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Evaluation of the Sensitivity and Specificity of 11C-Metomidate Positron Emission Tomography (PET)-CT for Lateralizing Aldosterone Secretion by Conn's Adenomas

meijin 添加于 2011/12/7 9:57:36  1333次阅读 | 0次推荐 | 0个评论

Context: Identification of unilateral aldosterone-producing (Conn's) adenomas has traditionally required lateralization by the invasive and technically difficult procedure of adrenal vein sampling (AVS). 11C-metomidate, a potent inhibitor of adrenal steroidogenic enzymes, is a positron emission tomography (PET) radiotracer that is selectively accumulated by Conn's adenomas. Objective: The objective of the study was to compare the sensitivity and specificity of 11C-metomidate PET-computed tomography (CT) against the current gold standard of AVS. Design: The design of the study was within-patient comparison of diagnostic techniques. Setting: The study was conducted at a single center-university teaching hospital. Patients: Thirty-nine patients with primary hyperaldosteronism (PHA) and five with nonfunctioning adenomas (incidentalomas) participated in the study. Intervention(s): The first six PHA patients were studied on three occasions to determine whether steroid pretreatment reduced 11C-metomidate uptake by normal adrenal. Subsequent patients received dexamethasone for 3 d prior to injection of 11C-metomidate 150–500 MBq. Main Outcome Measure(s): Maximum standardized uptake values (SUVmax) over regions of interest determined from 35–45 min after injection were measured. Results: Dexamethasone increased tumor to normal adrenal SUVmax ratio by 25.6 ± 5.0% (P < 0.01). PET-CT visualized subcentimeter adenomas and distinguished hot from cold adenomas within a gland. In 25 patients with PHA and AVS lateralization to the side of an adenoma, SUVmax over tumor (mean ± sem) of 21.7 ± 1.6 was greater than over normal adrenal, 13.8 ± 0.6 (P = 0.00003); this difference was absent in 10 patients without lateralization on AVS (P = 0.28) and in four of five incidentalomas. On receiver-operator characteristics analysis, an SUVmax ratio of 1.25:1 provided a specificity of 87% [95% confidence interval (69, 104)] and sensitivity of 76% (59, 93); in tumors with SUVmax greater than 17, the specificity rose to 100%. Conclusions: 11C-metomidate PET-CT is a sensitive and specific noninvasive alternative to AVS in the management of PHA.

作 者:Timothy J. Burton, Isla S. Mackenzie, Kottekkattu Balan, Brendan Koo, Nick Bird, Dmitri V. Soloviev, Elena A. B. Azizan, Franklin Aigbirhio, Mark Gurnell and Morris J. Brown
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学科领域:医学科学 » 循环系统 » 血压调节异常与高血压病
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原文链接:http://jcem.endojournals.org/content/early/2011/11/17/jc.2011-1537.abstract?sid=39a5c250-fe34-4ed2-8b4f-136d6a2c784f
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