Novel imaging approach accurately identifies sub-types of primary aldosteronism

A novel imaging approach, ⁶⁸Ga-pentixafor PET/CT, has been shown to accurately identify sub-types of primary aldosteronism (an adrenal gland disorder), outperforming traditional methods for diagnosis. Reported in the January issue of The Journal of Nuclear Medicine, this detailed imaging technique provides a clearer picture of the adrenal glands, helping doctors decide more confidently whether surgery is the right option for patients.

Primary aldosteronism is an endocrine disorder that occurs when the adrenal glands produce too much of the hormone aldosterone, frequently caused by the presence of nodules on the glands. High aldosterone levels cause the body to retain too much sodium and not enough potassium. This imbalance can lead to high blood pressure, putting patients at an increased risk of stroke and heart disease.

In primary aldosteronism, it's important for physicians to differentiate between surgically eligible and ineligible forms so that they can develop the best treatment plan. This is usually done with adrenal CT and adrenal venous sampling. However, is rather challenging and often imprecise to diagnose adrenal micronodules with these methods. To more clearly image these micronodules, we combined PET/CT with a unique tracer that targets specific receptors in the adrenal glands and evaluated its performance."

Li Huo, MD, PhD, professor and chair in the Department of Nuclear Medicine at the Chinese Academy of Medical Sciences and Peking Union Medical College Hospital in Beijing, China

In the study, 123 patients with adrenal micronodules identified by adrenal CT were examined using ⁶⁸Ga-pentixafor PET/CT, and 104 patients who underwent surgery or successful adrenal venous sampling were included in the analysis. Nuclear medicine physicians evaluated the ⁶⁸Ga-pentixafor PET/CT data for sensitivity, specificity and accuracy of visual analysis. This information was then compared to adrenal CT and adrenal venous sampling results.

⁶⁸Ga-pentixafor PET/CT showed superior sensitivity, specificity and accuracy (90.2 percent, 72.7 percent and 86.5 percent, respectively) in identifying surgically eligible primary aldosteronism patients compared with adrenal CT (73.1 percent, 53.8 percent and 68.3 percent, respectively). It was also able to predict surgical outcomes better than adrenal venous sampling (82.4 percent vs. 68.86 percent).

"The significance of this work lies in its potential to change how we diagnose and treat primary aldosteronism patients with tiny adrenal nodules. For patients, this means an improved chance of getting the right treatment, especially when it comes to deciding whether surgery is necessary. Accurate diagnosis is crucial because it leads to more effective treatments, less unnecessary surgery and overall better health outcomes. It's about offering patients a more personalized and precise medical approach," stated Huo.

This research was published online in November 2023.