TY - JOUR T1 - Functional characterization of adrenocortical masses in nononcological patients using [<sup>68</sup>Ga]-pentixafor JF - Journal of Nuclear Medicine JO - J Nucl Med DO - 10.2967/jnumed.121.261964 SP - jnumed.121.261964 AU - Jie Ding AU - Anli Tong AU - Yushi Zhang AU - Jin Wen AU - Hui Zhang AU - Marcus Hacker AU - Li Huo AU - Xiang Li Y1 - 2021/07/01 UR - http://jnm.snmjournals.org/content/early/2021/07/22/jnumed.121.261964.abstract N2 - Purpose: We aimed to investigate the diagnostic and prognostic value of 68Ga-pentixafor positron emission tomography (PET)/computed tomography (CT) imaging in non-cancer patients with suspected adrenal masses. Methods: Sixty-four patients who had benign adrenal masses on CT were retrospectively included in our study. All patients underwent 68Ga-pentixafor PET/CT scans, and 56 of these patients subsequently underwent adrenalectomy. The subtypes of 81 adrenal tumors including 14 nonfunctioning adrenal nodules, 4 cortisol-producing adenomas, 41 aldosterone-producing adenomas, 5 suspected unilateral adrenal hyperplasia, 15 idiopathic aldosterone hyperplasia and 2 pheochromocytomas, were determined by histology or follow-up evaluations. The functional lateralization diagnosis efficiency was calculated by visual analysis. Semi-quantitative parameters of these lesions including maximum standardized uptake value (SUVmax), the ratio of lesional SUVmax to normal liver SUVmean (LLR), and the ratio of lesional SUVmax to contralateral adrenal tissue SUVmean (LCR) have also been calculated. Dynamic analysis has also been performed on fifteen patients. Besides, clinical outcomes were assessed and compared in patients who underwent adrenalectomy. Results: The sensitivity and specificity of 68Ga-pentixafor PET for functional lateralization of patients with adrenocortical lesions were 97.8% (45/46) and 87.5% (14/16) respectively. The two pheochromocytoma lesions had lower pentixafor uptake compared to the normal adrenal glands. Functioning (active) adrenocortical adenomas showed an elevated SUVmax of 16.3±7.9 in comparison to 4.4±1.7 in nonfunctioning (inactive) adenomas and 5.5±2.7 in hyperplasia lesions (P&lt;0.0001). To identify active adrenocortical adenomas, a cutoff value of 7.1 for SUVmax showed a sensitivity of 90.9% and a specificity of 85.3% (AUC=0.96, P&lt;0.0001); a cutoff value of 2.5 for LLR showed a sensitivity of 95.5% and a specificity of 88.2% (AUC=0.97, P&lt;0.0001); and a cutoff value of 2.4 for LCR showed a sensitivity of 88.6% and a specificity of 91.8% (AUC=0.95, P&lt;0.0001). The graphical Ki of active adrenocortical adenomas was significantly higher than in-active adenomas. Uptake values for 68Ga-pentixafor were significantly higher in patients with preferable outcomes (cured/improved) (SUVmax=15.5±8.0, LLR=6.5±4.3, LCR=6.2±5.0) than in patients with nonpreferable outcomes (no improvement) (SUVmax=4.2±0.5, LLR=1.3±0.2, LCR =1.5±0.6, all P&lt;0.0001). Conclusion: 68Ga-pentixafor PET/CT imaging exhibits great potential for noninvasive functional lateralization and characterization of patients with adrenocortical masses. ER -