scholarly journals Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism

2020 ◽  
Vol 183 (6) ◽  
pp. 539-550
Author(s):  
Minna Soinio ◽  
Anna-Kaarina Luukkonen ◽  
Marko Seppänen ◽  
Jukka Kemppainen ◽  
Janne Seppänen ◽  
...  
Keyword(s):  
Functional Imaging ◽  
Primary Aldosteronism ◽  
Standardized Uptake Value ◽  
Random Order ◽  
Operating Characteristics ◽  
Endocrine Society ◽  
Subtype Classification ◽  
Characteristics Analysis ◽  
Adrenal Ct

Objective Endocrine Society guidelines recommend adrenal venous sampling (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imaging of adrenal cortex with 11C-metomidate (11C-MTO) could offer a noninvasive alternative to AVS in the subtype classification of PA. Design We prospectively recruited 58 patients with confirmed PA who were eligible for adrenal surgery. Methods Subjects underwent AVS and 11C-MTO-PET without dexamethasone pretreatment in random order. The lateralization of 11C-MTO-PET and adrenal CT were compared with AVS in all subjects and in a prespecified adrenalectomy subgroup in which the diagnosis was confirmed with immunohistochemical staining for CYP11B2. Results In the whole study population, the concordance of AVS and 11C-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and 11C-MTO-PET was 55% in unilateral and 44% in bilateral PA. In receiver operating characteristics analysis, the maximum standardized uptake value ratio of 1.16 in 11C-MTO-PET had an AUC of 0.507 (P = n.s.) to predict allocation to adrenalectomy or medical therapy with sensitivity of 55% and specificity of 44%. In the prespecified adrenalectomy subgroup, AVS and 11C-MTO-PET were concordant in 10 of 19 subjects with CYP11B2-positive adenoma and in 6 of 10 with CYP11B2-positivity without an adenoma. Conclusions The concordance of 11C-MTO-PET with AVS was clinically suboptimal, and did not outperform adrenal CT. In a subgroup with CYP11B2-positive adenoma, 11C-MTO-PET identified 53% of cases. 11C-MTO-PET appeared to be inferior to AVS for subtype classification of PA.

scholarly journals Functional imaging by 11C-metomidate PET: a really useless technique for Primary Aldosteronism subtyping?

2021 ◽  
Author(s):  
Filippo Crimì ◽  
Alessandro Spimpolo ◽  
Diego Cecchin ◽  
Gian Paolo Rossi
Keyword(s):  
Diagnostic Accuracy ◽  
Functional Imaging ◽  
Primary Aldosteronism ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Endocrine Society ◽  
Great Caution ◽  
Diagnostic Usefulness

Soinio et al. recently compared the diagnostic accuracy of 11C-metomidate PET (11C-MTO-PET) and cosyntropin-stimulated adrenal venous sampling (AVS) for the subtyping of patients with primary aldosteronism (PA), who were diagnosed according to the 2008 Endocrine Society guidelines. They concluded that 11C-MTO-PET offered no diagnostic usefulness in subtyping of PA patients. In our view, this conclusion needs to be taken with great caution owing to a number of concerns that can be raised concerning their study

Reassessment of the cosyntropin stimulation test in the confirmatory diagnosis and subtype classification of primary aldosteronism

2016 ◽  
Vol 86 (2) ◽  
pp. 170-176 ◽  
Author(s):  
Hironobu Umakoshi ◽  
Yang Xiaomei ◽  
Takamasa Ichijo ◽  
Kohei Kamemura ◽  
Yuichi Matsuda ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Stimulation Test ◽  
Subtype Classification ◽  
Cosyntropin Stimulation Test

PS 14-73 SUBTYPE CLASSIFICATION OF PRIMARY ALDOSTERONISM WITH SUBCLINCAL CUSHING SYNDROME BY SUPER-SELECTIVE ADRENAL VEIN SAMPLING AND ITS VALIDITY

2016 ◽  
Vol 34 (Supplement 1) ◽  
pp. e454
Author(s):  
Asuka Uto ◽  
Isao Kurihara ◽  
Kazuki Miyashita ◽  
Sakiko Kobayashi ◽  
Kenichi Yokota ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Cushing Syndrome ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling ◽  
Subtype Classification

scholarly journals MON-192 Comparison of the Seated and Recumbent Saline Infusion Test for the Diagnosis of Primary Aldosteronism in Chinese Population

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Dan Zhang ◽  
Tao Chen ◽  
Haoming Tian ◽  
Yuanmei Li ◽  
Dan Mo ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Operating Characteristic ◽  
Saline Infusion ◽  
Youden Index ◽  
Infusion Test ◽  
Subtype Classification ◽  
Aldosterone Producing Adenoma ◽  
Preliminary Study ◽  
Better Than

