Peng Yushi, Chen Fangansheng, Yao Rui, Lan Junping, Fu Yinuo, Ye Kaifeng, Wang Zhiqiang, Zhao Qianxiu, Ji Xiaowei, Xia Kang, Zhu Guoqing, Zheng Kewen, Gu Xuemei, Tang Kun
Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Front Endocrinol (Lausanne). 2025 Feb 27;16:1533295. doi: 10.3389/fendo.2025.1533295. eCollection 2025.
The study aimed to investigate the diagnostic value of F-AlF-NOTA-Pentixafor PET/CT in subtyping primary aldosteronism (PA).
This study enrolled 88 patients with PA or nonfunctional adenoma (NFA) for F-Pentixafor PET/CT scan. Of these, 20 patients underwent adrenal venous sampling (AVS), and 65 underwent adrenalectomy and postoperative follow-up.
In 88 patients, 76 were diagnosed with unilateral PA (UPA), 4 were diagnosed with bilateral PA (BPA), and 8 were diagnosed with NFA, resulting in a total of 95 lesions. To identify UPA, visual analysis received a specificity of 94.12% and a sensitivity of 89.74%. The optimal cutoff values for SUV at 5.45, the lesion-to-normal adrenal ratio (LAR) at 1.43, and lesion-to-liver ratio (LLR) all yielded a specificity of 100% and a sensitivity of 79.49%, 83.33%, and 80.77%, respectively. In 15 adrenal lesions with similar uptake to contralateral and adjacent normal adrenal tissue (defined as warm lesions), 7 were confirmed as UPA, 4 were confirmed as BPA, and 4 were confirmed as NFA. Furthermore, among the 20 patients who underwent AVS, the concordance rate of AVS and PET/CT visual analysis for PA subtyping was 65.00%.
The CXCR4-targeted F-AlF-NOTA-pentixafor PET/CT is a valuable noninvasive tool for diagnosing UPA, demonstrating high sensitivity and specificity. More attention should be paid to warm adrenal lesions for their high diagnostic ambiguity probability.
本研究旨在探讨F-AlF-NOTA-喷替沙氟PET/CT在原发性醛固酮增多症（PA）亚型诊断中的价值。
本研究纳入88例PA或无功能腺瘤（NFA）患者进行F-喷替沙氟PET/CT扫描。其中，20例患者接受了肾上腺静脉采血（AVS），65例接受了肾上腺切除术及术后随访。
88例患者中，76例被诊断为单侧PA（UPA），4例被诊断为双侧PA（BPA），8例被诊断为NFA，共95个病灶。为鉴别UPA，视觉分析的特异性为94.12%，敏感性为89.74%。SUV的最佳截断值为5.45，病灶与正常肾上腺比值（LAR）为1.43，病灶与肝脏比值（LLR）的特异性均为100%，敏感性分别为79.49%、83.33%和80.77%。在15个与对侧及相邻正常肾上腺组织摄取相似的肾上腺病灶（定义为热病灶）中，7例被确诊为UPA，4例被确诊为BPA，4例被确诊为NFA。此外，在20例接受AVS的患者中，AVS与PET/CT视觉分析对PA亚型诊断的符合率为65.00%。
靶向CXCR4的F-AlF-NOTA-喷替沙氟PET/CT是诊断UPA的一种有价值的非侵入性工具，具有较高的敏感性和特异性。对于诊断模糊概率较高的热肾上腺病灶应给予更多关注。
