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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: jnumed.109.064873v1 50/10/1631    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Related articles in JNM Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Yen, R.-F. PubMed PubMed Citation Articles by Yen, R.-F.

¹³¹I-6β-Iodomethyl-19-Norcholesterol SPECT/CT for Primary Aldosteronism Patients with Inconclusive Adrenal Venous Sampling and CT Results

¹ Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; ² Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; ³ Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; ⁴ Department of Urology, Cleveland Clinic, Cleveland, Ohio; ⁵ Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; and ⁶ Department of Nuclear Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan

Correspondence: For correspondence or reprints contact: Ching-Chu Lu, Department of Nuclear Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan, No. 579, Sec. 2, Yun-Lin Road, Douliou City, Yun-Lin, Taiwan. E-mail: ruohfyen{at}ntu.edu.tw

The 2 main causes of primary aldosteronism (PA) are aldosterone-producing adenoma (APA) and idiopathic adrenal hyperplasia (IAH). Dexamethasone-suppression ¹³¹I-6β-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy can assess the functioning of the adrenal cortex. This study evaluated the diagnostic usefulness of NP-59 SPECT/CT in differentiating APA from IAH and in predicting postadrenalectomy clinical outcome for PA patients who had inconclusive adrenal venous sampling (AVS) and CT results. Methods: We retrospectively reviewed the 31 adrenal lesions of 27 patients (age range, 33–71 y; mean age ± SD, 50.4 ± 10.9 y) who had been clinically confirmed (by saline infusion and captopril tests) to have PA, had inconclusive CT and AVS test results, and had undergone NP-59 imaging before adrenalectomy. The accuracy of NP-59 imaging was determined by comparison with histopathologic findings. Results: NP-59 SPECT/CT gave us 18 true-positive, 3 false-positive, 6 true-negative, and 4 false-negative results. Compared with planar imaging, SPECT/CT significantly improved diagnostic accuracy and prognostic predicting ability (P = 0.0390 and P = 0.0141, respectively). The NP-59 results were negative for 7 of the 23 patients with unilateral adrenal lesions, and none of these 7 patients had shown postsurgical clinical improvement. Conclusion: NP-59 SPECT/CT is an effective imaging tool for differentiating APA from IAH in PA patients whose CT and AVS results are inconclusive. Our results suggest that patients with presurgically negative NP-59 results should be treated medically and that noninvasive NP-59 SPECT/CT may be suited for use as the first lateralization modality after CT in patients with clinically confirmed PA.

Key Words: NP-59 • SPECT/CT • ¹³¹I • primary aldosteronism • adrenal adenoma

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