PET/CT在原发性醛固酮增多症功能定位诊断中的应用价值

Application value of PET/CT in functional localization diagnosisof primary aldosteronism

目的:探讨靶向CXC趋化因子受体4型(CXC chemokine receptor type 4,CXCR4)的68Ga-Pentixafor PET/CT核素显像在原发性醛固酮增多症(primary aldosteronism,PA)的优势侧功能定位以及预后的应用价值。方法:选取2022年3月至2023年5月重庆医科大学附属第一医院确诊为PA的66例住院患者。所有患者均接受PET/CT及肾上腺静脉取血(adrenal vein sample,AVS),且行腹腔镜下单侧或部分肾上腺切除术,分析比较PET/CT和AVS对PA分侧诊断的符合率;根据术后随访血压、用药改善情况及血钾水平,判断PET/CT对PA优势侧功能定位诊断的准确率及病灶最大标准化摄取值(maximum standardized uptake value,SUVmax)对患者术后预后的预测价值。结果:66例手术患者中行单侧肾上腺切除术63例、部分肾上腺切除术3例,术后病理检查结果中有腺瘤58例、增生8例,PET/CT和AVS对PA分侧诊断的符合率83.3%(55/66);以术后临床获益为标准,PET/CT对PA优势侧功能定位诊断的准确率为88.14%(52/59),AVS对PA优势侧功能定位诊断的准确率为93.22%(55/59);术后治愈患者病灶SUVmax[14.70(8.75~19.45)]要高于术后好转患者[10.90(6.65~14.10)],差异有统计学意义(P=0.026)。术前病灶SUVmax与术后醛固酮降低值、术后血浆醛固酮肾素比(aldosterone-to-renin ratio,ARR)降低值和术后血钾升高值呈正相关(r=0.267、0.365、0.392,P=0.034、0.003、0.001)。结论:靶向CXCR4的68Ga-Pentixafor PET/CT对PA优势侧定位诊断的准确率与AVS接近,但更具有可重复、无创等优势;病灶SUVmax越高,术后临床获益越明显,有一定的预后预测价值。

Objective:To investigate the clinical value of CXC chemokine receptor type 4(CXCR4)-targeting 68Ga-Pentixafor positron emission tomography/computed tomography(PET/CT)radionuclide-based imaging in the functional localization of the dominant side and prognosis of primary aldosteronism(PA).Methods:A total of 66 inpatients diagnosed with PA in The First Affiliated Hospital of Chongqing Medical University from March 2022 to May 2023 were selected.All patients were examined by PET/CT and adrenal vein sampling(AVS),and underwent unilateral or partial laparoscopic adrenalectomy.The coincidence rate of PET/CT and AVS in the diag-nosis of PA lateralization was analyzed and compared.According to the improvement in blood pressure,medication,and blood potas-sium level during postoperative follow-up,the accuracy rate of functional localization diagnosis on the dominant side of PA by PET/CT and the predictive value of maximum standardized uptake value(SUVmax)of lesions for postoperative prognosis of patients were evalu-ated.Results:Among the 66 surgical patients,unilateral adrenalectomy was performed in 63 patients and partial adrenalectomy in 3 patients.Postoperative pathological examinations showed adenoma in 58 patients and hyperplasia in 8 patients.The coincidence rate of PET/CT and AVS in the diagnosis of PA lateralization was 83.3%(55/66).Based on the postoperative clinical benefit,the accuracy rates of PET/CT and AVS in the functional localization diagnosis of the dominant side of PA were 88.14%(52/59)and 93.22%(55/59),respectively.SUVmax in postoperative cured patients[14.70(8.75,19.45)]was significantly higher than that in postoperative improved patients[10.90(6.65,14.10)](P=0.026).Preoperative SUVmax was positively correlated with postoperative aldosterone decrease,aldosterone/renin ratio decrease,and serum potassium increase(r=0.267,0.365,and 0.392,P=0.034,0.003,and 0.001,respectively).Conclusion:CXCR4-targeting 68Ga-Pentixafor PET/CT for localization diagnosis of the dominant side of PA has an accu-racy rate close to that of AVS,but with the advantages of repeatability and non-invasiveness.The higher the SUVmax,the more obvious the postoperative clinical benefit,showing a certain prognostic value.