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Purpose <p>This study aimed to determine the suitable imaging time and validate the diagnostic accuracy of <sup>68</sup>Ga-Pentixafor PET/CT for subtyping primary aldosteronism (PA).</p> Methods <p>This two-part study enrolled patients with PA. Part 1 identified suitable PET/CT time points (0–120&#xa0;min) using multi-time-point imaging. Part 2 assessed the diagnostic performance in distinguishing unilateral PA (UPA) and bilateral PA (BPA). The diagnostic classification integrated AVS lateralization, imaging (visual analysis and lateralization index [LI] based on SUVmax and SUVpeak), and follow-up.</p> Results <p>The multi-time-point group (<i>n</i> = 33) showed distinct SUVmax kinetics: the dominant adrenal glands in UPA patients peaked at 10&#xa0;min (mean SUVmax, 18.27; sustained for 40&#xa0;min), while the adrenal glands in BPA patients peaked at 5&#xa0;min (9.6; sustained for 10&#xa0;min). Normal adrenal glands peaked at 5&#xa0;min (5.51). The SUVmax differed significantly between normal adrenal glands and both abnormal uptake patterns at all time-points (<i>P</i> &lt; 0.05), while the SUVmax of dominant glands in UPA and glands in BPA began to differ significantly after 10&#xa0;min post-injection (<i>P</i> &lt; 0.05). In the subtype group (<i>n</i> = 101), 10-min LI based on SUVmax (cutoff 1.655) achieved 86.1% specificity, 89.1% accuracy, and an area under the curve of 0.943 (95% CI: 0.901–0.985). The 10-min visual analysis showed 93.8% sensitivity. Notably, diagnostic performance remained remarkably stable regardless of the quantification parameter used (LI-SUVmax vs. LI-SUVpeak), both yielding nearly identical accuracies (89.1% vs. 88.1% at 10&#xa0;min). The 10-min LI based on SUVmax agreed with the AVS (83.8%) and surgical outcomes (87.9%), confirming its clinical utility.</p> Conclusion <p>Early 10-min and late 40-min phases are suitable for <sup>68</sup>Ga-Pentixafor PET/CT in PA. The 10-min LI and visual analysis demonstrate significant potential as non-invasive tools for PA subtyping. The LI is a remarkably robust and parameter-independent metric, providing high diagnostic consistency across different calculation methods and time points. Larger multicenter studies are needed to validate these findings.</p>

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Clinical value of multi-time-point 68Ga-Pentixafor PET/CT imaging in the subtype diagnosis of primary aldosteronism

  • 期刊论文

  • 发表日期：

    2026年5月4日

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  • Tingting Xu,
  • Peng Wang,
  • Tengfei Li,
  • Xinyao Yu,
  • Ke Cheng,
  • Yan Zhu,
  • Yue Chen

摘要

Purpose

This study aimed to determine the suitable imaging time and validate the diagnostic accuracy of 68Ga-Pentixafor PET/CT for subtyping primary aldosteronism (PA).

Methods

This two-part study enrolled patients with PA. Part 1 identified suitable PET/CT time points (0–120 min) using multi-time-point imaging. Part 2 assessed the diagnostic performance in distinguishing unilateral PA (UPA) and bilateral PA (BPA). The diagnostic classification integrated AVS lateralization, imaging (visual analysis and lateralization index [LI] based on SUVmax and SUVpeak), and follow-up.

Results

The multi-time-point group (n = 33) showed distinct SUVmax kinetics: the dominant adrenal glands in UPA patients peaked at 10 min (mean SUVmax, 18.27; sustained for 40 min), while the adrenal glands in BPA patients peaked at 5 min (9.6; sustained for 10 min). Normal adrenal glands peaked at 5 min (5.51). The SUVmax differed significantly between normal adrenal glands and both abnormal uptake patterns at all time-points (P < 0.05), while the SUVmax of dominant glands in UPA and glands in BPA began to differ significantly after 10 min post-injection (P < 0.05). In the subtype group (n = 101), 10-min LI based on SUVmax (cutoff 1.655) achieved 86.1% specificity, 89.1% accuracy, and an area under the curve of 0.943 (95% CI: 0.901–0.985). The 10-min visual analysis showed 93.8% sensitivity. Notably, diagnostic performance remained remarkably stable regardless of the quantification parameter used (LI-SUVmax vs. LI-SUVpeak), both yielding nearly identical accuracies (89.1% vs. 88.1% at 10 min). The 10-min LI based on SUVmax agreed with the AVS (83.8%) and surgical outcomes (87.9%), confirming its clinical utility.

Conclusion

Early 10-min and late 40-min phases are suitable for 68Ga-Pentixafor PET/CT in PA. The 10-min LI and visual analysis demonstrate significant potential as non-invasive tools for PA subtyping. The LI is a remarkably robust and parameter-independent metric, providing high diagnostic consistency across different calculation methods and time points. Larger multicenter studies are needed to validate these findings.