Abstract Background: None of the diagnostic tests for primary aldosteronism (PA) are ideal according to the current literature. In a preliminary study, the seated saline infusion test (SSIT) was more sensitive than the recumbent saline infusion test (RSIT) for the diagnosis and subtype classification of PA. However, it is unclear whether the SSIT is suitable for Chinese PA patients. Objective: We prospectively investigated the accuracy of the seated saline infusion test (SSIT) in 113 patients with hypertension (including 93 PA and 20 essential hypertension (EH) patients) in the Department of Endocrinology and Metabolism. Approach and Results: Each patient underwent an recumbent saline infusion test (RSIT) and seated saline infusion test (SSIT). The accuracy of the SSIT for a confirmative primary aldosteronism (PA) diagnosis and subtype classification was evaluated and compared with the RSIT. The area under the receiver operating characteristic (ROC) curve (AUC) of aldosterone for the SSIT was significantly greater than that for the RSIT (0.945±0.0199 vs 0.828±0.0404; P<0.05). The ROC analysis showed that the optimal plasma aldosterone cutoff values were 12.94 ng/dl for the SSIT (sensitivity 86.02%, specificity 95%; Youden index (YI)=0.810) and 12.04 ng/dl for the RSIT (sensitivity 83.15%, specificity 57%; Youden index (YI)=0.401). The optimal aldosterone concentration cutoff value for classifying aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) was 18.12 ng/dl for the SSIT (sensitivity 73.5%, specificity 79.5%). No patients experienced adverse events during the SSIT. Conclusions: The SSIT was safe and convenient for PA diagnosis. The accuracy of the SSIT for a confirmatory diagnosis of PA was better than that of the RSIT. The SSIT is a reliable alternative for PA confirmation in Chinese individuals.

scholarly journals Reassessment of postural stimulation testing as a simple tool to identify a subgroup of patients with unilateral primary aldosteronism

2021 ◽  
Author(s):  
Carmina Teresa Fuss ◽  
Katharina Brohm ◽  
Martin Fassnacht ◽  
Matthias Kroiss ◽  
Stefanie Hahner
Keyword(s):  
Primary Aldosteronism ◽  
Roc Analysis ◽  
High Specificity ◽  
Preoperative Imaging ◽  
Operating Characteristics ◽  
Adrenal Vein Sampling ◽  
Endocrine Society ◽  
Non Invasive ◽  
Unilateral Disease ◽  
Subtype Differentiation

Abstract Context Adrenal vein sampling (AVS) represents the current diagnostic gold standard for differentiation between unilateral and bilateral primary aldosteronism (PA). Postural stimulation testing (PST) has been used to provide additional diagnostic information. Objective To evaluate diagnostic utility of PST in the differential diagnosis of PA. Design Cohort study. Setting Single tertiary reference center. Patients We analyzed 106 PST performed between 2008 and 2020. Diagnosis of PA and cause of PA were determined according to the Endocrine Society Clinical Practice Guideline, taking into account results of saline infusion testing, AVS, preoperative imaging and outcome after medical or surgical treatment. Main Outcome Measures The suggested cut-offs for the diagnosis of unilateral PA were revisited and optimized for high specificity using receiver operating characteristics (ROC)-analysis. Results 106 patients had confirmed PA (unilateral PA: n=55, bilateral PA: n=29, AVS unsuccessful/declined by patients: n=22). Based on decreased aldosterone plasma concentration of ≥ 28% after 4 hours in the upright position, the PST showed a sensitivity of 36.4% at a specificity of 100% to identify unilateral disease (AUC=0.72, 95% CI=0.62-0.83, p=0.001). In patients with valid testing (drop of cortisol ≥ 10% after 4 hours, n=53) sensitivity of PST rose to 51.4% at a specificity of 100% (AUC=0.77, 95% CI=0.65-0.90, p=0.001). Conclusion The high specificity of 100% for the detection of unilateral PA in patients with decreased aldosterone by at least 28% after 4 hours, makes PST a simple, non-invasive contribution to subtype differentiation in PA.

On the application of the system of machines modular block type in the advanced technology logging activities

2016 ◽  
Author(s):  
С.А. Демидов
Keyword(s):  
Advanced Technology ◽  
Modular System ◽  
Process Equipment ◽  
Block Type ◽  
Work Efficiency ◽  
Operating Characteristics ◽  
Promising Direction ◽  
Hydrostatic Transmission ◽  
Machine Module

