Abstract
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Introduction: To investigate the clinical value of 68Ga-Pentixafor PET/MR in the diagnosis of primary aldosteronism (PA) of functional adrenal nodules, especially those with diameter < 10mm, and compare it with conventional clinical methods.
Methods: We prospectively assessed 36 patients diagnosed with PA and 11 patients with non-functional adrenal adenoma (NFA). All patients underwent 68Ga-pentixafor PET/MR before adrenalectomy. Positive lesions were defined based on higher tracer uptake in adrenal nodular(s) shown on MRI than the normal adrenal. The semiquantitative parameter of PET/MR included SUVmax and SUVmean for adrenal lesion.
Results: The subtypes of 36 PA patients included 27 aldosterone-producing adenomas, 5 cases of suspected unilateral adrenal hyperplasia, and 4 cases of idiopathic aldosterone hyperplasia. ROC analysis revealed that the optimal SUVmax cut-off values for diagnosing functional adrenal nodules in PA patients with adrenal nodule diameter≥10mm and diameter<10mm were 7.8 (AUC of 0.931) and 6.4 (AUC of 0.893), respectively. The specificity and accuracy of visual analysis using 68Ga-pentixafor PET/MR to identify PA patients with functional adrenal nodules less than 10mm in diameter were 85.7%, and 86.7%, respectively, which were significantly higher than those of adrenal MRI (28.5% and 60.0%, respectively), and significantly improved the sensitivity of PET in adrenal micronodules (from 62.5% to 87.5%).
Conclusions: 68Ga-pentixafor PET/MR demonstrated promising diagnostic accuracy in functional nodules of PA patients, especially improved the sensitivity of PET for adrenal micronodules with diameters less than 10mm.
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