C-X-C Motif Chemokine Receptor 4–Directed Scintigraphy Using [99mTc]Tc-Pentixatec in Primary Aldosteronism: A Proof-of-Concept Study

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FIGURE 1.
[^99mTc]Tc-pentixatec scintigraphy and histopathologic findings of patient 4. Maximum-intensity projection (A), axial SPECT (B), CT (C), and fused SPECT/CT (D) images of abdomen depict intensive CXCR4 expression in left adrenal gland (arrows), corresponding to CT-graphic finding of 18-mm adenoma in left adrenal gland.
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FIGURE 2.
[^99mTc]Tc-pentixatec scintigraphy of patient 6. Maximum-intensity projection (A), axial SPECT (B), CT (C), and fused SPECT/CT (D) images of abdomen depict no lateralization of CXCR4 expression to either adrenal gland. Native CT imaging revealed nodular lesion (arrows) in right adrenal gland, which did not depict elevated CXCR4 expression, consistent with non–aldosterone-producing adenoma. Patient received MRA treatment after [^99mTc]Tc-pentixatec scintigraphy.
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FIGURE 3.
In patient 4, immunohistochemistry confirmed intense CXCR4 expression of APA (A and C) after adrenalectomy, and physiologic CXCR4 staining was detected in outer part of normal adrenal cortex (A and B).

TABLE 1.

Distinct Laboratory Findings of Included Patients Before [^99mTc]Tc-Pentixatec Scintigraphy

Patient no.	Sex	Age (y)	Syst. BP (mm Hg)	Diast. BP (mm Hg)	Prior antihypertensive medication	DDD	Potassium (mmol/L)	Aldosterone (pg/mL)	Renin (μU/mL)	ARR	ACTH (pg/mL)	Cortisol (μg/dL)
1	M	44	147	98	Doxazosin, 16 mg; Verapamil, 240 mg	5	4.1	73	2.17	33.64	12	9.8
2	F	61	150	100	Verapamil, 360 mg	1.5	4.5	190	2.5	76.00	56	—
3	F	47	169	106	Doxazosin, 4 mg; Verapamil, 140 mg	1.6	3.2	264	9.4	28.09	11	16.2
4	M	20	130	80	Verapamil, 240 mg	1	3.9	190	11	17.27	77	16
5	M	57	148	98	Verapamil, 240 mg	1	3.8	231	2	115.50	8	10.8
6	M	60	164	86	Doxazosin, 2 mg; Verapamil, 480 mg	2.5	3.4	465	2	232.5	16	14.2

Syst. BP = systolic blood pressure; Diast. BP = diastolic blood pressure; DDD = defined daily dose; ARR = aldosterone-to-renin ratio; ACTH = adrenocorticotropic hormone.
Presented data includes distinct laboratory findings and patients blood pressure at initial presentation; all patients were on antihypertensive medication at initial presentation.

TABLE 2.

Distinct Findings of CT, AVS, and [^99mTc]Tc-Pentixatec Scintigraphy

Patient no.	CT imaging	Maximum diameter (mm)	AVS	AVS LI	[^99mTc]Tc-pentixatec	Therapy recommendation
1	Adenoma in right adrenal gland	19	No lateralization	2.10	Lateralization to right adrenal gland (LCR, 1.70; 120 min after injection)	Recommendation for surgery
2	Unsuggestive imaging; no adrenal lesion detected	Not applicable	No selective sampling possible; lateralization to right adrenal gland	—	No lateralization (LCR, 1.20; 30 min after injection)	MRA treatment
3	Adenoma in right adrenal gland	12	Lateralization to right adrenal gland	9.75	No lateralization (LCR, 1.28; 30 min after injection)	MRA treatment
4	Adenoma in left adrenal gland	18	Lateralization once to right adrenal gland; lateralization twice to left adrenal gland	6.22	Lateralization to left adrenal gland (LCR, 1.52; 240 min after injection)	Recommendation for surgery
5	Adenoma in left adrenal gland	16	No lateralization	5.95	Lateralization to left adrenal gland (LCR, 1.65; 240 min after injection)	MRA treatment
6	Adenoma in right adrenal gland	11	No selective sampling possible; no lateralization	—	No lateralization (LCR, 1.22; 240 min after injection)	MRA treatment