Horm Metab Res 2017; 49(12): 929-935
DOI: 10.1055/s-0043-120672
Review
© Georg Thieme Verlag KG Stuttgart · New York

The Latest Developments of Functional Molecular Imaging in the Diagnosis of Primary Aldosteronism

Mitsuhide Naruse
1  Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
,
Hironobu Umakoshi
1  Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
2  Division of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
,
Mika Tsuiki
1  Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
2  Division of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
,
Maki Yokomoto
1  Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
2  Division of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
,
Tetsuya Tagami
1  Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
2  Division of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
,
Akiyo Tanabe
3  Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
,
Akira Shimatsu
1  Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
› Author Affiliations
Further Information

Publication History

received 21 August 2017

accepted 28 September 2017

Publication Date:
23 November 2017 (online)

Abstract

Differentiation of unilateral from bilateral aldosterone hypersecretion is the essential step in the clinical practice of primary aldosteronism (PA). Although adrenal venous sampling (AVS) has been established as the most standard test recommended by the guideline, its invasive and technically difficult nature has facilitated the approach to develop non-invasive functioning imaging as an alternative test. Compared to the conventional adrenocortical scintigraphy with cholesterol derivatives as tracer, the first-generation imaging, both of 11C-MTO/PET and 123I-IMTO/SPECT/CT, the second-generation imaging, bind with high specificity and affinity to CYP11B enzymes and have advantages in shortening the time for obtaining specific images, reducing the radiation exposure to the patient, and resolution of the images. Because of very short half-life of 11C-MTO, 123I-IMTO has a potential for a wider application than 11C-MTO. Sensitivity of identifying an adenoma smaller than 1 cm in diameter is still a common limitation of these new functional imaging methods. The new functional imaging could be supplementary to AVS in lateralization of PA when the results of AVS are not conclusive. To be a substitute for AVS, however, it should fulfill various conditions including high selectivity and binding affinity to CYP11B2, high sensitivity in detecting small adenoma, high resolution image, reduction of radiation exposure, and general versatility. Considering the potential number of patients, cost-effectiveness of the subtype testing in the clinical practice of PA could be one of the issues of the medical expenses. Thus, development of a new non-invasive functional imaging will have a significant impact on the clinical practice of PA and hypertension.