Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism

Minna Soinio; Anna-Kaarina Luukkonen; Marko Seppänen; Jukka Kemppainen; Janne Seppänen; Juha-Pekka Pienimäki; Helena Leijon; Tiina Vesterinen; Johanna Arola; Eila Lantto; Semi Helin; Ilkka Tikkanen; Saara Metso; Tuomas Mirtti; Ilkka Heiskanen; Leena Norvio; Mirja Tiikkainen; Tuula Tikkanen; Timo Sane; Matti Välimäki; Celso E Gomez-Sanchez; Ilkka Pörsti; Pirjo Nuutila; Pasi I Nevalainen; Niina Matikainen

doi:10.1530/EJE-20-0532

Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism

Minna Soinio, Anna-Kaarina Luukkonen, Marko Seppänen, Jukka Kemppainen, Janne Seppänen, Juha-Pekka Pienimäki, Helena Leijon, Tiina Vesterinen, Johanna Arola, Eila Lantto, Semi Helin, Ilkka Tikkanen, Saara Metso, Tuomas Mirtti, Ilkka Heiskanen, Leena Norvio, Mirja Tiikkainen, Tuula Tikkanen, Timo Sane, Matti VälimäkiCelso E Gomez-Sanchez, Ilkka Pörsti, Pirjo Nuutila, Pasi I Nevalainen, Niina Matikainen

Research output: Contribution to journal › Article › Scientific › peer-review

2 Citations (Scopus)

Abstract

Objective: Endocrine Society guidelines recommend adrenal venous sampling (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imaging of adrenal cortex with 11C-metomidate (11C-MTO) could offer a noninvasive alternative to AVS in the subtype classification of PA.

Design: We prospectively recruited 58 patients with confirmed PA who were eligible for adrenal surgery.

Methods: Subjects underwent AVS and 11C-MTO-PET without dexamethasone pretreatment in random order. The lateralization of 11C-MTO-PET and adrenal CT were compared with AVS in all subjects and in a prespecified adrenalectomy subgroup in which the diagnosis was confirmed with immunohistochemical staining for CYP11B2.

Results: In the whole study population, the concordance of AVS and 11C-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and 11C-MTO-PET was 55% in unilateral and 44% in bilateral PA. In receiver operating characteristics analysis, the maximum standardized uptake value ratio of 1.16 in 11C-MTO-PET had an AUC of 0.507 (P = n.s.) to predict allocation to adrenalectomy or medical therapy with sensitivity of 55% and specificity of 44%. In the prespecified adrenalectomy subgroup, AVS and 11C-MTO-PET were concordant in 10 of 19 subjects with CYP11B2-positive adenoma and in 6 of 10 with CYP11B2-positivity without an adenoma.

Conclusions: The concordance of 11C-MTO-PET with AVS was clinically suboptimal, and did not outperform adrenal CT. In a subgroup with CYP11B2-positive adenoma, 11C-MTO-PET identified 53% of cases. 11C-MTO-PET appeared to be inferior to AVS for subtype classification of PA.

Original language	English
Pages (from-to)	539-550
Number of pages	12
Journal	Eur J Endocrinol
Volume	183
Issue number	6
DOIs	https://doi.org/10.1530/EJE-20-0532
Publication status	Published - Oct 2020
Publication type	A1 Journal article-refereed

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Soinio, M., Luukkonen, A-K., Seppänen, M., Kemppainen, J., Seppänen, J., Pienimäki, J-P., Leijon, H., Vesterinen, T., Arola, J., Lantto, E., Helin, S., Tikkanen, I., Metso, S., Mirtti, T., Heiskanen, I., Norvio, L., Tiikkainen, M., Tikkanen, T., Sane, T., ... Matikainen, N. (2020). Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism. Eur J Endocrinol, 183(6), 539-550. https://doi.org/10.1530/EJE-20-0532

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title = "Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism",

abstract = "Objective: Endocrine Society guidelines recommend adrenal venous sampling (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imaging of adrenal cortex with 11C-metomidate (11C-MTO) could offer a noninvasive alternative to AVS in the subtype classification of PA.Design: We prospectively recruited 58 patients with confirmed PA who were eligible for adrenal surgery.Methods: Subjects underwent AVS and 11C-MTO-PET without dexamethasone pretreatment in random order. The lateralization of 11C-MTO-PET and adrenal CT were compared with AVS in all subjects and in a prespecified adrenalectomy subgroup in which the diagnosis was confirmed with immunohistochemical staining for CYP11B2.Results: In the whole study population, the concordance of AVS and 11C-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and 11C-MTO-PET was 55% in unilateral and 44% in bilateral PA. In receiver operating characteristics analysis, the maximum standardized uptake value ratio of 1.16 in 11C-MTO-PET had an AUC of 0.507 (P = n.s.) to predict allocation to adrenalectomy or medical therapy with sensitivity of 55% and specificity of 44%. In the prespecified adrenalectomy subgroup, AVS and 11C-MTO-PET were concordant in 10 of 19 subjects with CYP11B2-positive adenoma and in 6 of 10 with CYP11B2-positivity without an adenoma.Conclusions: The concordance of 11C-MTO-PET with AVS was clinically suboptimal, and did not outperform adrenal CT. In a subgroup with CYP11B2-positive adenoma, 11C-MTO-PET identified 53% of cases. 11C-MTO-PET appeared to be inferior to AVS for subtype classification of PA.",

