Imaging Aldosterone-Producing Adrenocortical Carcinoma With 68 Ga-Pentixafor PET/CT

Incidental Detection of Renal Cell Carcinoma on 18F-NOTA-Pentixather PET/CT in a Patient With Aldosterone-producing Adenoma

We report the 18F-NOTA-pentixather PET/CT findings of aldosterone-producing adenoma (APA) coincidence with renal cell carcinoma (RCC) in a 36-year-old man. He went to the hospital for persistent hypertension and new limb numbness and weakness. CT showed a nodule in the left adrenal gland, suggestive of an adenoma. 18F-NOTA-pentixather PET/CT showed the nodule with high NOTA-pentixather uptake. A surprisingly NOTA-pentixather-avid lesion in the right kidney was also noted. Postoperative pathology supported a diagnosis of APA of the left adrenal gland nodule, and the right kidney lesion was RCC.

Clinical value of CXCR4-targeted PET-CT in primary aldosteronism: a systematic review and meta-analysis

PURPOSE

Primary aldosteronism (PA), a common cause of secondary hypertension, requires precise localization and subtype differentiation for appropriate management. C-X-C chemokine receptor 4 (CXCR4) targeted PET-CT emerges as a promising non-invasive modality for evaluating PA. This study aims to assess its performance in three key areas: lateralizing aldosterone secretion, differentiating PA subtypes, and predicting surgical outcomes.

METHODS

A systematic review and meta-analysis were performed, including studies that evaluated CXCR4-targeted PET-CT for PA diagnosis. Relevant literature was retrieved from PubMed, Embase, Scopus, Web of Science, WanFang, and CNKI (through January 10, 2025). Studies were included if they provided data on lateralization, subtype differentiation, or postoperative outcomes. Risk of bias was assessed using the QUADAS-2 tool. Pooled diagnostic metrics were calculated using random-effects models, with summary receiver operating characteristic curves analysis.

RESULTS

Fourteen studies involving 1043 patients were included. CXCR4-targeted PET-CT demonstrated a pooled sensitivity of 74%[95%CI: 69-79%] and specificity of 85%[95%CI: 64-95%] for lateralizing aldosterone secretion. For subtype differentiation, sensitivity was 91%[95%CI: 82-96%] and specificity 92%[95%CI: 85-96%] in distinguishing aldosterone-producing adenoma from non- aldosterone-producing adenoma. In predicting postoperative outcomes, the sensitivity was 91%[95%CI: 84-95%], with accuracy of 77%[95%CI: 64-90%].

CONCLUSION

CXCR4-targeted PET-CT demonstrated clinical applications in: (1) accurately determining PA lateralization with high specificity; (2) reliably distinguishing PA subtypes; and (3) effectively predicting postoperative benefit. These findings support its potential use as an adjunctive tool in the clinical management of PA.

SYSTEMATIC REVIEW REGISTRATION NO

CRD42025636887 (PROSPERO).

Diffuse Uptake of 68 Ga-Pentixafor in the Breasts During the Ovulatory Phase in a Patient With SAPHO Syndrome

ABSTRACT

We report a case of a woman with SAPHO syndrome who exhibited increased tracer uptake in the sternal angle on a 99m Tc-MDP bone scan. This patient was enrolled in a 68 Ga-pentixafor PET/CT trial for inflammatory diseases. The PET/CT showed no abnormal tracer uptake in the sternal angle. Unexpectedly, diffuse uptake of 68 Ga-pentixafor was observed in both breasts, which might be due to hormonal stimulation because the woman underwent the 68 Ga-pentixafor PET/CT scan during the ovulatory phase.

Mildly Increased 68 Ga-Pentixafor Uptake in Hepatic Hemangioma

ABSTRACT

68 Ga-pentixafor uptake in hemangioma is rare. We report 68 Ga-pentixafor PET/MRI findings of a hepatic hemangioma in a 54-year-old woman. The images revealed a hyperintense lesion in the right posterior liver on T2-weighted images, with mild pentixafor uptake. The lesion was consistent with typical presentations of a hemangioma on MRI and contrast-enhanced CT.

Exploring Theranostic Avenues in Adrenocortical Carcinoma Using Chemokine Receptor and Prostate-Specific Membrane Antigen-Directed PET/CT

ABSTRACT

We report on an adrenocortical carcinoma (ACC) patient, which has exhausted previous treatment options and was scheduled for prostate-specific membrane antigen (PSMA)- and C-X-C motif chemokine receptor 4 (CXCR4)-targeted PET/CT. We identified PSMA-avid pulmonary metastases exhibiting modest radiotracer accumulation, while chemokine receptor PET/CT provided intense uptake. This dual-tracer molecular imaging approach revealed that chemokine receptor PET appears to be more suitable in patients with advanced ACC, indicating that CXCR4-directed radioligand therapy may be considered in such patients suffering from end-stage disease. Given its dismal prognosis, chemokine receptor-directed theranostics may therefore extend the therapeutic armamentarium as last-line option in advanced ACC.

Superiority of 18 F-FDG PET/CT to 68 GA-FAPI PET/CT in Adrenocortical Tumor Imaging

ABSTRACT

18 F-FDG PET/CT was performed to evaluate the response to treatment in a 62-year-old female patient who was operated for adrenocortical carcinoma. High FDG uptake was observed in recurrent lesion in the left adrenal gland site and metastatic lesions. In the 68 Ga-FAPI-04 PET/CT study, low FAPI uptake was observed in both recurrences and metastases. In this case, we demonstrated the superiority of 18 F-FDG PET/CT over 68 Ga-FAPI-04 PET/CT in the evaluation of adrenocortical carcinoma.

Similar Findings on 68 Ga-Pentixafor PET/CT and 18 F-FDG PET/CT in a Patient With Widespread Metastatic Hepatic Neuroendocrine Carcinoma

ABSTRACT

A patient with suspected malignant tumor underwent 18 F-FDG PET/CT. Based on the findings, the patient was suspected of having multiple myeloma. Then the patient underwent 68 Ga-pentixafor PET/CT, which showed similar results to 18 F-FDG PET/CT. Finally, the patient was eventually diagnosed with neuroendocrine carcinoma.