^(68)Ga-Pentixafor PET/CT鉴别肾上腺醛固酮产生腺瘤和无功能瘤的价值初探

Preliminary study on the ability of^(68)Ga-Pentixafor PET/CT to differentiate between adrenal aldosterone-producing adenoma and nonfunctional adenoma

目的评估^(68)Ga-Pentixafor(趋化因子受体4常用核素配体显像剂)PET/CT对醛固酮产生腺瘤(APA)和肾上腺无功能腺瘤(NFA)的鉴别价值,并探究其与临床指标及术后结局的相关性。方法横断面研究。纳入2018年8月至2021年10月于北京协和医院行^(68)Ga-Pentixafor PET/CT核素显像检查的73例APA和12例NFA患者,利用受试者工作特征(ROC)曲线评估视觉分析及病灶最大标准摄取值(SUV_(max))对APA和NFA的鉴别价值。采用Pearson或Spearman及χ^(2)检验分析APA病灶SUV_(max)的相关因素以及核素显像结果对病灶切除术后临床结局的预测作用。结果^(68)Ga-Pentixafor PET/CT视觉分析显示,73例APA患者中64例肾上腺病灶显像阳性(敏感度为87.7%);12例NFA患者肾上腺病灶显像均阴性(特异度为100%)。SUV_(max)鉴别APA与NFA的ROC曲线下面积为0.932(P<0.001)。SUV_(max)切点值为6.23时,鉴别诊断的敏感度为80.8%,特异度为100%。SUV_(max)与APA病灶大小(r=0.598)及醛固酮/肾素活性比值(r=0.313)呈正相关,与血钾水平(r=-0.286)、肾素活性(r=-0.240)及诊断年龄(r=-0.273)呈负相关(均P<0.05)。进行肾上腺病灶切除手术并术后随访6个月以上的患者中,^(68)Ga-Pentixafor PET/CT显像阳性患者的临床完全缓解比例高于显像阴性患者(24/39比0/4,P=0.031)。结论^(68)Ga-Pentixafor PET/CT对鉴别肾上腺APA和NFA具有较好的识别作用,其SUV_(max)与患者起病年龄、病灶大小及临床表现严重程度相关,且对术后结局有一定的预测作用。

Objective To evaluate the ability of^(68)Ga-Pentixafor(nuclide ligand imaging agents for chemokine receptor 4)PET/CT to differentiate between aldosterone-producing adenoma(APA)and adrenal nonfunctional adenoma(NFA),and to assess how well this imaging method correlates with clinical features and postoperative outcomes.Methods This was a cross-sectional study involving 73 APA and 12 NFA patients who received^(68)Ga-Pentixafor PET/CT imaging at Peking Union Medical College Hospital from August 2018 to October 2021.The receiver operating characteristic(ROC)curve was used to evaluate the differential value of visual analysis and the maximum standard uptake value(SUV_(max))of the focus on APA and NFA.The related factors of SUV_(max),and its predictive effect on postoperative outcomes were analyzed using Pearson or Spearman analysis and χ^(2) text.Results^(68)Ga-Pentixafor PET/CT imaging was positive in 64 APA patients(sensitivity=87.7%)and negative in all 12 NFA patients(specificity=100%).The area under the ROC curve with SUV_(max) differentiating APA and NFA was 0.932(P<0.001).When the SUV_(max) cut-off point was 6.23,the sensitivity was 80.8%and the specificity was 100%.The SUV_(max) correlated positively with lesion size(r=0.598)and aldosterone/renin activity ratio(r=0.313)and correlated negatively with potassium level(r=-0.286),renin activity(r=-0.240)and age of diagnosis(r=-0.273)(all P<0.05).Of the patients who underwent adrenalectomy and received more than 6 months of post-surgical follow-up,the clinical complete remission rate was higher for^(68)Ga-Pentixafor PET/CT imaging-positive patients than imaging-negative patients(24/39 vs.0/4,P=0.031).Conclusions^(68)Ga-Pentixafor PET/CT is effective at differentiating between APA and NFA.The SUV_(max) of^(68)Ga-Pentixafor PET/CT correlates with age at onset,lesion size,and the severity of clinical manifestations,and is able to predict postoperative outcomes.