author = "Minna Soinio and Anna-Kaarina Luukkonen and Marko Sepp{\"a}nen and Jukka Kemppainen and Janne Sepp{\"a}nen and Juha-Pekka Pienim{\"a}ki and Helena Leijon and Tiina Vesterinen and Johanna Arola and Eila Lantto and Semi Helin and Ilkka Tikkanen and Saara Metso and Tuomas Mirtti and Ilkka Heiskanen and Leena Norvio and Mirja Tiikkainen and Tuula Tikkanen and Timo Sane and Matti V{\"a}lim{\"a}ki and Gomez-Sanchez, {Celso E} and Ilkka P{\"o}rsti and Pirjo Nuutila and Nevalainen, {Pasi I} and Niina Matikainen",

year = "2020",

month = oct,

doi = "10.1530/EJE-20-0532",

language = "English",

volume = "183",

pages = "539--550",

number = "6",

}

Soinio, M, Luukkonen, A-K, Seppänen, M, Kemppainen, J, Seppänen, J, Pienimäki, J-P, Leijon, H, Vesterinen, T, Arola, J, Lantto, E, Helin, S, Tikkanen, I, Metso, S, Mirtti, T, Heiskanen, I, Norvio, L, Tiikkainen, M, Tikkanen, T, Sane, T, Välimäki, M, Gomez-Sanchez, CE, Pörsti, I, Nuutila, P, Nevalainen, PI & Matikainen, N 2020, 'Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism', Eur J Endocrinol, vol. 183, no. 6, pp. 539-550. https://doi.org/10.1530/EJE-20-0532

TY - JOUR

T1 - Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism

AU - Soinio, Minna

AU - Luukkonen, Anna-Kaarina

AU - Seppänen, Marko

AU - Kemppainen, Jukka

AU - Seppänen, Janne

AU - Pienimäki, Juha-Pekka

AU - Leijon, Helena

AU - Vesterinen, Tiina

AU - Arola, Johanna

AU - Lantto, Eila

AU - Helin, Semi

AU - Tikkanen, Ilkka

AU - Metso, Saara

AU - Mirtti, Tuomas

AU - Heiskanen, Ilkka

AU - Norvio, Leena

AU - Tiikkainen, Mirja

AU - Tikkanen, Tuula

AU - Sane, Timo

AU - Välimäki, Matti

AU - Gomez-Sanchez, Celso E

AU - Pörsti, Ilkka

AU - Nuutila, Pirjo

AU - Nevalainen, Pasi I

AU - Matikainen, Niina

PY - 2020/10

Y1 - 2020/10

N2 - Objective: Endocrine Society guidelines recommend adrenal venous sampling (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imaging of adrenal cortex with 11C-metomidate (11C-MTO) could offer a noninvasive alternative to AVS in the subtype classification of PA.Design: We prospectively recruited 58 patients with confirmed PA who were eligible for adrenal surgery.Methods: Subjects underwent AVS and 11C-MTO-PET without dexamethasone pretreatment in random order. The lateralization of 11C-MTO-PET and adrenal CT were compared with AVS in all subjects and in a prespecified adrenalectomy subgroup in which the diagnosis was confirmed with immunohistochemical staining for CYP11B2.Results: In the whole study population, the concordance of AVS and 11C-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and 11C-MTO-PET was 55% in unilateral and 44% in bilateral PA. In receiver operating characteristics analysis, the maximum standardized uptake value ratio of 1.16 in 11C-MTO-PET had an AUC of 0.507 (P = n.s.) to predict allocation to adrenalectomy or medical therapy with sensitivity of 55% and specificity of 44%. In the prespecified adrenalectomy subgroup, AVS and 11C-MTO-PET were concordant in 10 of 19 subjects with CYP11B2-positive adenoma and in 6 of 10 with CYP11B2-positivity without an adenoma.Conclusions: The concordance of 11C-MTO-PET with AVS was clinically suboptimal, and did not outperform adrenal CT. In a subgroup with CYP11B2-positive adenoma, 11C-MTO-PET identified 53% of cases. 11C-MTO-PET appeared to be inferior to AVS for subtype classification of PA.

AB - Objective: Endocrine Society guidelines recommend adrenal venous sampling (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imaging of adrenal cortex with 11C-metomidate (11C-MTO) could offer a noninvasive alternative to AVS in the subtype classification of PA.Design: We prospectively recruited 58 patients with confirmed PA who were eligible for adrenal surgery.Methods: Subjects underwent AVS and 11C-MTO-PET without dexamethasone pretreatment in random order. The lateralization of 11C-MTO-PET and adrenal CT were compared with AVS in all subjects and in a prespecified adrenalectomy subgroup in which the diagnosis was confirmed with immunohistochemical staining for CYP11B2.Results: In the whole study population, the concordance of AVS and 11C-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and 11C-MTO-PET was 55% in unilateral and 44% in bilateral PA. In receiver operating characteristics analysis, the maximum standardized uptake value ratio of 1.16 in 11C-MTO-PET had an AUC of 0.507 (P = n.s.) to predict allocation to adrenalectomy or medical therapy with sensitivity of 55% and specificity of 44%. In the prespecified adrenalectomy subgroup, AVS and 11C-MTO-PET were concordant in 10 of 19 subjects with CYP11B2-positive adenoma and in 6 of 10 with CYP11B2-positivity without an adenoma.Conclusions: The concordance of 11C-MTO-PET with AVS was clinically suboptimal, and did not outperform adrenal CT. In a subgroup with CYP11B2-positive adenoma, 11C-MTO-PET identified 53% of cases. 11C-MTO-PET appeared to be inferior to AVS for subtype classification of PA.

U2 - 10.1530/EJE-20-0532

DO - 10.1530/EJE-20-0532

M3 - Article

C2 - 33055298

VL - 183

SP - 539

EP - 550

IS - 6

ER -

Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism

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