New Imaging Method Improves Primary Aldosteronism Management

A novel approach using two imaging agents is transforming how doctors manage primary aldosteronism, a condition causing high blood pressure. This innovative dual-modality method allows for better diagnosis and assessment of potential heart damage in patients.

Comprehensive Imaging Approach

A study presented at the Society of Nuclear Medicine and Molecular Imaging 2025 annual meeting details the combined use of two PET imaging agents. This approach enables a thorough imaging method for treating individuals with primary aldosteronism. According to the research, the radiotracer gallium-68 (Ga-68) Pentixafor was used to pinpoint disease subtypes, while Ga-68 FAPI-04 was employed to detect potential cardiac issues.

“Precise diagnosis and assessment of cardiac issues is critical for patients with primary aldosteronism,” said Dr. Jie Ding. “Our study evaluated the effectiveness of this dual-modality approach integrating adrenal and cardiac imaging in disease management.”

—Dr. Jie Ding, Tongji University

Primary aldosteronism, marked by excessive aldosterone production, is a common cause of secondary hypertension. It can lead to severe cardiac events, with cardiovascular disease being the leading cause of death in these patients. In the U.S., it is estimated that as many as 10% of people with high blood pressure have primary aldosteronism (National Institutes of Health, 2015).

Differentiating Disease Subtypes

Ga-68 Pentixafor is an effective PET imaging agent that differentiates between aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). Meanwhile, Ga-68 FAPI-04 helps visualize cardiomyopathies. Researchers assessed whether this dual method offered a comprehensive approach. They enrolled 30 patients with primary aldosteronism and 15 with primary hypertension for the study, using PET/MRI with both imaging agents.

The adrenal glands and myocardium’s standardized uptake values (SUVs) were quantified and compared. The study revealed that 15 of the PA patients were diagnosed with APA and 15 with IHA. Patients with APA had notably higher adrenal Ga-68 Pentixafor SUV than those with IHA.

Cardiac Impact

Myocardial FAPI uptake was found in 17 PA patients using Ga-68 FAPI-04 PET/MRI, predominantly in the interventricular septum and right ventricular insertion points. APA patients also exhibited a higher prevalence of myocardial FAPI uptake compared to IHA and primary hypertension patients.

Follow-up imaging after adrenalectomy in four APA patients revealed a decrease in SUV. Dr. Ding stated that this new method enables precise diagnosis, subtype classification, cardiovascular complication evaluation, and treatment response tracking. Given the rapid adoption of Ga-68 Pentixafor and Ga-68 FAPI-04, this dual-imaging method could swiftly become standard practice.