摘要
目的探讨靶向趋化因子CXC亚家族受体4(CXCR4)的68Ga-Pentixafor PET/CT在原发性醛固酮增多症(PA)患者分型诊断与病灶精准定位中的应用价值。方法前瞻性纳入2022年7月1日至2023年7月1日于湘雅二医院经临床确诊为PA且行肾上腺静脉取样(AVS)的患者33例[男24例,女9例,年龄(49.6±10.3)岁],所有患者行68Ga-Pentixafor PET/CT检查。PET/CT或AVS检出优势侧的患者行单侧肾上腺手术切除治疗,无优势侧的行药物治疗。应用PA手术预后(PASO)标准,根据病理及随访结果将手术者分为单侧PA(UPA)和双侧PA(BPA);药物治疗者为BPA。计算68Ga-Pentixafor PET/CT对UPA的诊断效能;构建ROC曲线,判断PET/CT定量参数SUVmax、病变SUVmax与对侧肾上腺SUVmean比值(LCR)、病变SUVmax与肝脏SUVmean比值(LLR)对PA分型诊断的准确性和最佳阈值。采用Spearman秩相关分析评估上述定量参数与患者临床特征和病灶宽径的相关性。使用两独立样本t检验比较不同疗效组间LCR和LLR的差异。结果20例患者接受单侧肾上腺切除手术。33例PA患者中最终诊断UPA 19例、BPA 14例。PET/CT和AVS判断结果一致的占81.8%(27/33),且2种方法均独立检出在另一检查中表现为阴性的UPA。68Ga-Pentixafor PET/CT视觉诊断UPA的灵敏度、特异性和准确性分别为18/19、14/14、97.0%(32/33)。在68Ga-Pentixafor PET/CT定量参数中,LLR的AUC达0.944,最佳阈值为3.1。SUVmax、LCR、LLR与醛固酮浓度(rs值:0.35、0.47、0.36,均P<0.05)和病灶宽径(rs值:0.43、0.49、0.58,均P<0.05)呈正相关。同时达到生化及临床完全治愈患者的优势侧肾上腺病灶LCR(3.9±2.2与1.6±0.3;t=2.00,P=0.041)和LLR(8.7±4.1与4.2±1.3;t=2.06,P=0.045)高于部分好转患者的对应指标。结论68Ga-Pentixafor PET/CT显像可用于PA亚型诊断与精准定位的方式,其可以发现AVS未检测出的可手术治愈的PA患者,且定量分析可能对预后预测有价值。
ObjectiveTo investigate the application value of 68Ga-Pentixafor PET/CT targeting CXC subfamily receptor 4(CXCR4)in the subtyping and precise localization of primary aldosteronism(PA).MethodsThirty-three patients with PA confirmed by clinical examination and undergoing 68Ga-Pentixafor PET/CT and adrenal vein sampling(AVS)in the Second Xiangya Hospital between July 1st 2022 and July 1st 2023 were prospectively enrolled(24 males,9 females,age(49.6±10.3)years).Patients with a dominant side identified by PET/CT or AVS underwent unilateral adrenalectomy,while those without a dominant side received medical treatment.According to the standard of PA surgical outcome(PASO),patients underwent surgery were divided into unilateral PA(UPA)and bilateral PA(BPA)based on the pathological and follow-up results.Those who received medical treatment were BPA.The diagnostic efficacy of 68Ga-Pentixafor PET/CT for UPA was calculated.The ROC curve was constructed to analyze the accuracy and optimal threshold of SUV max,the ratio of lesion SUV max to contralateral adrenal tissue SUV mean(LCR),and the ratio of lesion SUV max to liver SUV mean(LLR)in the diagnosis of PA subtype.The correlation between the quantitative parameters and the clinical features and lesion width of the patients was evaluated by Spearman rank correlation analysis.The differences of LCR and LLR between different efficacy groups were compared by the independent-sample t test.ResultsA total of 20 patients underwent unilateral adrenalectomy.Nineteen patients were finally diagnosed with UPA and 14 with BPA.The agreement rate of PET/CT and AVS was 81.8%(27/33),and both methods independently detected UPA that was negative in the other examination.The sensitivity,specificity,and accuracy of 68Ga-Pentixafor PET/CT visual diagnosis of UPA were 18/19,14/14,and 97.0%(32/33),respectively.ROC curve showed that the AUC of LLR for subtype diagnosis was 0.944,with the optimal threshold of 3.1.SUV max,LCR,and LLR were positively correlated with aldosterone concentration(r s values:0.35,0.47,and 0.36,all P<0.05)and lesion width(r s values:0.43,0.49,and 0.58,all P<0.05).The LCR(3.9±2.2 vs 1.6±0.3;t=2.00,P=0.041)and LLR(8.7±4.1 vs 4.2±1.3;t=2.06,P=0.045)of the dominant side lesions in patients who achieved complete biochemical and clinical cure were higher than those in patients with partial improvement.Conclusions 68Ga-Pentixafor PET/CT imaging can be used in the diagnosis and precise localization of PA subtype.It also can detect patients with PA which can be surgically cured but not detected by AVS,and the quantitative analysis may be valuable for prognosis prediction.
作者
尹璇
马晓伟
董楚宁
周廉博
安荣臣
虢红辉
向馨
张昕璐
向鸿
王云华
Yin Xuan;Ma Xiaowei;Dong Chuning;Zhou Lianbo;An Rongchen;Guo Honghui;Xiang Xin;Zhang Xinlu;Xiang Hong;Wang Yunhua(PET Imaging Center,Department of Nuclear Medicine,the Second Xiangya Hospital,Central South University,Chagnsha 410011,China)
出处
《中华核医学与分子影像杂志》
北大核心
2025年第2期76-81,共6页
Chinese Journal of Nuclear Medicine and Molecular Imaging
