The value of targeted CXCR4 18F-AlF-NOTA-pentixafor PET/CT for subtyping primary aldosteronism

Objective The study aimed to investigate the diagnostic value of 18 F-AlF-NOTA-Pentixafor PET/CT in subtyping primary aldosteronism (PA). Methods This study enrolled 88 patients with PA or nonfunctional adenoma (NFA) for 18 F-Pentixafor PET/CT scan. Of these, 20 patients underwent adrenal venous sampling (AVS), and 65 underwent adrenalectomy and postoperative follow-up. Results In 88 patients, 76 were diagnosed with unilateral PA (UPA), 4 were diagnosed with bilateral PA (BPA), and 8 were diagnosed with NFA, resulting in a total of 95 lesions. To identify UPA, visual analysis received a specificity of 94.12% and a sensitivity of 89.74%. The optimal cutoff values for SUV max at 5.45, the lesion-to-normal adrenal ratio (LAR) at 1.43, and lesion-to-liver ratio (LLR) all yielded a specificity of 100% and a sensitivity of 79.49%, 83.33%, and 80.77%, respectively. In 15 adrenal lesions with similar uptake to contralateral and adjacent normal adrenal tissue (defined as warm lesions), 7 were confirmed as UPA, 4 were confirmed as BPA, and 4 were confirmed as NFA. Furthermore, among the 20 patients who underwent AVS, the concordance rate of AVS and PET/CT visual analysis for PA subtyping was 65.00%. Conclusions The CXCR4-targeted 18 F-AlF-NOTA-pentixafor PET/CT is a valuable noninvasive tool for diagnosing UPA, demonstrating high sensitivity and specificity. More attention should be paid to warm adrenal lesions for their high diagnostic ambiguity probability.