68Ga-pentixafor PET/CT in guiding surgical management of primary aldosteronism

Abstract

Purpose: This study aimed to explore the significance of ⁶⁸Ga-pentixafor PET/CT in guiding surgical treatments for primary aldosteronism (PA) patients, by identifying functional lesions and determining the dominant side of aldosterone secretion.

Materials and methods: We prospectively included 91 PA patients receiving surgical treatments based on the results of ⁶⁸Ga-pentixafor PET/CT. The ⁶⁸Ga-pentixafor PET/CT images were evaluated by visual and semi-quantitative analysis. The relationship between radionuclide imaging characteristics and postoperative outcomes was assessed following surgery.

Results: The positive detection rate of ⁶⁸Ga-pentixafor PET/CT in 91 PA patients was 85.7 % (78/91) with a median maximum standardized uptake value (SUV_max) of 10.2 (6.0-16.0). The SUV_max was positively correlated with lesion diameter (r = 0.497, P < 0.001), while negatively correlated with the blood potassium level (r = -0.450, P < 0.001) and plasma renin activity (r = -0.297, P = 0.004). 63 cases of 73 PA patients with unilateral adrenal lesion were identified positive by ⁶⁸Ga-pentixafor PET/CT, and 95.2 % of the 63 positive cases benefited from surgical resection of the identified positive lesions. Among 18 PA patients with bilateral lesions, ⁶⁸Ga-pentixafor PET/CT identified positive lesions in 15 cases, and 86.7 % (13/15) of the positive cases benefited from total or partial adrenalectomy guided by ⁶⁸Ga-pentixafor PET/CT. There was no significant difference in postoperative outcomes between patients undergoing partial adrenalectomy with those subjected to total adrenalectomy. The accuracy rate of ⁶⁸Ga-pentixafor PET/CT in determining the dominant side of aldosterone secretion for PA was 85.7 %, which was comparable to the 71.4 % of adrenal vein sampling (AVS).

Conclusions: ⁶⁸Ga-pentixafor PET/CT could effectively guide the surgical management for PA patients, achieving favorable postoperative outcomes. The accuracy rate of ⁶⁸Ga-pentixafor PET/CT in identifying the dominant side of aldosterone secretion was not inferior to that of AVS.

Keywords: 68Ga-pentixafor PET/CT; Adrenalectomy; CXCR4 receptor; Primary aldosteronism.

Fig. 1

Image of classic unilateral adrenal lesion. Female PA patient, 40 years old, one positive lesion in the right adrenal gland was detected by ⁶⁸Ga-pentixafor PET/CT, with a SUV_max of 11.4 and a diameter of 1.8 cm. This patient achieved complete clinical success and complete biochemical success after laparoscopic partial adrenalectomy to resect the positive lesion, and the result of pathological diagnosis was APA.

Fig. 2

Image of positive adrenal lesion with small size. Male PA patient, 59 years old, one small size lesion in left adrenal gland was identified as positive by ⁶⁸Ga-pentixafor PET/CT, with a SUV_max of 7.7 and a diameter of 0.8 cm. This patient achieved both complete clinical and biochemical success after laparoscopic total adrenalectomy and result of pathological diagnosis was APA.

Fig. 3

Images of positive adrenal lesion in one side and negative lesion in contralateral side. Female PA patient, 58 years old, ⁶⁸Ga-pentixafor PET/CT showed one negative lesion in right adrenal gland with a SUV_max of 3.4 and a diameter of 1.4 cm (A), and one positive lesion in left adrenal gland with a SUV_max of 8.4 and a diameter of 2.2 cm (B). This patient underwent laparoscopic partial adrenalectomy to resect the positive adrenal lesion in left side, and achieved both complete clinical and biochemical success after operation, with a pathological diagnosis of APA.

Fig. 4

Images of PA with bilateral positive adrenal lesions. Female PA patient, 70 years old, ⁶⁸Ga-pentixafor PET/CT showed similar positive lesions in bilateral adrenal glands, with a SUV_max of 8.0 and a diameter of 2.3 cm in right side (A), with a SUV_max of 8.3 and a diameter of 0.7 cm in left side (B). AVS also showed no endocrine functional dominance in bilateral adrenal glands. The laparoscopic adrenalectomy was performed on the right side due to the larger diameter, and no clinical and biochemical benefit was observed after operation.