Response to Letter on use of functional imaging by 11C-metomidate PET for primary aldosteronism subtyping

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

doi:10.1530/eje-21-0048

Cited by 2 publications

(4 citation statements)

References 13 publications

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“…However, more than half of the patients exhibited discordant results between MTO PET and AVS, which was also observed in our study. Third, although Soinio et al 35 have stated that the tracer activity plateaus at 10 minutes, Crimi et al 36 reported that the optimal start of acquisition is 35 minutes instead of 15 minutes after the tracer injection. We observed similar MTO kinetics reported by Burton et al 21 and O'Shea et al 22 …”

Section: Discussionmentioning

confidence: 98%

Predicting Treatment Response in Primary Aldosteronism Using 11C-Metomidate Positron Emission Tomography

Lu¹,

Chen²,

Peng³

et al. 2022

Clin Nucl Med

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Background: Appropriate treatment of primary aldosteronism (PA) depends on accurate lateralization. 11 C-metomidate (MTO) is a tracer used in PET that provides functional information about the adrenal cortex. We aimed to perform MTO PET for patients with PA who are managed according to the guideline and to verify its correlation with other lateralization modalities and usefulness in outcome prediction. Methods: Seventeen patients with PA who underwent MTO PET and had ≥1 lateralization modality (adrenal venous sampling and/or NP-59 adrenal scintigraphy) were included. SUV max of each adrenal gland (higher uptake side, HSUV max ; lower uptake side, LSUV max ) and the ratio of HSUV max to LSUV max (contrast) were compared with lateralization modalities, postsurgical outcomes, and medical treatment outcomes. Cutoff values were used as outcome predictors. Results: HSUV max and LSUV max increased in the order of bilateral, unilateral, and negative findings of CT, with opposite order of contrast. High discordant rate between MTO PET and other lateralization modalities was noted. Biochemical responders (n = 8) had significantly lower HSUV max and LSUV max than nonresponders, and clinical responders (n = 6) had borderline lower HSUV max than nonresponders. By optimal cutoff values of HSUV max and LSUV max , MTO PET was able to predict biochemical and clinical outcomes in patients with medical treatment. Conclusion: According to adrenal CT findings, MTO PET presented different uptake patterns. Patients with PA under medical treatment showed significantly lower tracer uptake in responders. Thus, MTO PET may be a useful imaging biomarker to predict medical treatment outcome. Multicenter prospective study with a larger number of patients is needed for further validation.

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Section: Discussionmentioning

confidence: 98%

Predicting Treatment Response in Primary Aldosteronism Using 11C-Metomidate Positron Emission Tomography

Lu¹,

Chen²,

Peng³

et al. 2022

Clin Nucl Med

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“…Although CYP11B1 activity is suppressed by dexamethasone pretreatment, the effect of dexamethasone on CYP11B2 activity, 11 C‐MTO uptake, and lateralization of aldosterone secretion through inhibition of ACTH secretion remains unknown. However, more than 50% suppression of plasma aldosterone concentration has been demonstrated after dexamethasone pretreatment in both APA and bilateral hyperplasia 21,32,33 . The main problem with the 11 C‐MTO isotope tracer is its selectivity for both CYP11B1 and CYP11B2, which is an obstacle for non‐invasive subtype diagnostics in PA, and more specific tracers are awaited 34 …”

Section: Discussionmentioning

confidence: 99%

“…However, more than 50% suppression of plasma aldosterone concentration has been demonstrated after dexamethasone pretreatment in both APA and bilateral hyperplasia. 21,32,33 The main problem with the 11 C-MTO isotope tracer is its selectivity for both CYP11B1 and CYP11B2, which is an obstacle for non-invasive subtype diagnostics in PA, and more specific tracers are awaited. 34 The strength of the current approach is ascertainment of the diagnosis by including only those undergoing surgical treatment and by using immunohistochemistry in addition to assessing postoperative cure.…”

Section: Discussionmentioning

confidence: 99%

“…All 11 C-MTO-PET studies were performed in Turku PET Centre without dexamethasone pretreatment, as previously described in detail. 20,21 All scans were analysed by an expert in nuclear medicine, but the SUVs were inaccessible through biobank data. ACTHstimulated AVS was performed at Tampere University Hospital for 36 subjects, 31 of which were successful.…”

Section: Lateralization Studiesmentioning

confidence: 99%

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Lateralization in ¹¹C‐Metomidate PET and outcome of adrenalectomy in primary aldosteronism

Isojärvi

Viukari

Pörsti

et al. 2022

Endocrino Diabet & Metabol

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Introduction: Subtype classification method is essential when considering adrenalectomy as a possible treatment for primary aldosteronism. We aimed to retrospectively evaluate surgical outcomes of primary aldosteronism in patients who had undergone 11 C-metomidate positron emission tomography ( 11 C-MTO-PET) for subtype classification. Methods: Postoperative clinical and biochemical cure and histopathological diagnosis from biobank samples were retrospectively evaluated in 44 patients who had all undergone preoperative 11 C-MTO-PET with or without adrenal venous sampling (AVS). We compared those operated based on 11 C-MTO-PET alone and those with concordant or discordant lateralization in 11 C-MTO-PET and AVS studies according to postoperative immunohistochemical findings and biochemical and clinical cure. Results: Adrenalectomy side was based on 11 C-MTO-PET alone in 14 cases and on AVS in 30 cases of whom 42 achieved complete and two partial biochemical cures. Among those who underwent AVS and were operated according to it, the two lateralization methods were concordant in 22 cases and discordant in 8 cases. Similar immunohistochemical profiles and cure rates were seen after 11 C-MTO-PET alone or AVS-based operations. Respectively, those with concordant or discordant 11 C-MTO-PET and AVS lateralization did not differ in surgical outcome. Together, we found errors of lateralization diagnostics with 11 C-MTO-PET in 18% and with AVS in 3% among those eligible for adrenal surgery. Conclusions: Outcomes of adrenalectomy based on clinically significant lateralization in 11 C-MTO-PET alone correspond to those based on 11 C-MTO-PET with concordant AVS lateralization. However, our results suggest that diagnosis of unilateral PA should be performed with caution with 11 C-MTO-PET in case of discordant lateralization studies.

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Response to Letter on use of functional imaging by 11C-metomidate PET for primary aldosteronism subtyping

Abstract: -

Cited by 2 publications

References 13 publications

Predicting Treatment Response in Primary Aldosteronism Using 11C-Metomidate Positron Emission Tomography

Predicting Treatment Response in Primary Aldosteronism Using 11C-Metomidate Positron Emission Tomography

Lateralization in ¹¹C‐Metomidate PET and outcome of adrenalectomy in primary aldosteronism

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Response to Letter on use of functional imaging by 11C-metomidate PET for primary aldosteronism subtyping

Abstract: -

Cited by 2 publications

References 13 publications

Predicting Treatment Response in Primary Aldosteronism Using 11C-Metomidate Positron Emission Tomography

Predicting Treatment Response in Primary Aldosteronism Using 11C-Metomidate Positron Emission Tomography

Lateralization in 11C‐Metomidate PET and outcome of adrenalectomy in primary aldosteronism

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Lateralization in ¹¹C‐Metomidate PET and outcome of adrenalectomy in primary aldosteronism