Research ArticleClinical Investigation

Clinical Value of 68Ga-Pentixafor PET/CT in Subtype Diagnosis of Primary Aldosteronism Patients with Adrenal Micronodules

Jie Ding, Xiang Li, Shengyan Liu, Yinjie Gao, Guoyang Zheng, Marcus Hacker, Yushi Zhang, Anli Tong and Li Huo
Journal of Nuclear Medicine November 2023, jnumed.123.266061; DOI: https://doi.org/10.2967/jnumed.123.266061

Article Figures & Data

Figures

  • Figure
  • FIGURE 1.
    FIGURE 1.

    Flowchart of PA patients included in study. Because of impact of coronavirus disease 2019 pandemic, surgical treatment of 5 patients with lateralization in AVS had been postponed.

  • FIGURE 2.
    FIGURE 2.

    Performance of 68Ga-pentixafor PET/CT in PA patients with different adrenal micronodules. MIP = maximum-intensity projection; NFN = nonfunctioning nodule.

  • FIGURE 3.
    FIGURE 3.

    Performance of 68Ga-pentixafor PET/CT in PA patients with bilateral microlesions on adrenal CT: unilateral micro-APA (A), micro-APA (B), micro-BAH (C), and bilateral micro-APA (D).

  • FIGURE 4.
    FIGURE 4.

    (A) Highest proportion of patients with 68Ga-pentixafor PET/CT–positive adrenal microlesions was observed in biochemical/clinical cure group, followed by biochemical/clinical improvement group, whereas all patients in biochemical/clinical persistence group had negative PET/CT imaging results. (B) Patients in biochemical cure/improvement group had significantly higher 68Ga-pentixafor uptake values than those in biochemical persistence group. (C) Values of SUVmax, LLR, and LAR of removed adrenal micronodules decreased gradually from group of patients with clinical cure to those with clinical improvement and finally to those with clinical persistence. ns = not statistically significant. *P < 0.05. **P < 0.01.

Tables

  • TABLE 1.

    Clinical Characteristics of Included 104 PA Patients with Adrenal Micronodules

    Clinical characteristicsTotal (n = 104)Surgically eligible group (n = 82)Surgically ineligible group (n = 22)P
    Age (y)48.4 ± 9.948.5 ± 10.048.0 ± 9.70.84
    Sex<0.05
     Male573819
     Female47443
    Body mass index (kg/m2)27.2 ± 5.426.2 ± 4.031.3 ± 7.6<0.05
    Hypertension104 (100%)82 (100%)22 (100%)1
    Refractory hypertension26 (25.0%)17 (20.7%)4 (44.4%)0.54
    Stage 1 hypertension2 (1.9%)1 (1.2%)1 (4.5%)0.24
    Stage 2 hypertension28 (26.9%)25 (30.5%)3 (13.6%)
    Stage 3 hypertension74 (71.2%)56 (68.3%)18 (81.8%)
    Duration of hypertension (y)8.1 ± 7.98.8 ± 7.111.9 ± 7.50.09
    Systolic pressure (mm Hg)179.8 ± 22.3180.2 ± 22.7178.5 ± 21.10.75
    Diastolic pressure (mm Hg)110.9 ± 14.3110.5 ± 14.1112.8 ± 15.30.50
    Preoperative defined daily dose2.7 ± 1.22.6 ± 1.13.2 ± 1.4<0.05
    Hypokalemia69 (66.3%)55 (67.1%)14 (63.6%)0.28
    Duration of hypokalemia (y)3.1 ± 3.02.9 ± 2.83.8 ± 3.10.22
    Serum potassium (mmol/L)3.0 ± 0.53.0 ± 0.63.0 ± 0.50.62
    Aldosterone-to-renin ratio ([ng/dL]/[ng/mL/h])131.0 ± 83.7131.1 ± 83.0130.6 ± 88.10.98
    Serum aldosterone (ng/dL)20.4 ± 5.720.4 ± 5.920.7 ± 5.20.82
    Lesion located on right36 (34.6%)31 (37.8%)5 (22.7%)0.56
    Lesion located on left29 (27.9%)25 (30.5%)4 (18.2%)
    Lesion bilateral39 (37.5%)26 (31.7%)13 (59.1%)

    • Qualitative data are number; continuous data are mean and SD.