Рассматриваются возможности применения системы машин модульно-блочного типа в перспективных технологиях лесосечных работ, а также проблемы машинного парка лесозаготовительных предприятий России. Цель исследования - изучение структуры и особенностей эксплуатации системы лесных машин модульно блочного типа в современных условиях лесозаготовок с перспективой применения на ближайшее будущее. Для улучшения технологии проведения лесосечных работ и повышения экономической эффективности лесопромышленного комплекса предлагается провести ряд важных технических и технологических изменений. Одним из решений проблемы по улучшению эффективности работы является разработка и внедрение комплекса лесных машин, основанного на принципе эксплуатационной модульности. Это будет гарантировать технологическую гибкость производства, предоставит высокую производительность и обеспечит совместимость с окружающей средой. Приведен принцип устройства машин модульно-блочного типа с разделением функций между транспортными и технологическими модулями. Представлены графически классификация модулей по их назначению и концепция компоновки системы машин модульно-блочного типа, а также главный модуль (энергетический) и несколько технологических модулей, способных выполнять различные технологические операции в зависимости от условий и технологии производства. Как показал анализ рынка, наиболее перспективным направлением по улучшению механизации лесного парка машин является создание комплекса модульно-блочных машин на базе колесного трактора, оснащенных гидрообъемными передачами. Это делает конструкцию машины более гибкой и мобильной. Принцип формирования и работы модульной системы машин с многофункциональным технологическим оборудованием рассматривается в качестве перспективного направления по улучшению лесозаготовительного процесса. The article deals with the prospects for the use of machines modular block type in the advanced technology logging activities, as well as the machinery problems of logging enterprises in Russia. The research objective. The study of the structure and operating characteristics of a system of forest modular block type machines in current conditions with the prospect of their application in the nearest future. It is necessary that a number of important technical and technological changes should be made to improve the technology of logging operations and increase the economic efficiency of timber industry complex. One of the solutions to improve work efficiency is the development and introduction of forest machines based on the principle of operational modularity. It will ensure the flexibility of the production process, provide high work efficiency and, what counts, will be environmentally friendly. The article gives the description of the principle of the machine module block type, as well as the functions and how they are divided between the two modules. There are two pictures in the article. The first picture gives the classification of modules according to their application. The second picture shows the principle of arrangement of modular machine-block type. Both the main energetic module and some technological modules capable of performing processing steps depending on the conditions and production technology are presented. According to the market analysis that shows that the most promising direction to improve the mechanization of forest machinery is to create a complex modular block machines on the base of a wheeled tractor equipped with hydrostatic transmission. It will make the machine design more flexible and mobile. The principle of formation and operation of the modular system with multi-function machines process equipment is considered as a promising direction for improvement of the process of logging.

scholarly journals Multiple PET tracers for use in the classification of gliomas according to the 2016 WHO criteria

2020 ◽  
Author(s):  
Keisuke Miyake ◽  
Kenta Suzuki ◽  
Tomoya B Ogawa ◽  
Daisuke Ogawa ◽  
Tetsuhiro Hatakeyama ◽  
...  
Keyword(s):  
Who Classification ◽  
Standardized Uptake Value ◽  
Metabolic Tumor Volume ◽  
Who Criteria ◽  
Pet Tracers ◽  
Pet Tracer ◽  
Positron Emission ◽  
18F Fdg ◽  
Classification Of Gliomas

Abstract Background The molecular diagnosis of gliomas such as isocitrate dehydrogenase (IDH) status (wild-type [wt] or mutation [mut]) is especially important in the 2016 WHO classification. Positron emission tomography (PET) has afforded molecular and metabolic diagnostic imaging. The present study aimed to define the interrelationship between the 2016 WHO classification of gliomas and the integrated data from PET images using multiple tracers, including 18F-fluorodeoxyglucose ( 18F-FDG), 11C-methionine ( 11C-MET), 18F-fluorothymidine ( 18F-FLT), and 18F-fluoromisonidazole ( 18F-FMISO). Methods This retrospective, single-center study comprised 113 patients with newly diagnosed glioma based on the 2016 WHO criteria. Patients were divided into four glioma subtypes (Mut, Codel, Wt, and glioblastoma multiforme [GBM]). Tumor standardized uptake value (SUV) divided by mean normal cortical SUV (tumor-normal tissue ratio [TNR]) was calculated for 18F-FDG, 11C-MET, and 18F-FLT. Tumor-blood SUV ratio (TBR) was calculated for 18F-FMISO. To assess the diagnostic accuracy of PET tracers in distinguishing glioma subtypes, a comparative analysis of TNRs and TBR as well as the metabolic tumor volume (MTV) were calculated by Scheffe’s multiple comparison procedure for each PET tracer following the Kruskal–Wallis test. Results The differences in mean 18F-FLT TNR and 18F-FMISO TBR were significant between GBM and other glioma subtypes (p < 0.001). Regarding the comparison between Gd-T1WI volumes and 18F-FLT MTVs or 18F-FMISO MTVs, we identified significant differences between Wt and Mut or Codel (p < 0.01). Conclusion Combined administration of four PET tracers might aid in the preoperative differential diagnosis of gliomas according to the 2016 WHO criteria.

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