在原发性醛固酮增多症（PA）定位诊断中的临床疗效。
我们回顾性分析了161例PA患者。我们评估了双时相镓喷替酸PET/CT在诊断单侧原发性醛固酮增多症（UPA）和醛固酮瘤（APA）方面的诊断性能。我们还探讨了镓喷替酸PET/CT检查结果、术后结局与KCNJ5基因突变存在之间的关系。
镓喷替酸PET在10分钟和40分钟时对UPA的诊断准确性（分别为75.2%和76.4%）超过了CT（55.3%，p<0.01）。诊断APA的最佳截断值为10分钟时病变与正常肾上腺比值=1.95，曲线下面积（AUC）为91.9%，敏感性、特异性和准确性分别为76.0%、91.3%和83.3%。这种高诊断效能扩展到结节≥1cm或<1cm的亚组，镓喷替酸PET/CT诊断病变≥1cm和<1cm的APA的最大AUC分别为88.2%和97.0%。镓喷替酸PET/CT提供的定位结果在92.0%的PA患者中证实了手术治疗决策，超过95%的患者实现了临床和/或生化治愈或改善。KCNJ5突变的PET阳性率高于KCNJ5野生型，在40分钟时病变与肝脏比值=4.79时诊断效能最佳（AUC 81.3%，敏感性90.0%，特异性66.7%）。
双时相镓喷替酸PET/CT在PA定位诊断中表现出强大的诊断效能。此外，镓喷替酸PET/CT有望作为预测PA患者KCNJ5基因突变存在的影像学标志物。