  • TABLE 2.

    Efficacy of 68Ga-Pentixafor PET/CT Visual Analysis in Diagnosing Surgically Eligible PA Patients and Comparison with Adrenal CT and AVS in Patients with Pathology and Postoperative Follow-up

    ModalityTPTNFPFNSensitivitySpecificityAccuracyPPVNPV
    Both CT and PET/CT*
     Adrenal CT55671776.4% (65.4%–84.7%)46.2% (23.3%–70.9%)71.8% (62.2%–81.3%)88.7% (78.5%–94.4%)26.1% (12.5%–46.5%)
     PET/CT7081692.1% (86.0%–98.2%)88.9% (68.3%–100%)91.8% (85.9%–97.6%)98.6% (95.9%–100%)57.1% (31.2%–83.1%)
    Both AVS and PET/CT†
     AVS1022376.9% (49.7%–91.8%)50.0% (15.0%–85.0%)70.6% (48.9%–92.2%)83.3% (55.2%–95.3%)40.0% (11.8%–77.0%)
     PET/CT1131284.6% (57.8%–95.7%)75.0% (30.0%–95.4%)82.4% (64.2%–100%)91.7% (76.0%–100%)60.0% (23.1%–88.2%)

    • ↵* n = 85.

    • ↵† n = 17.

    • TP = true-positive; TN = true-negative; FP = false-positive; FN = false-negative; PPV = positive prediction value; NPV = negative prediction value.

    • Data in parentheses are 95% CIs.

  • TABLE 3.

    Consistency Evaluation in Patients Undergoing Concurrent AVS and 68Ga-Pentixafor PET/CT (n = 36)

    AVS
    68Ga-pentixafor PET/CTLeft lateralizationRight lateralizationNo lateralizationTotalκP
    Left lateralization60280.45<0.01
    Right lateralization1438
    No lateralization421420
    Total1161936

    • Consistency index: (6 + 4 + 14)/36 = 66.7%. Inconsistency index: (1 + 4 + 2 + 2 + 3)/36 = 33.3%.

  • TABLE 4.

    Imaging Variables of 183 Adrenal Micronodules in All PA Patients

    VariableMicro-APA (n = 76)Micro-UAH (n = 16)Micro-BAH (n = 51)Nonfunctioning micronodule (n = 40)P
    Size (cm)0.9 ± 0.10.8 ± 0.10.8 ± 0.10.8 ± 0.10.23
    SUVmax8.4 ± 4.26.7 ± 2.33.9 ± 1.23.2 ± 0.8<0.001
    LLR4.9 ± 3.04.0 ± 1.52.2 ± 0.71.8 ± 0.6<0.001
    LAR3.5 ± 1.82.9 ± 1.01.5 ± 0.41.4 ± 0.5<0.001
  • TABLE 5.

    Diagnostic Performance of 68Ga-Pentixafor PET/CT to Distinguish Surgically Eligible and Ineligible Micronodules

    ParameterEligible (n = 92)Ineligible (n = 91)SensitivitySpecificityAccuracyArea under curve
    Visual analysis
     Avid lesions (n = 97)831490.2% (84.1%–96.3%)84.6% (77.2%–92.0%)87.4% (82.6%–92.2%)—
     Nonavid lesions (n = 86)977
    Semiquantitative analysis
     SUVmax
      ≥4.55 (n = 92)781484.8% (77.4%–92.1%)84.6% (77.2%–92.0%)84.7% (79.4%–89.9%)0.91 (0.87–0.95)
      <4.55 (n = 91)1477
     LLR
      ≥2.17 (n = 80)701076.1% (67.3%–84.8%)89.0% (82.6%–95.4%)82.5% (77.0%–88.0%)0.88 (0.83–0.93)
      <2.17 (n = 103)2281
     LAR
      ≥1.90 (n = 87)78984.8% (77.4%–92.1%)90.1% (84.0%–96.2%)87.4% (82.6%–92.2%)0.91 (0.86–0.95)
      <1.90 (n = 96)1482

    • Data in parentheses are 95% CIs.

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