68Ga-pentixafor PET/CT in guiding surgical management of primary aldosteronism

IF 4.2 Q1 ENDOCRINOLOGY & METABOLISM Journal of Clinical and Translational Endocrinology Pub Date : 2025-01-25 DOI:10.1016/j.jcte.2025.100384

Guoyang Zheng , Jie Ding , Yinjie Gao , Shengyan Liu , Xinchun Yan , Wenda Wang , Yang Zhao , Zhan Wang , Li Huo , Anli Tong , Yushi Zhang

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Abstract

Purpose

This study aimed to explore the significance of ⁶⁸Ga-pentixafor PET/CT in guiding surgical treatments for primary aldosteronism (PA) patients, by identifying functional lesions and determining the dominant side of aldosterone secretion.

Materials and methods

We prospectively included 91 PA patients receiving surgical treatments based on the results of ⁶⁸Ga-pentixafor PET/CT. The ⁶⁸Ga-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.

Results

The positive detection rate of ⁶⁸Ga-pentixafor PET/CT in 91 PA patients was 85.7 % (78/91) with a median maximum standardized uptake value (SUV_max) of 10.2 (6.0–16.0). The SUV_max was positively correlated with lesion diameter (r = 0.497, P < 0.001), while negatively correlated with the blood potassium level (r = -0.450, P < 0.001) and plasma renin activity (r = -0.297, P = 0.004). 63 cases of 73 PA patients with unilateral adrenal lesion were identified positive by ⁶⁸Ga-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, ⁶⁸Ga-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 ⁶⁸Ga-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 ⁶⁸Ga-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).

Conclusions

⁶⁸Ga-pentixafor PET/CT could effectively guide the surgical management for PA patients, achieving favorable postoperative outcomes. The accuracy rate of ⁶⁸Ga-pentixafor PET/CT in identifying the dominant side of aldosterone secretion was not inferior to that of AVS.

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