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Evaluation of standardized uptake value on 131I-6β-iodomethyl-19-norcholesterol scintigraphy for diagnosis of primary aldosteronism and correspondence with adrenal venous sampling

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Abstract

Purpose

Adrenal venous sampling (AVS) is a reliable method for lateralization of adrenal hormone secretion, which is important for discriminating between aldosterone-producing adenoma and bilateral adrenal hyperplasia, both of which cause primary aldosteronism (PA). The aim of this study was to evaluate the diagnostic accuracy of the maximum and mean standardized uptake values (SUVmax and SUVmean, respectively) of 131I-6β-iodomethyl-19-norcholesterol (NP-59) single-photon emission computed tomography (SPECT) for PA and its correspondence with AVS.

Methods

Adrenal NP-59 scintigraphy was performed in 14 patients with suspected PA, and AVS was also performed in 7 of them. SUVmax and SUVmean of the adrenal lesions on the dominant side and their ratios to the values on the non-dominant side (SUVRmax and SUVRmean, respectively) were calculated on SPECT images using ordered-subset conjugate gradient minimization (OSCGM) and three-dimensional ordered-subset expectation maximization (3D-OSEM) reconstruction algorithms.

Results

SUVmax and SUVmean on NP-59 SPECT images were significantly higher for aldosterone-producing adenoma than for bilateral adrenal hyperplasia or non-functioning adenoma and slightly superior to SUVRmax and SUVRmean (P = 0.0475 and P = 0.0447 vs. P = 0.124 and P = 0.132, respectively, with OSCGM). The respective areas under the receiver-operating characteristic curve for SUV and SUVR were 0.933 and 0.725 with OSCGM and 0.844 and 0.750 with 3D-OSEM, while SUVmax and SUVRmax had exactly the same diagnostic accuracy as SUVmean and SUVRmean. SUV and SUVR were associated with the diagnostic features on AVS and consistent with lateralization by AVS in most patients.

Conclusion

In this study, SUV on NP-59 SPECT helped in the diagnosis of PA and was consistent with the results of AVS in nearly all cases.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, Van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004;136(6):1227–35.

    Article  Google Scholar 

  2. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266–81.

    Article  Google Scholar 

  3. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(5):1889–916.

    Article  Google Scholar 

  4. The Japan Endocrine Society. [Clinical guidelines for primary aldosteronism 2021] Genpatsusei arudosuteron-shou shinryou gaidorain. Tokyo: Shindan to chiryousha; 2021 (in Japanese).

  5. The Japan Endocrine Society. [Consensus statement on the clinical practice of primary aldosteronism in Japan] Genpatsusei arudosuteron-shou gaidorain zisshi no zittai-chosa to fukyu ni muketa hyouzyunka ni kansuru kentou. Tokyo: Shindan to chiryousha; 2016 (in Japanese).

  6. Mansoor GA, Malchoff CD, Arici MH, Karimeddini MK, Whalen GF. Unilateral adrenal hyperplasia causing primary aldosteronism: limitations of I-131 norcholesterol scanning. Am J Hypertens. 2002;15(5):459–64.

    Article  Google Scholar 

  7. Nomura K, Kusakabe K, Maki M, Ito Y, Aiba M, Demura H. Iodomethylnorcholesterol uptake in an aldosteronoma shown by dexamethasone-suppression scintigraphy: relationship to adenoma size and functional activity. J Clin Endocrinol Metab. 1990;71(4):825–30.

    Article  CAS  Google Scholar 

  8. Weinberger MH, Grim CE, Hollifield JW, Kem DC, Ganguly A, Kramer NJ, et al. Primary aldosteronism: diagnosis, localization, and treatment. Ann Intern Med. 1979;90(3):386–95.

    Article  CAS  Google Scholar 

  9. Gross MD, Shapiro B, Freitas JE. Limited significance of asymmetric adrenal visualization on dexamethasone-suppression scintigraphy. J Nucl Med. 1985;26(1):43–8.

    CAS  Google Scholar 

  10. Avram AM, Fig LM, Gross MD. Adrenal gland scintigraphy. Semin Nucl Med. 2006;36(3):212–27.

    Article  Google Scholar 

  11. Yen RF, Wu VC, Liu KL, Cheng MF, Wu YW, Chueh SC, et al. 131I–6beta-iodomethyl-19-norcholesterol SPECT/CT for primary aldosteronism patients with inconclusive adrenal venous sampling and CT results. J Nucl Med. 2009;50(10):1631–7.

