Evaluating the value of chemokine receptor type 4–targeted PET imaging in diagnosing primary aldosteronism lateralization: A comparison with adrenal venous sampling
Nan Lu, Liang Chen, Fang Yu, Zhiwei Xiao, Diankui Xing, Juan Zhong, Dongmei Zeng, Yichun Wang, Shuaihu Tang, Yong He, Zhe Meng
Abstract
Background Primary aldosteronism lateralization is critical for the treatment option. This study evaluated the preoperative localization diagnostic efficiency of 68 Ga-pentixafor positron emission tomography/computed tomography imaging, targeting C-X-C chemokine receptor type 4 in patients with primary aldosteronism and comparing with adrenal venous sampling, the current gold standard for primary aldosteronism lateralization. Methods Fifty patients with primary aldosteronism underwent adrenal venous sampling and 68 Ga-pentixafor positron emission tomography/computed tomography imaging of the adrenal region separately. Patients with lateralization determined by adrenal venous sampling or positron emission tomography/computed tomography underwent adrenalectomy, followed by pathologic diagnoses and immunohistochemical staining for aldosterone synthase (CYP11B2) and C-X-C chemokine receptor type 4, and follow up 12 months after surgery. Correlations among positron emission tomography/computed tomography and adrenal venous sampling, pathologic results, and clinical outcomes were analyzed. The positron emission tomography/computed tomography threshold for primary aldosteronism lateralization was determined using receiver operating characteristic curve analysis. Results The maximum standard uptake value, with a cutoff value of 11.95, achieved a sensitivity of 74.1% and a specificity of 100.0% for primary aldosteronism lateralization in patients with aldosterone-producing adenoma. A cutoff value of 5.85 for the maximum standard uptake value reached a sensitivity of 81.6% and a specificity of 73.1% in all patients with primary aldosteronism. The concordance rate between 68 Ga-pentixafor positron emission tomography/computed tomography and adrenal venous sampling for primary aldosteronism lateralization was 96.2% in patients with aldosterone-producing adenoma and 75.7% in all patients. Patients with positron emission tomography/computed tomography lateralization benefited from adrenalectomy, and primary aldosteronism lateralization based on positron emission tomography/computed tomography strongly correlated with pathologic classifications, CYP11B2 and C-X-C chemokine receptor type 4 expression levels, and clinical outcomes during follow-up. Conclusion 68 Ga-pentixafor positron emission tomography imaging, as a noninvasive method, performed excellently in detecting aldosterone-producing adenoma and could act as an effective supplement to adrenal venous sampling in primary aldosteronism lateralization.