Clinical Utility of Dual‐Time ⁶⁸ Ga‐Pentixafor PET/CT in Diagnosing and Subtyping Primary Aldosteronism

Abstract

ABSTRACT Objectives This study aimed to compare the clinical efficacy of dual‐time 68 Ga‐pentixafor PET/CT with adrenal vein sampling (AVS) in PA lateralization. Methods and Methods We retrospectively analysed 161 patients with PA. We assessed the diagnostic performance of dual‐time 68 Ga‐pentixafor PET/CT in diagnosing unilateral primary aldosteronism (UPA) and aldosterone‐producing adenoma (APA). We also explored the relationship between 68 Ga‐pentixafor PET/CT findings, postoperative outcomes, and the presence of the KCNJ5 gene mutation. Results The diagnostic accuracy of 68 Ga‐pentixafor PET at 10 and 40 min for UPA (75.2% and 76.4%, respectively) surpassed that of CT (55.3%, p < 0.01). The optimal cutoff for diagnosing APA was 10 min lesion‐to‐normal adrenal ratio = 1.95, yielding an AUC of 91.9%, with sensitivity, specificity, and accuracy of 76.0%, 91.3%, and 83.3%, respectively. This high diagnostic efficacy extended to subgroups with nodules ≥ 1 or < 1 cm, and the largest AUC of 68 Ga‐pentixafor PET/CT for diagnosis APA with lesions ≥ 1 and < 1 cm is 88.2% and 97.0%, respectively. The lateralization results provided by 68 Ga‐pentixafor PET/CT corroborated the surgical treatment decision in 92.0% of PA patients, and more than 95% achieved clinical and/or biochemical cure or improvement. The PET positive rate of KCNJ5 mutation was higher than that of KCNJ5 wild‐type, with optimal diagnostic efficacy at 40 min lesion‐to‐liver ratio = 4.79 (AUC 81.3%, sensitivity 90.0%, specificity 66.7%). Conclusion Dual‐time 68 Ga‐pentixafor PET/CT exhibits robust diagnostic efficacy in PA lateralization. Furthermore, 68 Ga‐pentixafor PET/CT holds promise as an imaging marker for predicting the presence of the KCNJ5 mutation in PA patients.

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