    Article  CAS  Google Scholar 

  12. Chang CH, Yang SS, Tsai YC, Kuo SW, Cherng SC, Lu CC, et al. Surgical outcomes of patients with primary aldosteronism lateralized with I-131-6β-iodomethyl-norcholesterol single photon emission/computed tomography without discontinuation or modification of antihypertensive medications. Ci Ji Yi Xue Za Zhi. 2018;30(3):169–75.

    Google Scholar 

  13. Cava GL, Imperiale A, Olianti C, Gheri GR, Ladu C, Mannelli M, et al. SPECT semiquantitative analysis of adrenocortical (131)I-6 beta iodomethyl-norcholesterol uptake to discriminate subclinical and preclinical functioning adrenal incidentaloma. J Nucl Med. 2003;44(7):1057–64.

    Google Scholar 

  14. Lucignani G, Paganelli G, Bombardieri E. The use of standardized uptake values for assessing FDG uptake with PET in oncology: a clinical perspective. Nucl Med Commun. 2004;25(7):651–6.

    Article  CAS  Google Scholar 

  15. Bailey DL, Willowson KP. An evidence-based review of quantitative SPECT imaging and potential clinical applications. J Nucl Med. 2013;54(1):83–9.

    Article  Google Scholar 

  16. Kuji I, Yamane T, Seto A, Yasumizu Y, Shirotake S, Oyama M. Skeletal standardized uptake values obtained by quantitative SPECT/CT as an osteoblastic biomarker for the discrimination of active bone metastasis in prostate cancer. Eur J Hybrid Imaging. 2017;1(1):2.

    Article  Google Scholar 

  17. Dong F, Li L, Bian Y, Li G, Han X, Li M, et al. Standardized uptake value using thyroid quantitative SPECT/CT for the diagnosis and evaluation of Graves’ disease: a prospective multicenter study. Biomed Res Int. 2019;2019:7589853.

    Article  Google Scholar 

  18. Tabotta F, Jreige M, Schaefer N, Becce F, Prior JO, Lalonde MN. Quantitative bone SPECT/CT: high specificity for identification of prostate cancer bone metastasis. BMC Musculoskelet Disord. 2019;20(1):619.

    Article  CAS  Google Scholar 

  19. Motegi K, Matsutomo N, Yamamoto T, Koizumi M. Evaluation of bone metastasis burden as an imaging biomarker by quantitative single-photon emission computed tomography/computed tomography for assessing prostate cancer with bone metastasis: a phantom and clinical study. Radiol Phys Technol. 2020;13(3):219–29.

    Article  Google Scholar 

  20. Nakajo M, Jinguji M, Tani A, Yoshiura T. Application of adrenal maximum standardized uptake value to 131I–6β-iodomethyl-19-norcholesterol SPECT/CT for characterizing unilateral hyperfunctioning adrenocortical masses. Eur J Radiol. 2020;133: 109397.

    Article  Google Scholar 

  21. Nishikawa T, Kuwa K. [Present status for standardization of aldosterone measurement in blood] Arudosuteron-sokutei no hyouzyunka no genzyou. Diabetol Endocrinol Metabolol. 2021;52(5):496–503 ((in Japanese)).

    Google Scholar 

  22. Nishikawa T, Omura M, Kawaguchi M, Takatsu A, Satoh F, Ito S, et al. Calibration and evaluation of routine methods by serum certified reference material for aldosterone measurement in blood. Endocr J. 2016;63(12):1065–80.

    Article  CAS  Google Scholar 

  23. Yanase T, Oki Y, Katabami T, Otsuki M, Kageyama K, Tanaka T, et al. New diagnostic criteria of adrenal subclinical Cushing’s syndrome: opinion from the Japan Endocrine Society. Endocr J. 2018;65(4):383–93.

    Article  CAS  Google Scholar 

  24. Miyaji N, Miwa K, Tokiwa A, Ichikawa H, Terauchi T, Koizumi M, et al. Phantom and clinical evaluation of bone SPECT/CT image reconstruction with xSPECT algorithm. EJNMMI Res. 2020;10(1):71.

