Diagnostic concordance of CXCR4-PET/CT and adrenal vein sampling in subtyping primary aldosteronism and its guiding value for percutaneous adrenal artery embolisation: a prospective diagnostic test accuracy study protocol.

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Τίτλος:	Diagnostic concordance of CXCR4-PET/CT and adrenal vein sampling in subtyping primary aldosteronism and its guiding value for percutaneous adrenal artery embolisation: a prospective diagnostic test accuracy study protocol.
Συγγραφείς:	Chen S; Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Yu H; Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Liang W; Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Li C; Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Ma R; Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Zhang X; Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Sun R; Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Zhao X; Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Huang L; Department of Nuclear Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Wu X; Department of Urology, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Du F; Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China., Wang Q; Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China wqyconnie@163.com.
Πηγή:	BMJ open [BMJ Open] 2026 Oct 05; Vol. 16 (10), pp. e124662. Date of Electronic Publication: 2026 Oct 05.
Τύπος έκδοσης:	Journal Article
Γλώσσα:	English
Στοιχεία περιοδικού:	Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
Imprint Name(s):	Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
Ιατρικοί όροι (MeSH):	Hyperaldosteronism/therapy , Hyperaldosteronism/diagnostic imaging , Hyperaldosteronism/diagnosis , Adrenal Glands/blood supply , Adrenal Glands/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Receptors, CXCR4/metabolism , Embolization, Therapeutic/methods, Aldosterone/blood ; Humans ; Prospective Studies ; Female ; Veins ; Adult ; Male
Περίληψη:	Introduction: Primary aldosteronism (PA) is the most common cause of secondary hypertension, and accurate differentiation between unilateral and bilateral disease is critical for selecting appropriate therapy. In patients undergoing adrenalectomy, histopathological classification based on the International Histopathology Consensus for Unilateral Primary Aldosteronism provides a definitive reference for unilateral disease. Although adrenal vein sampling (AVS) remains the diagnostic gold standard, it is invasive, technically demanding and often limited by variable success rates. CXCR4-targeted positron emission tomography (CXCR4-PET)/CT has emerged as a promising non-invasive imaging modality capable of identifying aldosterone-producing lesions, but robust prospective evidence comparing it directly with AVS is lacking. This study aims to evaluate the diagnostic accuracy of CXCR4-PET/CT and to determine whether PET imaging can support treatment decision-making. Methods and Analysis: This prospective single-centre diagnostic test accuracy study will enrol adults with confirmed PA and blood pressure ≥140/90 mm Hg. All participants will undergo adrenal CT, CXCR4-PET/CT and AVS following standardised protocols. Diagnostic accuracy will be evaluated by receiver operating characteristic curve, using a hierarchical reference standard, with AVS as the primary clinical reference and postoperative histopathology (according to the International Histopathology Consensus for Unilateral Primary Aldosteronism). Eligible patients may receive superselective adrenal arterial embolisation (SAAE), adrenalectomy or medical therapy. Clinical and biochemical outcomes, including blood pressure, aldosterone-renin parameters and medication burden, will be assessed at 1, 3, 6 and 12 months. Safety will be monitored and graded using Common Terminology Criteria for Adverse Events (CTCAE) V.5.0 criteria. Multivariable analyses will explore predictors of unilateral disease and factors associated with PET-AVS discordance. Ethics and Dissemination: By integrating functional imaging, AVS, and treatment outcomes within a unified prospective framework, this study may provide comprehensive evaluations of CXCR4-PET/CT in PA to date. Findings may clarify its diagnostic utility, reduce dependence on AVS, and support precision treatment strategies in PA management. Trial Registration Number: ChiCTR2600118245. (© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)
Competing Interests:	Competing interests: None declared.
