11C-Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice
11C-Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice
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DOI：
10.1111/cen.13942
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发表时间：
2019-05-01
影响因子：
3.2
通讯作者：
Dennedy, Michael C.
中科院分区：
文献类型：
--
作者：
O'Shea, Paula M.;O'Donoghue, Darragh;Dennedy, Michael C.
目的 描述 C-11-甲托咪酯 PET/CT 辅助肾上腺静脉取样 (AVS) 在原发性醛固酮增多症 (PA) 产生醛固酮的腺瘤 (APA) 侧化中的临床实践经验。背景 在 PA 情况下 APA 的准确侧化提供了手术治愈和改善长期心血管结局的潜力。 AVS（目前的金标准偏侧治疗方式）所面临的挑战意味着目前只有一小部分可能符合条件的患者能够接受手术。这促使人们考虑侧化的替代策略，包括应用新型分子 PET 示踪剂，如 C-11-甲托咪酯。设计临床服务评估/回顾性审核。患者 15 名确诊为 PA 的患者，在做出手术还是药物治疗的最终临床决定之前，接受 C-11-甲托咪酯 PET/CT 侧化检查。测量 根据内分泌学会临床实践指南，所有患者均接受醛固酮肾素比值 (ARR) 筛查，然后通过坐式盐水输注试验进行验证性测试。使用专用肾上腺 CT 对肾上腺进行成像。由于 AVS 模棱两可或失败而进行了 C-11-Metomidate PET/CT。通过纵向测量血压、ARR、肾上腺切除术或药物治疗后高血压药物的数量来评估管理结果。结果 我们描述了 15 名 PA 患者的个体侧化和临床结果。结论 C-11-甲托咪酯 PET/CT 结合肾上腺 CT 和 AVS 提供了有用的信息，有助于多学科高血压诊所内 PA 的临床决策。
Objective To describe clinical practice experience of C-11-Metomidate PET/CT as an adjunct to adrenal vein sampling (AVS) in the lateralization of aldosterone-producing adenomas (APA) in primary aldosteronism (PA). Context Accurate lateralization of APA in the setting of PA offers the potential for surgical cure and improved long-term cardiovascular outcomes. Challenges associated with AVS, the current gold standard lateralization modality, mean that only a small proportion of potentially eligible patients currently make it through to surgery. This has prompted consideration of alternative strategies for lateralization, including the application of novel molecular PET tracers such as C-11-Metomidate. Design Clinical Service Evaluation/Retrospective audit. Patients Fifteen individuals with a confirmed diagnosis of PA, undergoing lateralization with C-11-Metomidate PET/CT prior to final clinical decision on surgical vs medical management. Measurements All patients underwent screening aldosterone renin ratio (ARR), followed by confirmatory testing with the seated saline infusion test, according to Endocrine Society Clinical Practice Guidelines. Adrenal glands were imaged using dedicated adrenal CT. C-11-Metomidate PET/CT was undertaken due to equivocal or failed AVS. Management outcomes were assessed by longitudinal measurement of blood pressure, ARR, number of hypertensive medications following adrenalectomy or institution of medical therapy. Results We describe the individual lateralization and clinical outcomes for 15 patients with PA. Conclusion C-11-Metomidate PET/CT in conjunction with adrenal CT and AVS provided useful information which aided clinical decision-making for PA within a multidisciplinary hypertension clinic.