    Article  Google Scholar 

  25. Maeda Y, Nagaki A, Komi Y, Abe N, Kashimura S. Evaluation of resolution correction in single photon emission computed tomography reconstruction method using a body phantom: study of three different models. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2015;71(11):1070–9 ((in Japanese)).

    Article  CAS  Google Scholar 

  26. Tran-Gia J, Lassmann M. Characterization of noise and resolution for quantitative 177Lu SPECT/CT with xSPECT Quant. J Nucl Med. 2019;60(1):50–9.

    Article  CAS  Google Scholar 

  27. Ceral J, Solar M, Krajina A, Ballon M, Suba P, Cap J. Adrenal venous sampling in primary aldosteronism: a low dilution of adrenal venous blood is crucial for a correct interpretation of the results. Eur J Endocrinol. 2010;162(1):101–7.

    Article  CAS  Google Scholar 

  28. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    Article  CAS  Google Scholar 

  29. Spath M, Korovkin S, Antke C, Anlauf M, Willenberg HS. Aldosterone- and cortisol-co-secreting adrenal tumors: the lost subtype of primary aldosteronism. Eur J Endocrinol. 2011;164(4):447–55.

    Article  Google Scholar 

  30. Armstrong IS, Hoffmann SA. Activity concentration measurements using a conjugate gradient (Siemens xSPECT) reconstruction algorithm in SPECT/CT. Nucl Med Commun. 2016;37(11):1212–7.

    Article  Google Scholar 

  31. Vija AH. Introduction to xSPECT Technology: Evolving Multi-modal SPECT to Become Context-based and Quantitative. White paper 2013. https://cdn0.scrvt.com/39b415fb07de4d9656c7b516d8e2d907/1800000003359764/038bd47eb17e/MI-2706_xSPECT_TECHNICAL_White-paper_final_1800000003359764.pdf. Accessed 6 July 2022

  32. Yoh T, Hosono M, Komeya Y, Im SW, Ashikaga R, Shimono T, et al. Quantitative evaluation of norcholesterol scintigraphy, CT attenuation value, and chemical-shift MR imaging for characterizing adrenal adenomas. Ann Nucl Med. 2008;22(6):513–9.

    Article  Google Scholar 

  33. Zito F, Gilardi MC, Magnani P, Fazio F. Single-photon emission tomographic quantification in spherical objects: effects of object size and background. Eur J Nucl Med. 1996;23(3):263–71.

    Article  CAS  Google Scholar 

  34. Lethielleux G, Amar L, Raynaud A, Plouin PF, Steichen O. Influence of diagnostic criteria on the interpretation of adrenal vein sampling. Hypertension. 2015;65(4):849–54.

    Article  CAS  Google Scholar 

  35. Vonend O, Ockenfels N, Gao X, Allolio B, Lang K, Mai K, et al. Adrenal venous sampling: evaluation of the German Conn’s registry. Hypertension. 2011;57(5):990–5.

    Article  CAS  Google Scholar 

  36. Nwariaku FE, Miller BS, Auchus R, Holt S, Watumull L, Dolmatch B, et al. Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Arch Surg. 2006;141(5):497–502.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Chiba Aoba Municipal Hospital, 1273-2 Aoba-Cho, Chuo-Ku, Chiba-Shi, Chiba, 260-0852, Japan

    Tomohiro Sato

  2. Department of Medical Radiological Technology, Faculty of Health Sciences, Graduate School of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-Shi, Tokyo, 181-8612, Japan

    Tomohiro Sato, Norikazu Matsutomo & Tomoaki Yamamoto

  3. Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-Shi, Tokyo, 181-8612, Japan

    Norikazu Matsutomo, Tomoaki Yamamoto & Mitsuha Fukami

  4. Department of Internal Medicine, Chiba Aoba Municipal Hospital, 1273-2 Aoba-Cho, Chuo-Ku, Chiba-Shi, Chiba, 260-0852, Japan

    Takashi Kono

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Sato, T., Matsutomo, N., Yamamoto, T. et al. Evaluation of standardized uptake value on 131I-6β-iodomethyl-19-norcholesterol scintigraphy for diagnosis of primary aldosteronism and correspondence with adrenal venous sampling. Ann Nucl Med 37, 89–98 (2023). https://doi.org/10.1007/s12149-022-01805-w

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