References:	Hypertension. 2023 May;80(5):995-1010. (PMID: 36825503) J Endocrinol Invest. 2022 Oct;45(10):1899-1908. (PMID: 35612811) Eur J Nucl Med Mol Imaging. 2026 Jan;53(2):1289-1298. (PMID: 40815389) Int J Surg. 2024 Nov 01;110(11):7367-7380. (PMID: 39248318) Singapore Med J. 2022 Feb;63(2):111-116. (PMID: 33264832) Eur J Endocrinol. 2023 Jul 20;189(1):G1-G42. (PMID: 37318239) Endocr Rev. 2025 Jul 15;46(4):501-517. (PMID: 39965116) J Clin Hypertens (Greenwich). 2025 Jul;27(7):e70088. (PMID: 40685750) Gland Surg. 2020 Feb;9(1):14-24. (PMID: 32206595) Endocrine. 2025 Aug;89(2):603-613. (PMID: 40388084) Curr Opin Endocr Metab Res. 2019 Oct;8:30-39. (PMID: 32832727) J Clin Endocrinol Metab. 2025 Aug 07;110(9):2453-2495. (PMID: 40658480) J Nucl Med. 2024 Nov 1;65(11):1681-1684. (PMID: 39299785) Endocrine. 2022 Nov;78(2):363-372. (PMID: 35751774) J Hypertens. 2021 Sep 1;39(9):1918-1925. (PMID: 34039913) Rev Esp Med Nucl Imagen Mol (Engl Ed). 2019 Jan - Feb;38(1):29-37. (PMID: 30442558) Endocrinol Diabetes Metab. 2022 Nov;5(6):e368. (PMID: 36039035) J Clin Endocrinol Metab. 2020 Jun 1;105(6):. (PMID: 31536622) Circ Cardiovasc Qual Outcomes. 2015 Nov;8(6):621-30. (PMID: 26555126) Pol J Radiol. 2019 Mar 04;84:e136-e141. (PMID: 31019607) Eur Radiol. 2023 Feb;33(2):996-1003. (PMID: 36070092) Ann Intern Med. 2025 Mar;178(3):336-347. (PMID: 40030172) Hypertens Res. 2025 Apr;48(4):1422-1427. (PMID: 39849050) Front Endocrinol (Lausanne). 2025 Feb 27;16:1533295. (PMID: 40084145) CVIR Endovasc. 2021 Apr 1;4(1):38. (PMID: 33939038) Eur J Radiol. 2025 Sep;190:112240. (PMID: 40543282) J Clin Endocrinol Metab. 2021 Jan 1;106(1):42-54. (PMID: 32717746) Clin Endocrinol (Oxf). 2025 Jan;102(1):31-43. (PMID: 39360599) Hypertension. 2018 Feb;71(2):317-325. (PMID: 29279316) Ann Surg. 2020 Dec;272(6):1125-1132. (PMID: 30672800) Hypertension. 2023 Oct;80(10):2187-2195. (PMID: 37593884) Sci Rep. 2022 Apr 6;12(1):5781. (PMID: 35388079) Hypertension. 2014 Jan;63(1):151-60. (PMID: 24218436) Front Endocrinol (Lausanne). 2024 Feb 14;15:1291775. (PMID: 38419957) Int J Surg. 2024 Feb 01;110(2):839-846. (PMID: 37916935) Hypertension. 2024 Mar;81(3):604-613. (PMID: 38174562) Mol Imaging Biol. 2025 Feb;27(1):142-150. (PMID: 39715984) Ann Vasc Surg. 2024 Jan;98:258-267. (PMID: 37820987) Hypertension. 2023 Dec;80(12):2495-2500. (PMID: 37800386) BMC Surg. 2024 Aug 24;24(1):242. (PMID: 39182043) Front Endocrinol (Lausanne). 2021 Nov 26;12:784706. (PMID: 34899614) Cardiovasc Intervent Radiol. 2025 Jul;48(7):984-989. (PMID: 40175635) Semin Nucl Med. 2024 Jan;54(1):163-170. (PMID: 37923671) BMJ Open. 2022 Aug 23;12(8):e060779. (PMID: 35998969) Diagn Interv Radiol. 2023 May 16;29(4):640-646. (PMID: 37191468) J Clin Endocrinol Metab. 2022 Jan 18;107(2):e865-e873. (PMID: 34415988) Front Cardiovasc Med. 2022 Oct 11;9:1013426. (PMID: 36304542) Front Endocrinol (Lausanne). 2022 Apr 26;13:861581. (PMID: 35557845) Hypertension. 2019 Oct;74(4):800-808. (PMID: 31476901) EJNMMI Res. 2025 Apr 17;15(1):41. (PMID: 40246740) EJNMMI Res. 2025 Aug 28;15(1):111. (PMID: 40875090) CMAJ. 2017 Jun 5;189(22):E773-E778. (PMID: 28584041) Hypertens Res. 2023 May;46(5):1297-1310. (PMID: 36869143) J ASEAN Fed Endocr Soc. 2025 Nov;40(2):126-131. (PMID: 41357052) Surgery. 2019 Jan;165(1):221-227. (PMID: 30415872)
Contributed Indexing:	Keywords: Adrenal disorders; Diagnostic Imaging; Hypertension
Substance Nomenclature:	0 (Receptors, CXCR4) 4964P6T9RB (Aldosterone)
Entry Date(s):	Date Created: 20261005 Date Completed: 20261005 Latest Revision: 20261010
Update Code:	20261010
PubMed Central ID:	PMC13646990
DOI:	10.1136/bmjopen-2026-124662
PMID:	42833710
Βάση Δεδομένων:	MEDLINE

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ISSN:	2044-6055
DOI:	10.1136/bmjopen-2026-124662