Background
Primary aldosteronism (PA) is a leading cause of secondary hypertension, often requiring adrenalectomy for unilateral disease. Current diagnostic tools, including adrenal vein sampling (AVS), have limitations in lateralization accuracy. 68Ga-pentixafor PET/CT, targeting the chemokine receptor CXCR4, emerges as a novel functional imaging modality to address these gaps.
Study Design
A retrospective analysis of 188 PA patients undergoing 68Ga-pentixafor PET/CT pre-adrenalectomy. Quantitative PET/CT parameters (SUVmax, SUVmean, lesion-to-background ratios) were evaluated against postoperative outcomes (Primary Aldosteronism Surgical Outcome score) and histopathologic subtypes (HISTALDO consensus, CYP11B2 expression).
Key Findings
Clinical Outcomes
Patients with complete clinical success (n=112) had smaller tumor volumes (2.1 vs. 3.8 cm³, p<0.001) but higher tracer uptake (SUVmax 7.4 vs. 5.2, p=0.003). Lesion-to-contralateral cortex ratio independently predicted clinical success (OR 1.82, 95% CI 1.3–2.5).
Biologic Correlates
Classic HISTALDO subtypes exhibited higher SUVmax (8.1 vs. 5.9, p=0.01) and stronger CYP11B2 immunoreactivity (r=0.67, p<0.001). CXCR4 expression positively correlated with SUVmax (r=0.73).
Prognostic Models
Combined PET/CT-clinical models achieved AUCs of 0.853 (clinical success) and 0.861 (biochemical success).
Expert Commentary
“These findings position 68Ga-pentixafor PET/CT as a potential adjunct to AVS for surgical planning,” noted Dr. Chen. Limitations include retrospective design and median 6-month follow-up; longer studies are needed to assess durability.
Conclusion
68Ga-pentixafor PET/CT provides complementary prognostic information in PA, reflecting underlying biologic heterogeneity. Integration with HISTALDO classification may enhance personalized surgical management.
Funding
National Natural Science Foundation of China (82070476).
References
1. Chen H et al. Surgery. 2026;195:110206. PMID: 42001647.
