PET/CT在原发性醛固酮增多症功能定位诊断中的应用价值

Application value of PET/CT in functional localization diagnosis of primary aldosteronism

摘要:

目的 探讨靶向CXC趋化因子受体4型（CXC chemokine receptor type 4，CXCR4）的⁶⁸Ga-Pentixafor PET/CT核素显像在原发性醛固酮增多症（primary aldosteronism，PA）的优势侧功能定位以及预后的应用价值。方法 选取2022年3月至2023年5月重庆医科大学附属第一医院确诊为PA的66例住院患者。所有患者均接受PET/CT及肾上腺静脉取血（adrenal vein sample，AVS），且行腹腔镜下单侧或部分肾上腺切除术，分析比较PET/CT和AVS对PA分侧诊断的符合率；根据术后随访血压、用药改善情况及血钾水平，判断PET/CT对PA优势侧功能定位诊断的准确率及病灶最大标准化摄取值（maximum standardized uptake value，SUVmax）对患者术后预后的预测价值。结果 66例手术患者中行单侧肾上腺切除术63例、部分肾上腺切除术3例，术后病理检查结果中有腺瘤58例、增生8例，PET/CT和AVS对PA分侧诊断的符合率83.3%（55/66）；以术后临床获益为标准，PET/CT对PA优势侧功能定位诊断的准确率为88.14%（52/59），AVS对PA优势侧功能定位诊断的准确率为93.22%（55/59）；术后治愈患者病灶SUVmax［14.70（8.75~19.45）］要高于术后好转患者［10.90（6.65~14.10）］，差异有统计学意义（P=0.026）。术前病灶SUVmax与术后醛固酮降低值、术后血浆醛固酮肾素比（aldosterone-to-renin ratio，ARR）降低值和术后血钾升高值呈正相关（r=0.267、0.365、0.392，P=0.034、0.003、0.001）。结论 靶向CXCR4的⁶⁸Ga-Pentixafor PET/CT对PA优势侧定位诊断的准确率与AVS接近，但更具有可重复、无创等优势；病灶SUVmax 越高，术后临床获益越明显，有一定的预后预测价值。

Abstract:

Objective To investigate the clinical value of CXC chemokine receptor type 4（CXCR4）-targeting ⁶⁸Ga-Pentixafor positron emission tomography/computed tomography（PET/CT） radionuclide-based imaging in the functional localization of the dominant side and prognosis of primary aldosteronism（PA）.Methods A total of 66 inpatients diagnosed with PA in The First Affiliated Hospital of Chongqing Medical University from March 2022 to May 2023 were selected. All patients were examined by PET/CT and adrenal vein sampling（AVS），and underwent unilateral or partial laparoscopic adrenalectomy. The coincidence rate of PET/CT and AVS in the diagnosis of PA lateralization was analyzed and compared. According to the improvement in blood pressure，medication，and blood potassium level during postoperative follow-up，the accuracy rate of functional localization diagnosis on the dominant side of PA by PET/CT and the predictive value of maximum standardized uptake value（SUVmax） of lesions for postoperative prognosis of patients were evaluated.Results Among the 66 surgical patients，unilateral adrenalectomy was performed in 63 patients and partial adrenalectomy in 3 patients. Postoperative pathological examinations showed adenoma in 58 patients and hyperplasia in 8 patients. The coincidence rate of PET/CT and AVS in the diagnosis of PA lateralization was 83.3%（55/66）. Based on the postoperative clinical benefit，the accuracy rates of PET/CT and AVS in the functional localization diagnosis of the dominant side of PA were 88.14%（52/59） and 93.22%（55/59），respectively. SUVmax in postoperative cured patients［14.70 （8.75，19.45）］ was significantly higher than that in postoperative improved patients［10.90 （6.65，14.10）］（P=0.026）. Preoperative SUVmax was positively correlated with postoperative aldosterone decrease，aldosterone/renin ratio decrease，and serum potassium increase（r=0.267，0.365，and 0.392，P=0.034，0.003，and 0.001，respectively）.Conclusion CXCR4-targeting ⁶⁸Ga-Pentixafor PET/CT for localization diagnosis of the dominant side of PA has an accuracy rate close to that of AVS，but with the advantages of repeatability and non-invasiveness. The higher the SUVmax，the more obvious the postoperative clinical benefit，showing a certain prognostic value.