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. 2025 Jan 16;15(1):5.
doi: 10.1186/s13550-024-01194-3.

68Ga-Pentixafor PET/CT for the assessment of therapeutic outcomes following superselective adrenal arterial embolization in patients with primary aldosteronism

MengDan Li #  1 , Lili Guan #  1 , Lu Yang  1 , WenBo Li  1 , Zhu Xia  1 , Min Mao  2 , Hua Pang  3
Affiliations

68Ga-Pentixafor PET/CT for the assessment of therapeutic outcomes following superselective adrenal arterial embolization in patients with primary aldosteronism

MengDan Li et al. EJNMMI Res. .

Abstract

Background: Superselective adrenal artery embolization (SAAE) represents a novel therapeutic strategy for managing primary aldosteronism (PA). Currently, the evaluation of its efficacy is primarily restricted to clinical indicators, with a notable deficiency in imaging evaluation methodologies. In recent years, several studies have investigated the application of 68Ga-Pentixafor PET/CT for the classification of PA. However, there is a scarcity of specific research investigating the role of PET/CT in the evaluation of efficacy of this condition. Consequently, this study aims to evaluate the therapeutic efficacy of SAAE in patients with PA using 68Ga-Pentixafor PET/CT, with the objective of establishing imaging evaluation methodologies for assessing PA patients post-SAAE treatment.

Results: Of the 27 patients, 2 achieved complete clinical remission, while 25 experienced partial remission. Biochemically, 13 patients attained complete remission, 13 had partial remission, and 1 did not. For patients with aldosterone-producing adenoma, both visual and semi-quantitative analyses of PET/CT effectively assessed changes in radioactive uptake of the lesion. For idiopathic hyperaldosteronism patients, PET/CT parameters were more effective than visual analysis in evaluating SAAE efficacy. A significant difference in the ΔTLR-40 min parameter was observed across biochemical outcomes (P = 0.041), with patients having ΔTLR-40 min ≥ 0.07 showing better outcomes (AUC = 0.789, P = 0.041).

Conclusions: 68Ga-Pentixafor PET/CT enables timely assessment of therapeutic outcomes in patients with PA following SAAE, thereby improving clinical decision-making and patient management.

Keywords: 68Ga-Pentixafor; PET/CT; Primary aldosteronism; Superselective adrenal arterial embolization.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in strict accordance with the ethical principles of the Declaration of Helsinki and received formal approval from the Ethics Review Committee of the First Affiliated Hospital of Chongqing Medical University (Approval Number: 2024-135-01). Consent for publication: Written informed consent was obtained from the patient for publication of this study and accompanying images. Competing interests: The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of the study design
Fig. 2
Fig. 2
Both Patient 4 (row A) and Patient 6 (row D) presented with a soft tissue density nodule in the left adrenal gland before surgery, and visual analysis revealed a significant increase in radioactive uptake in the corresponding area. After the first SAAE, Patient 4 (line B) and Patient 6 (line E) demonstrated continued high radioactive uptake of the lesion, suggesting embolization failure. For further treatment, a second SAAE was conducted, and PET/CT imaging was performed both before and after the procedure. After the second SAAE, Patient 4 (row C) exhibited a significant reduction in radioactive uptake of the lesion, while Patient 6 (row F) demonstrated radioactive uptake similar to that of the surrounding adrenal tissue. In the semi-quantitative analysis, Patient 4 experienced a notable decrease in postoperative SUVmax (23.1 vs. 2.7), LAR (9.63 vs. 0.55), and LLR (19.25 vs. 1.5), ultimately achieving clinical partial remission and biochemical complete remission. Patient 6 also exhibited a downward trend in postoperative SUVmax (11.7 vs. 8.1), LAR (2.49 vs. 1.98), and LLR (5.09 vs. 4.76), ultimately achieving clinical partial remission and biochemical complete remission
Fig. 3
Fig. 3
A total of 29 SAAE lesions were observed in 19 patients with IHA. Analysis of the changes in LLR and TLR for each lesion before and after SAAE indicated that the LLR and TLR of most lesions decreased after SAAE, suggesting that SAAE was effective
Fig. 4
Fig. 4
ROC Curve for ΔTLR-40 min
See this image and copyright information in PMC

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