Typing diagnostic value of 68Ga-pentixafor PET/CT for patients with primary aldosteronism and unilateral nodules

Abstract

Purpose

Our goal was to compare the lateralization of ⁶⁸Ga-pentixafor PET/CT with adrenal vein sampling (AVS) in primary aldosteronism (PA) patients with unilateral lesions.

Methods

We retrospectively enrolled 61 patients with PA and all patients showed unilateral nodular lesions on CT and underwent ⁶⁸Ga-Pentixafor PET/CT. The general clinical data, imaging and AVS results were collected. The diagnostic efficiency of ⁶⁸Ga-Pentixafor PET/CT imaging in PA patients was calculated by visual and semi-quantitative analysis to compare the consistency with AVS, and the correlation between CXCR4 express and ⁶⁸Ga-Pentixafor uptake was performed.

Results

The study included 42 unilateral PA (UPA) and 19 bilateral PA (BPA). The area under curve (AUC) of ⁶⁸Ga-Pentixafor PET/CT to diagnosis UPA with 10 min maximum standardized uptake value (SUVmax) > 8.17 was 0.82 ([0.70–0.90], P < 0.001), and the sensitivity and specificity were 0.64 and 0.90, respectively. The maximal AUC of ⁶⁸Ga-pentixafor PET/CT for the diagnosis UPA in patients with nodules with a diameter ≥1 cm was 0.87 ([0.73–0.95],P both <0.001,[10 min SUVmax=8.17 and 10 min mean standardized uptake value (SUVmean)=5.57]), and the sensitivity and specificity were 0.73 and 0.93, respectively. Unilateral adrenalectomy and significant CXCR4 expression were present in 32 UPA, including 27 aldosterone-producing adenoma and 5 idiopathic adrenal hyperplasia. Additionally, ⁶⁸Ga-pentixafor uptake in adrenal lesions was significantly correlated with CXCR4 expression, and statistical differences in ⁶⁸Ga-pentixafor uptake among IRS subgroups.

Conclusions

⁶⁸Ga-Pentixafor PET/CT can be helpful for subtyping diagnosis of PA patients with unilateral adrenal nodular, showing significant potential in non-invasive PA classification.