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

Author:

Soinio Minna12,Luukkonen Anna-Kaarina3,Seppänen Marko24,Kemppainen Jukka24,Seppänen Janne5,Pienimäki Juha-Pekka5,Leijon Helena6,Vesterinen Tiina67,Arola Johanna6,Lantto Eila8,Helin Semi2,Tikkanen Ilkka9,Metso Saara3,Mirtti Tuomas610,Heiskanen Ilkka11,Norvio Leena12,Tiikkainen Mirja12,Tikkanen Tuula13,Sane Timo12,Välimäki Matti12,Gomez-Sanchez Celso E14,Pörsti Ilkka3,Nuutila Pirjo12,Nevalainen Pasi I3,Matikainen Niina1215

Affiliation:

1. 1Department of Endocrinology, Turku University Hospital, Turku, Finland

2. 2Turku PET Centre, University of Turku, Turku, Finland

3. 3Department of Internal Medicine and Tampere University, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland

4. 4Department of clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland

5. 5Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland

6. 6Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland

7. 7Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland

8. 8Medical Imaging Center, Radiology, Helsinki University Hospital, Helsinki, Finland

9. 9Abdominal Center, Nephrology, University of Helsinki, and Helsinki University Hospital, and Minerva Institute for Medical Research, Helsinki, Finland

10. 10Research Program in Systems Oncology (ONCOSYS), University of Helsinki, Helsinki, Finland

11. 11Endocrine Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

12. 12Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

13. 13Internal Medicine Outpatient Clinics, Helsinki, Finland

14. 14Department of Pharmacology, G.V. (Sonny) Montgomery VA Medical Center, University of Mississippi Medical Center, Jackson, Mississippi, USA

15. 15Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland

Abstract

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.

Publisher

Bioscientifica

Subject

Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism

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