Molecular Imaging Versus Adrenal Vein Sampling for the Detection of Surgically Curable Primary Aldosteronism : A Prospective Within-Patient Trial
Authors' conclusion
Molecular imaging is an accurate, noninvasive alternative to AVS.
Study context
- Population
- Patients with primary aldosteronism (PA) desiring surgery if a unilateral source of PA was diagnosed[11C]MTO and adrenal vein sampling (AVS) in 169 patients, plus [18F]CETO in the final 31
- Participants
- 174 patients
- Comparison
- Accuracy of [11C]MTO vs AVS in predicting outcomes from unilateral adrenalectomy; agreement of [11C]MTO with [18F]CETO
- [11C]MTOn = 169
- AVSn = 169
- [18F]CETOn = 31
- Outcome
- Predicted unilateral PA
Methodological detailsThree referral centers
- Three referral centers
Performance
As reported in the abstract
- Predicted unilateral by both [11C]MTO and AVS
- 43 of 169 (25.4%)
Further findings
Accuracy
| Outcome | [11C]MTO | AVS | κ (CI) |
|---|---|---|---|
| Accuracy of prediction of complete or partial biochemical success | 71.3% (95% CI 61.0%–80.1%) | 62.8% (CI 52.2%–72.6%) | |
| Agreement between [18F]CETO and [11C]MTO[18F]CETO vs [11C]MTO · agreed in 29 of 31 patients | 0.85 (0.68–1.00) |
- Accuracy of prediction of complete or partial biochemical success: 95% CIs around differences between accuracies crossed zero, excluding superiority for [11C]MTO
- Accuracy of prediction of complete or partial biochemical success: Prespecified noninferiority lower bound −17% not crossed; [11C]MTO declared noninferior to AVS
Accuracy of prediction of complete or partial biochemical success
- Predictions least accurate for complete clinical success (home blood pressure <135/85 mm Hg off treatment)
Assignment to adrenalectomy and primary outcome data availability
- Assigned to adrenalectomy by the multidisciplinary team
- 100 of 169 (59.1%)
- Primary outcome data available
- 156 of 169
- The accuracy of [11C]MTO could be assessed only in the surgical group.
Original publication
Molecular Imaging Versus Adrenal Vein Sampling for the Detection of Surgically Curable Primary Aldosteronism : A Prospective Within-Patient Trial. Ann Intern Med. Published 4 March 2025. doi:10.
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