Innovative Dual PET/MRI Technique Enhances Management of Primary Aldosteronism

In a groundbreaking development presented at the Society of Nuclear Medicine and Molecular Imaging (SNMMI) 2025 annual meeting, researchers have unveiled a dual imaging technique utilizing both positron emission tomography (PET) and magnetic resonance imaging (MRI) to improve the management of primary aldosteronism (PA). This disorder, characterized by excessive production of aldosterone from the adrenal glands, is a leading cause of secondary hypertension and is associated with significant cardiovascular risks.

The study, led by Dr. Jie Ding, MD, from Tongji University in Shanghai, China, highlighted how the combination of two PET imaging agents can provide a comprehensive diagnostic approach. Specifically, the use of gallium-68 (Ga-68) Pentixafor identified the different subtypes of PA, while Ga-68 FAPI-04 enabled visualization of potential cardiac damage in patients. “Precise diagnosis and assessment of cardiac issues are critical for patients with primary aldosteronism,” stated Dr. Ding during his presentation.

Dr. Ding’s team enrolled 30 patients diagnosed with PA and 15 individuals with primary hypertension as a control group. All participants underwent PET/MRI scans using both imaging agents. The results were striking; half of the PA patients were diagnosed with aldosterone-producing adenoma (APA), while the other half had idiopathic hyperaldosteronism (IHA). The study found that APA patients exhibited significantly higher adrenal Ga-68 Pentixafor standardized uptake values (SUVs) compared to IHA patients (10.5 vs. 3.6, p < 0.001).

Additionally, myocardial FAPI uptake was detected in 56.7% of PA patients, particularly in the interventricular septum and right ventricular insertion points. This finding is crucial, as previous studies have indicated that cardiovascular disease is the primary cause of mortality among PA patients, emphasizing the need for effective imaging methods to assess cardiac complications.

In a follow-up analysis of APA patients who underwent adrenalectomy, imaging results showed a decrease in myocardial FAPI uptake, suggesting that the dual-imaging approach may also assist in tracking treatment responses. “This work revolutionizes the management of primary aldosteronism by enabling precise diagnosis and subtype classification, evaluating cardiovascular complications, and tracking treatment responses,” Dr. Ding added.

The significance of this study lies not only in its immediate clinical implications but also in its potential to shape future practices in the management of PA. The findings could facilitate early intervention strategies, ultimately improving patient outcomes. Given that Ga-68 Pentixafor and Ga-68 FAPI-04 are emerging PET tracers that have gained clinical traction, the transition of this dual-imaging method into routine clinical practice is anticipated to be swift.

As healthcare professionals continue to seek innovative solutions for complex medical conditions, the integration of advanced imaging techniques like dual PET/MRI underscores the ongoing evolution in the diagnostic landscape. This research serves as a pivotal step toward enhancing the understanding and management of primary aldosteronism, a disorder that has long posed challenges for effective treatment.