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Purpose <p>To evaluate the diagnostic utility of integrating [<sup>68</sup>Ga]Ga-Pentixafor PET with contrast-enhanced CT (CECT) for the visualization and localization of adrenal lesions in patients with primary aldosteronism (PA).</p> Methods <p>Thirty-five patients with clinically suspected PA who underwent [<sup>68</sup>Ga]Ga-Pentixafor PET and integrated CECT scans were retrospectively enrolled in this study. Adrenal lesions were identified and segmented using non-threshold methods. PET parameters (SUVmax, lesion-to-contralateral adrenal ratio [LCR], lesion-to-liver ratio [LLR]) and CT parameters (attenuation values, absolute and relative washout) were measured, and their correlations were analyzed. Abdominopelvic CT angiography was reconstructed to rule out vasogenic hypertension, and three-dimensional volume reconstruction from CECT data was applied for the visualization and localization of adrenal lesions. Additionally, a logistic regression model with cross-validation was constructed to predict aldosterone-producing adenomas (APA).</p> Results <p>Among these 35 patients, a total of 56 adrenal lesions including APA (<i>n</i> = 26), idiopathic hyperplasia (IHA, <i>n</i> = 26), nonfunctioning adenomas (NFA, <i>n</i> = 3), and familial hyperaldosteronism (<i>n</i> = 1) were identified and segmented from both [<sup>68</sup>Ga]Ga-Pentixafor PET and CECT images. APA demonstrated significantly higher SUVmax, LCR, and LLR, as well as lower delayed-phase CT values and greater absolute/relative washout compared with non-APA lesions (<i>P</i> &lt; 0.05). One (1/35) patient exhibited mild renal artery stenosis, while no patients were found to have other renal abnormalities. A multivariable model incorporating SUVmax, relative washout, and diameter of lesions, achieved excellent discrimination between APA and non-APA lesions (area under the curve [AUC] = 0.912), outperforming individual parameters.</p> Conclusion <p>The integration of [<sup>68</sup>Ga]Ga-Pentixafor PET with CECT provides a non-invasive, comprehensive diagnostic approach for PA, enhancing lesion detection, subtype classification, and surgical planning, which may be incorporated into clinical practice.</p>

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One-stop evaluation using [68Ga]Ga-Pentixafor PET integrated with contrast-enhanced CT for visualization and localization of adrenal nodules in patients with primary aldosteronism

  • 期刊论文

  • 发表日期：

    2026年3月6日

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  • Zican Feng,
  • Yuxiang Shang,
  • Fanghu Wang,
  • Xinze Song,
  • Danyi Guo,
  • Yijun Lu,
  • Peng Wang,
  • Yang Chen,
  • Lei Jiang,
  • Hui Yuan

摘要

Purpose

To evaluate the diagnostic utility of integrating [68Ga]Ga-Pentixafor PET with contrast-enhanced CT (CECT) for the visualization and localization of adrenal lesions in patients with primary aldosteronism (PA).

Methods

Thirty-five patients with clinically suspected PA who underwent [68Ga]Ga-Pentixafor PET and integrated CECT scans were retrospectively enrolled in this study. Adrenal lesions were identified and segmented using non-threshold methods. PET parameters (SUVmax, lesion-to-contralateral adrenal ratio [LCR], lesion-to-liver ratio [LLR]) and CT parameters (attenuation values, absolute and relative washout) were measured, and their correlations were analyzed. Abdominopelvic CT angiography was reconstructed to rule out vasogenic hypertension, and three-dimensional volume reconstruction from CECT data was applied for the visualization and localization of adrenal lesions. Additionally, a logistic regression model with cross-validation was constructed to predict aldosterone-producing adenomas (APA).

Results

Among these 35 patients, a total of 56 adrenal lesions including APA (n = 26), idiopathic hyperplasia (IHA, n = 26), nonfunctioning adenomas (NFA, n = 3), and familial hyperaldosteronism (n = 1) were identified and segmented from both [68Ga]Ga-Pentixafor PET and CECT images. APA demonstrated significantly higher SUVmax, LCR, and LLR, as well as lower delayed-phase CT values and greater absolute/relative washout compared with non-APA lesions (P < 0.05). One (1/35) patient exhibited mild renal artery stenosis, while no patients were found to have other renal abnormalities. A multivariable model incorporating SUVmax, relative washout, and diameter of lesions, achieved excellent discrimination between APA and non-APA lesions (area under the curve [AUC] = 0.912), outperforming individual parameters.

Conclusion

The integration of [68Ga]Ga-Pentixafor PET with CECT provides a non-invasive, comprehensive diagnostic approach for PA, enhancing lesion detection, subtype classification, and surgical planning, which may be incorporated into clinical practice.