Evaluating the value of chemokine receptor type 4–targeted PET imaging in diagnosing primary aldosteronism lateralization: A comparison with adrenal venous sampling

Primary aldosteronism lateralization is critical for the treatment option. This study evaluated the preoperative localization diagnostic efficiency of 68Ga-pentixafor positron emission tomography/computed tomography imaging, targeting C-X-C chemokine receptor type 4 in patients with primary aldosteronism and comparing with adrenal venous sampling, the current gold standard for primary aldosteronism lateralization. Fifty patients with primary aldosteronism underwent adrenal venous sampling and 68Ga-pentixafor positron emission tomography/computed tomography imaging of the adrenal region separately. Patients with lateralization determined by adrenal venous sampling or positron emission tomography/computed tomography underwent adrenalectomy, followed by pathologic diagnoses and immunohistochemical staining for aldosterone synthase (CYP11B2) and C-X-C chemokine receptor type 4, and follow up 12 months after surgery. Correlations among positron emission tomography/computed tomography and adrenal venous sampling, pathologic results, and clinical outcomes were analyzed. The positron emission tomography/computed tomography threshold for primary aldosteronism lateralization was determined using receiver operating characteristic curve analysis. The maximum standard uptake value, with a cutoff value of 11.95, achieved a sensitivity of 74.1% and a specificity of 100.0% for primary aldosteronism lateralization in patients with aldosterone-producing adenoma. A cutoff value of 5.85 for the maximum standard uptake value reached a sensitivity of 81.6% and a specificity of 73.1% in all patients with primary aldosteronism. The concordance rate between 68Ga-pentixafor positron emission tomography/computed tomography and adrenal venous sampling for primary aldosteronism lateralization was 96.2% in patients with aldosterone-producing adenoma and 75.7% in all patients. Patients with positron emission tomography/computed tomography lateralization benefited from adrenalectomy, and primary aldosteronism lateralization based on positron emission tomography/computed tomography strongly correlated with pathologic classifications, CYP11B2 and C-X-C chemokine receptor type 4 expression levels, and clinical outcomes during follow-up. 68Ga-pentixafor positron emission tomography imaging, as a noninvasive method, performed excellently in detecting aldosterone-producing adenoma and could act as an effective supplement to adrenal venous sampling in primary aldosteronism lateralization.