[11C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: a prospective, within-patient trial

Wu, X; Senanayake, R; Goodchild, E; Bashari, WA; Salsbury, J; Cabrera, CP; Argentesi, G; O'Toole, SM; Matson, M; Koo, B; Parvanta, L; Hilliard, N; Kosmoliaptsis, V; Marker, A; Berney, DM; Tan, W; Foo, R; Mein, CA; Wozniak, E; Savage, E; Sahdev, A; Bird, N; Laycock, K; Boros, I; Hader, S; Warnes, V; Gillett, D; Dawnay, A; Adeyeye, E; Prete, A; Taylor, AE; Arlt, W; Bhuva, AN; Aigbirhio, F; Manisty, C; McIntosh, A; McConnachie, A; Cruickshank, JK; Cheow, H; Gurnell, M; Drake, WM; Brown, MJ

doi:10.1038/s41591-022-02114-5

Adrenal disease

[11C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: a prospective, within-patient trial

Nat MedPublished 16 Jan 2023Prospective within-patient diagnostic accuracy trial

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Authors' conclusion

MTO enables non-invasive diagnosis of unilateral PA.

Study context

Population: Patients with primary aldosteronism (PA)128 reached follow-up
Participants: 143 patients

Comparison: [11C]metomidate PET-CT vs adrenal vein sampling (AVS)
Outcome: Accuracy in predicting biochemical remission of PA and resolution of hypertension after surgery
Follow-up: 6- to 9-month follow-up

Methodological detailsnon-inferiority

Non-inferiority

Performance

As reported in the abstract

MTO72.7%

AVS63.6%

Within pre-specified −17% non-inferiority margin; not significantly superior

Each group vs AVSEstimate (95% CI)P value

MTO

difference (biochemical success) 9.1 %(−6.5 to 24.1)

P = 0.00055

MTO

difference (clinical success) 3.8 %(−11.9 to 9.4)

P = 0.0077

Further findings

Surgical outcome success · 6- to 9-month follow-up

Treated surgically: 78 (61%)
Managed medically: 50 (39%)
Surgical patients achieving ≥1 PA surgical outcome criterion for success: 77 of 78

Safety

Serious adverse events: 24
Related to either investigation: 0
Fully resolved: 22

Reference

Authors: Wu X, Senanayake R, Goodchild E, Bashari WA, Salsbury J, Cabrera CP, et al.
All 42 authors
Wu X, Senanayake R, Goodchild E, Bashari WA, Salsbury J, Cabrera CP, Argentesi G, O'Toole SM, Matson M, Koo B, Parvanta L, Hilliard N, Kosmoliaptsis V, Marker A, Berney DM, Tan W, Foo R, Mein CA, Wozniak E, Savage E, Sahdev A, Bird N, Laycock K, Boros I, Hader S, Warnes V, Gillett D, Dawnay A, Adeyeye E, Prete A, Taylor AE, Arlt W, Bhuva AN, Aigbirhio F, Manisty C, McIntosh A, McConnachie A, Cruickshank JK, Cheow H, Gurnell M, Drake WM, Brown MJ
Journal: Nature Medicine
Published: 16 Jan 2023
DOI: 10.1038/s41591-022-02114-5
PubMed: 36646800
Registration: NCT02945904

Topic: Adrenal disease

Diagnostic definitions

MTO: [11C]metomidate positron emission tomography computed tomography
AVS: adrenal vein sampling

Key notes

Non-inferiority margin −17%

Original publication

[11C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: a prospective, within-patient trial. Nat Med. Published 16 January 2023. doi:10.1038/s41591-022-02114-5

Read the original article ↗

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