KCNJ5-Dependent 68Ga-Pentixafor PET/CT in Primary Aldosteronism Surgery

Area of Science:

• Nuclear Medicine
• Endocrinology
• Surgical Management

Background:

• Primary aldosteronism (PA) is a common cause of secondary hypertension.
• Accurate lateralization of aldosterone production is crucial for surgical management.
• Current diagnostic tools like adrenal venous sampling (AVS) have limitations.

Purpose of the Study:

• To evaluate the utility of 68Ga-pentixafor PET/CT in guiding surgical decisions for PA.
• To assess the correlation between PET/CT findings, AVS results, and KCNJ5 mutation status.
• To determine the impact of PET/CT on postoperative outcomes.

Main Methods:

• Retrospective analysis of 162 patients with PA undergoing unilateral adrenalectomy.
• Comparison of AVS-guided versus PET/CT-guided treatment pathways.
• Analysis of PET/CT findings in relation to KCNJ5 mutation status and lesion characteristics.
• Assessment of outcomes using the PASO criteria.

Main Results:

• 68Ga-pentixafor PET/CT demonstrated a high positive predictive value (98.2%) for unilateral PA when findings were clearly unilateral.
• However, 26 of 82 AVS-confirmed unilateral PA cases showed negative or bilateral PET findings.
• KCNJ5 mutation status and lesion size were independently associated with PET positivity.
• SUVmax LI on PET/CT correlated with biochemical success, even in KCNJ5-nonmutated patients.

Conclusions:

• 68Ga-pentixafor PET/CT is a strong tool for ruling in unilateral PA when uptake is distinctly unilateral.
• Negative or bilateral PET/CT findings, especially in small or KCNJ5-nonmutated lesions, warrant careful consideration and should not replace AVS.
• PET/CT findings should be integrated with clinical and other imaging data for optimal patient management.