Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism

in European Journal of Endocrinology
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  • 1 Department of Endocrinology, Turku University Hospital, Turku, Finland
  • 2 Turku PET Centre, University of Turku, Turku, Finland
  • 3 Department of Internal Medicine and Tampere University, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
  • 4 Department of clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
  • 5 Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
  • 6 Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
  • 7 Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
  • 8 Medical Imaging Center, Radiology, Helsinki University Hospital, Helsinki, Finland
  • 9 Abdominal Center, Nephrology, University of Helsinki, and Helsinki University Hospital, and Minerva Institute for Medical Research, Helsinki, Finland
  • 10 Research Program in Systems Oncology (ONCOSYS), University of Helsinki, Helsinki, Finland
  • 11 Endocrine Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  • 12 Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  • 13 Internal Medicine Outpatient Clinics, Helsinki, Finland
  • 14 Department of Pharmacology, G.V. (Sonny) Montgomery VA Medical Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
  • 15 Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland

Correspondence should be addressed to N Matikainen; Email: niina.matikainen@fimnet.fi

*(P I Nevalainen and N Matikainen share senior authorship)

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Objective

Endocrine Society guidelines recommend adrenal venous sampling (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imaging of adrenal cortex with 11C-metomidate (11C-MTO) could offer a noninvasive alternative to AVS in the subtype classification of PA.

Design

We prospectively recruited 58 patients with confirmed PA who were eligible for adrenal surgery.

Methods

Subjects underwent AVS and 11C-MTO-PET without dexamethasone pretreatment in random order. The lateralization of 11C-MTO-PET and adrenal CT were compared with AVS in all subjects and in a prespecified adrenalectomy subgroup in which the diagnosis was confirmed with immunohistochemical staining for CYP11B2.

Results

In the whole study population, the concordance of AVS and 11C-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and 11C-MTO-PET was 55% in unilateral and 44% in bilateral PA. In receiver operating characteristics analysis, the maximum standardized uptake value ratio of 1.16 in 11C-MTO-PET had an AUC of 0.507 (P = n.s.) to predict allocation to adrenalectomy or medical therapy with sensitivity of 55% and specificity of 44%. In the prespecified adrenalectomy subgroup, AVS and 11C-MTO-PET were concordant in 10 of 19 subjects with CYP11B2-positive adenoma and in 6 of 10 with CYP11B2-positivity without an adenoma.

Conclusions

The concordance of 11C-MTO-PET with AVS was clinically suboptimal, and did not outperform adrenal CT. In a subgroup with CYP11B2-positive adenoma, 11C-MTO-PET identified 53% of cases. 11C-MTO-PET appeared to be inferior to AVS for subtype classification of PA.

 

     European Society of Endocrinology

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