The diagnostic value of 68Ga-pentixafor PET/CT in differentiating adrenal aldosterone-producing adenomas from...

Aldosterone-producing adenoma (APA) is one of the major causes of primary aldosteronism (PA). Although 68Ga-pentixafor PET/CT has emerged as a promising tool for subtyping diagnosis of PA, its diagnostic efficacy in distinguishing APA from non-functional adrenal adenoma (NFA) remains to be evaluated. To evaluate the value of 68Ga-pentixafor PET/CT in differentiating APA from NFA, this study prospectively included patients suspicious of APA and patients diagnosed with NFA to undergo 68Ga-pentixafor PET/CT. APA was further confirmed by post-surgery histopathology and biochemical results. The diagnostic efficacy of visual analysis, maximum standardized uptake value (SUVmax) of adrenal lesions, and lateralization index of SUVmax (LI) was analyzed by receiver operating characteristic (ROC) curve. The cohort included 75 patients with APA and 51 patients with NFA. Visual analysis achieved an area under the ROC curve (AUC) of 0.84, with a sensitivity and a specificity of 0.95 and 0.73, respectively. The AUC for SUVmax and LI was 0.96 and 0.93, respectively. At an LI cutoff of 1.65, the sensitivity and specificity were both 0.87. Using an SUVmax cutoff of 7.0, the sensitivity and specificity reached 0.88 and 0.85, respectively. Visual analysis revealed a higher false-positive rate (27.27%) compared to LI (12.73%) and SUVmax (14.55%). 68Ga-pentixafor PET/CT is useful in differentiating APA from NFA; however, false-positive results remain a concern, particularly with visual analysis.