TY - JOUR
T1 - 11C-Metomidate PET-CT versus adrenal vein sampling to subtype primary aldosteronism
T2 - a prospective clinical trial
AU - Puar, Troy H.
AU - Khoo, Chin Meng
AU - Tan, Colin Jingxian
AU - Tong, Aaron Kian Ti
AU - Tan, Michael Chien Sheng
AU - Teo, Ada Ee Der
AU - Ng, Keng Sin
AU - Wong, Kang Min
AU - Reilhac, Anthonin
AU - O'Doherty, Jim
AU - Gomez-Sanchez, Celso E.
AU - Kek, Peng Chin
AU - Yee, Szemen
AU - Tan, Alvin W.K.
AU - Chuah, Matthew Bingfeng
AU - Lee, Daphne Hui Min
AU - Wang, Kuo Weng
AU - Zheng, Charles Qishi
AU - Shi, Luming
AU - Robins, Edward George
AU - Foo, Roger Sik Yin
N1 - Funding Information:
This study was funded by National Medical Research Council (NMRC), Singapore. R.S. Foo was supported by NMRC, Singapore and A∗Star Biomedical Research Council. T.H. Puar was supported by the NMRC Research Training Fellowship award, Singapore.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Objective:Adrenal vein sampling (AVS) is recommended to subtype primary aldosteronism, but it is technically challenging. We compared 11C-Metomidate-PET-computed tomography (PET-CT) and AVS for subtyping of primary aldosteronism.Methods:Patients with confirmed primary aldosteronism underwent both AVS and 11C-Metomidate PET-CT (post-dexamethasone). All results were reviewed at a multidisciplinary meeting to decide on final subtype diagnosis. Primary outcome was accuracy of PET versus AVS to diagnosis of unilateral primary aldosteronism based on post-surgical biochemical cure. Secondary outcome was accuracy of both tests to final subtype diagnosis.Results:All 25 patients recruited underwent PET and successful AVS (100%). Final diagnosis was unilateral in 22 patients, bilateral in two and indeterminate in one due to discordant lateralization. Twenty patients with unilateral primary aldosteronism underwent surgery, with 100% complete biochemical success, and 75% complete/partial clinical success. For the primary outcome, sensitivity of PET was 80% [95% confidence interval (95% CI): 56.3-94.3] and AVS was 75% (95% CI: 50.9-91.3). For the secondary outcome, sensitivity and specificity of PET was 81.9% (95% CI: 59.7-94.8) and 100% (95% CI: 15.8-100), and AVS was 68.2% (95% CI: 45.1-86.1) and 100% (95% CI: 15.8-100), respectively. Twelve out of 20 (60%) patients had both PET and AVS lateralization, four (20%) PET-only, three (15%) AVS-only, while one patient did not lateralize on PET or AVS. Post-surgery outcomes did not differ between patients identified by either test.Conclusion:In our pilot study, 11C-Metomidate PET-CT performed comparably to AVS, and this should be validated in larger studies. PET identified patients with unilateral primary aldosteronism missed on AVS, and these tests could be used together to identify more patients with unilateral primary aldosteronism.Video Abstract:http://links.lww.com/HJH/B918.
AB - Objective:Adrenal vein sampling (AVS) is recommended to subtype primary aldosteronism, but it is technically challenging. We compared 11C-Metomidate-PET-computed tomography (PET-CT) and AVS for subtyping of primary aldosteronism.Methods:Patients with confirmed primary aldosteronism underwent both AVS and 11C-Metomidate PET-CT (post-dexamethasone). All results were reviewed at a multidisciplinary meeting to decide on final subtype diagnosis. Primary outcome was accuracy of PET versus AVS to diagnosis of unilateral primary aldosteronism based on post-surgical biochemical cure. Secondary outcome was accuracy of both tests to final subtype diagnosis.Results:All 25 patients recruited underwent PET and successful AVS (100%). Final diagnosis was unilateral in 22 patients, bilateral in two and indeterminate in one due to discordant lateralization. Twenty patients with unilateral primary aldosteronism underwent surgery, with 100% complete biochemical success, and 75% complete/partial clinical success. For the primary outcome, sensitivity of PET was 80% [95% confidence interval (95% CI): 56.3-94.3] and AVS was 75% (95% CI: 50.9-91.3). For the secondary outcome, sensitivity and specificity of PET was 81.9% (95% CI: 59.7-94.8) and 100% (95% CI: 15.8-100), and AVS was 68.2% (95% CI: 45.1-86.1) and 100% (95% CI: 15.8-100), respectively. Twelve out of 20 (60%) patients had both PET and AVS lateralization, four (20%) PET-only, three (15%) AVS-only, while one patient did not lateralize on PET or AVS. Post-surgery outcomes did not differ between patients identified by either test.Conclusion:In our pilot study, 11C-Metomidate PET-CT performed comparably to AVS, and this should be validated in larger studies. PET identified patients with unilateral primary aldosteronism missed on AVS, and these tests could be used together to identify more patients with unilateral primary aldosteronism.Video Abstract:http://links.lww.com/HJH/B918.
KW - adrenalectomy
KW - adrenocortical adenoma
KW - diagnostic testing
KW - functional imaging
KW - hyperaldosteronism
KW - subtyping
UR - http://www.scopus.com/inward/record.url?scp=85132131784&partnerID=8YFLogxK
U2 - 10.1097/HJH.0000000000003132
DO - 10.1097/HJH.0000000000003132
M3 - Article
C2 - 35703880
AN - SCOPUS:85132131784
SN - 0263-6352
VL - 40
SP - 1179
EP - 1188
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 6
ER -