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

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.