| Evaluation of the Sensitivity and Specificity of 11C-Metomidate Positron Emission Tomography (PET)-CT for Lateralizing Aldosterone Secretion by Conn's Adenomas. | |
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MedLine Citation:
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PMID: 22112805 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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). (11)C-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 (11)C-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 (11)C-metomidate uptake by normal adrenal. Subsequent patients received dexamethasone for 3 d prior to injection of (11)C-metomidate 150-500 MBq.Main Outcome Measure(s):Maximum standardized uptake values (SUV(max)) over regions of interest determined from 35-45 min after injection were measured.Results:Dexamethasone increased tumor to normal adrenal SUV(max) 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, SUV(max) 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 SUV(max) ratio of 1.25:1 provided a specificity of 87% [95% confidence interval (69, 104)] and sensitivity of 76% (59, 93); in tumors with SUV(max) greater than 17, the specificity rose to 100%.Conclusions:(11)C-metomidate PET-CT is a sensitive and specific noninvasive alternative to AVS in the management of PHA. |
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Authors:
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Timothy J Burton; Isla S Mackenzie; Kottekkattu Balan; Brendan Koo; Nick Bird; Dmitri V Soloviev; Elena A B Azizan; Franklin Aigbirhio; Mark Gurnell; Morris J Brown |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-23 |
Journal Detail:
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Title: The Journal of clinical endocrinology and metabolism Volume: - ISSN: 1945-7197 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0375362 Medline TA: J Clin Endocrinol Metab Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Clinical Pharmacology Unit (T.J.B., I.S.M., E.A.B.A., M.J.B.), Department of Medicine, University of Cambridge, Cambridge CB2 2QQ, United Kingdom; Department of Radiology (K.B., B.K., N.B.), Addenbrooke's Hospital, Cambridge CB2 2QQ, United Kingdom; and Wolfson Brain Imaging Centre (D.V.S., F.A.) and Institute of Metabolic Science (M.G.), Department of Medicine, University of Cambridge, Cambridge CB2 OQQ, United Kingdom. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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