[11C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: a prospective, within-patient trial.
Creators: name: Wu, Xilin
name: Senanayake, Russell
name: Goodchild, Emily
name: Bashari, Waiel A
name: Salsbury, Jackie
name: Cabrera, Claudia P
name: Argentesi, Giulia
name: O'Toole, Samuel M
name: Matson, Matthew
name: Koo, Brendan
name: Parvanta, Laila
name: Hilliard, Nick
name: Kosmoliaptsis, Vasilis
name: Marker, Alison
name: Berney, Daniel M
name: Tan, Wilson
name: Foo, Roger
name: Mein, Charles A
name: Wozniak, Eva
name: Savage, Emmanuel
name: Sahdev, Anju
name: Bird, Nicholas
name: Laycock, Kate
name: Boros, Istvan
name: Hader, Stefan
name: Warnes, Victoria
name: Gillett, Daniel
name: Dawnay, Anne
name: Adeyeye, Elizabeth
name: Prete, Alessandro
name: Taylor, Angela E
name: Arlt, Wiebke
name: Bhuva, Anish N
name: Aigbirhio, Franklin
name: Manisty, Charlotte
name: McIntosh, Alasdair
name: McConnachie, Alexander
name: Cruickshank, J Kennedy
name: Cheow, Heok
name: Gurnell, Mark
name: Drake, William M
name: Brown, Morris J
Publisher: name: Apollo - University of Cambridge Repository
Year: 2023
Subjects: Article
/692/699/2743/1279
/692/699/75/243
article

description: Funder: Barts and the London Charity project (no. MGU0360) Senior Investigator award no. NF-SI-0512-10052
description: Funder: NIHR Cambridge BRC (no. IS-BRC-1215-20014)
description: Funder: NIHR Biomedical Research Centre at Barts and The London School of Medicine and Dentistry
description: Funder: National Medical Research Council and BRC of Singapore
description: Funder: NIHR Birmingham Biomedical Research Centre (grant reference number BRC-1215-20009) European Union’s Horizon 2020 Research Innovation Program under grant agreement no. 633983 (ENSAT-HT)
description: Funder: Barts and The London Charity
description: Funder: Barts and the London Charity project (no. MGU0360)
description: Funder: Barts and the London Charity project
description: Primary aldosteronism (PA) due to a unilateral aldosterone-producing adenoma is a common cause of hypertension. This can be cured, or greatly improved, by adrenal surgery. However, the invasive nature of the standard pre-surgical investigation contributes to fewer than 1% of patients with PA being offered the chance of a cure. The primary objective of our prospective study of 143 patients with PA ( NCT02945904 ) was to compare the accuracy of a non-invasive test, [11C]metomidate positron emission tomography computed tomography (MTO) scanning, with adrenal vein sampling (AVS) in predicting the biochemical remission of PA and the resolution of hypertension after surgery. A total of 128 patients reached 6- to 9-month follow-up, with 78 (61%) treated surgically and 50 (39%) managed medically. Of the 78 patients receiving surgery, 77 achieved one or more PA surgical outcome criterion for success. The accuracies of MTO at predicting biochemical and clinical success following adrenalectomy were, respectively, 72.7 and 65.4%. For AVS, the accuracies were 63.6 and 61.5%. MTO was not significantly superior, but the differences of 9.1% (95% confidence interval = -6.5 to 24.1%) and 3.8% (95% confidence interval = -11.9 to 9.4) lay within the pre-specified -17% margin for non-inferiority (P = 0.00055 and P = 0.0077, respectively). Of 24 serious adverse events, none was considered related to either investigation and 22 were fully resolved. MTO enables non-invasive diagnosis of unilateral PA.