Zheng Guoyang, Ding Jie, Gao Yinjie, Liu Shengyan, Yan Xinchun, Wang Wenda, Zhao Yang, Wang Zhan, Huo Li, Tong Anli, Zhang Yushi
Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1st Shuaifuyuan Road, Dongcheng District, Beijing 100730 China.
Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1st Shuaifuyuan Road, Dongcheng District, Beijing 100730 China.
J Clin Transl Endocrinol. 2025 Jan 25;39:100384. doi: 10.1016/j.jcte.2025.100384. eCollection 2025 Mar.
This study aimed to explore the significance of Ga-pentixafor PET/CT in guiding surgical treatments for primary aldosteronism (PA) patients, by identifying functional lesions and determining the dominant side of aldosterone secretion.
We prospectively included 91 PA patients receiving surgical treatments based on the results of Ga-pentixafor PET/CT. The Ga-pentixafor PET/CT images were evaluated by visual and semi-quantitative analysis. The relationship between radionuclide imaging characteristics and postoperative outcomes was assessed following surgery.
The positive detection rate of Ga-pentixafor PET/CT in 91 PA patients was 85.7 % (78/91) with a median maximum standardized uptake value (SUV) of 10.2 (6.0-16.0). The SUV was positively correlated with lesion diameter ( = 0.497, < 0.001), while negatively correlated with the blood potassium level ( = -0.450, < 0.001) and plasma renin activity ( = -0.297, = 0.004). 63 cases of 73 PA patients with unilateral adrenal lesion were identified positive by Ga-pentixafor PET/CT, and 95.2 % of the 63 positive cases benefited from surgical resection of the identified positive lesions. Among 18 PA patients with bilateral lesions, Ga-pentixafor PET/CT identified positive lesions in 15 cases, and 86.7 % (13/15) of the positive cases benefited from total or partial adrenalectomy guided by Ga-pentixafor PET/CT. There was no significant difference in postoperative outcomes between patients undergoing partial adrenalectomy with those subjected to total adrenalectomy. The accuracy rate of Ga-pentixafor PET/CT in determining the dominant side of aldosterone secretion for PA was 85.7 %, which was comparable to the 71.4 % of adrenal vein sampling (AVS).
Ga-pentixafor PET/CT could effectively guide the surgical management for PA patients, achieving favorable postoperative outcomes. The accuracy rate of Ga-pentixafor PET/CT in identifying the dominant side of aldosterone secretion was not inferior to that of AVS.
本研究旨在通过识别功能性病变并确定醛固酮分泌的优势侧，探讨镓喷替酸PET/CT在指导原发性醛固酮增多症（PA）患者手术治疗中的意义。
我们前瞻性纳入了91例根据镓喷替酸PET/CT结果接受手术治疗的PA患者。通过视觉和半定量分析对镓喷替酸PET/CT图像进行评估。术后评估放射性核素成像特征与术后结果之间的关系。
91例PA患者中镓喷替酸PET/CT的阳性检出率为85.7%（78/91），最大标准化摄取值（SUV）中位数为10.2（6.0 - 16.0）。SUV与病变直径呈正相关（r = 0.497，P < 0.001），而与血钾水平呈负相关（r = -0.450，P < 0.001）以及与血浆肾素活性呈负相关（r = -0.297，P = 0.004）。73例单侧肾上腺病变的PA患者中有63例经镓喷替酸PET/CT检查为阳性，63例阳性病例中有95.2%受益于对所确定的阳性病变进行手术切除。在18例双侧病变的PA患者中，镓喷替酸PET/CT在15例中识别出阳性病变，阳性病例中有86.7%（13/15）受益于在镓喷替酸PET/CT指导下进行的肾上腺全切或部分切除术。接受部分肾上腺切除术的患者与接受肾上腺全切术的患者术后结果无显著差异。镓喷替酸PET/CT在确定PA醛固酮分泌优势侧方面的准确率为85.7%，与肾上腺静脉采血（AVS）的71.4%相当。
镓喷替酸PET/CT可有效指导PA患者的手术治疗，取得良好的术后效果。镓喷替酸PET/CT在识别醛固酮分泌优势侧方面的准确率不低于AVS。
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