Primary Aldosteronism Subtype Diagnosis: Adrenal Venous Sampling vs. CXCR4 PET CT.

Abstract

Purpose: To explore the clinical value of adrenal venous sampling (AVS) and CXCR4-directed ⁶⁸Ga-pentixafor PET/CT in the subtype diagnosis of primary aldosteronism (PA), with postsurgical blood pressure control and biochemical cure as primary endpoints, and to compare the accuracy and practicability of the two methods.

Methods: A retrospective cohort study was conducted in PA patients undergoing unilateral adrenalectomy at West China Hospital between February 2023 and June 2025. Patients were divided into the AVS and CXCR4 imaging groups. The primary outcome was the clinical and biochemical success rate according to the Primary Aldosteronism Surgical Outcome (PASO) criteria. In the subgroup with both procedures, AVS was considered the reference standard to assess the diagnostic efficacy of CXCR4.

Results: A total of 160 patients completed the trial. According to the PASO criteria, the total biochemical success rate was 93.1%, among which the complete biochemical success rate in the AVS group was 84.1%, and in the CXCR4 group it was 93.1% (p = 0.091); the total clinical success rate was 82.5%, with a complete clinical success rate of 40.9% in the AVS group and 30.3% in the CXCR4 group (p = 0.412). There were no statistically significant differences between the two groups. In 16 patients with both examinations, CXCR4 showed a sensitivity of 70.0%, specificity of 83.3%, accuracy of 75.0%, and moderate agreement with AVS.

Conclusion: CXCR4 showed no statistical difference from AVS in diagnostic and prognostic outcomes in this study. However, discordance in multinodular disease indicates that molecular imaging cannot fully reflect the heterogeneity of aldosterone secretion. This finding requires verification in a larger cohort.