The 2 main causes of primary aldosteronism (PA) are aldosterone-producing adenoma (APA) and idiopathic adrenal hyperplasia (IAH). Dexamethasone-suppression ¹³¹I-6β-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy can assess the functioning of the adrenal cortex. This study evaluated the diagnostic usefulness of NP-59 SPECT/CT in differentiating APA from IAH and in predicting postadrenalectomy clinical outcome for PA patients who had inconclusive adrenal venous sampling (AVS) and CT results. Methods: We retrospectively reviewed the 31 adrenal lesions of 27 patients (age range, 33–71 y; mean age ± SD, 50.4 ± 10.9 y) who had been clinically confirmed (by saline infusion and captopril tests) to have PA, had inconclusive CT and AVS test results, and had undergone NP-59 imaging before adrenalectomy. The accuracy of NP-59 imaging was determined by comparison with histopathologic findings. Results: NP-59 SPECT/CT gave us 18 true-positive, 3 false-positive, 6 true-negative, and 4 false-negative results. Compared with planar imaging, SPECT/CT significantly improved diagnostic accuracy and prognostic predicting ability (P = 0.0390 and P = 0.0141, respectively). The NP-59 results were negative for 7 of the 23 patients with unilateral adrenal lesions, and none of these 7 patients had shown postsurgical clinical improvement. Conclusion: NP-59 SPECT/CT is an effective imaging tool for differentiating APA from IAH in PA patients whose CT and AVS results are inconclusive. Our results suggest that patients with presurgically negative NP-59 results should be treated medically and that noninvasive NP-59 SPECT/CT may be suited for use as the first lateralization modality after CT in patients with clinically confirmed PA.

Circulating tumor cells (CTCs) released from a periampullary or pancreatic cancer can be more frequently detected in the portal than the systemic circulation and potentially can be used to identify patients with liver micrometastases. Aims of this study is to determine if CTCs count in portal venous blood of patients with nonmetastatic periampullary or pancreatic adenocarcinoma can be used as a predictor for subsequent liver metastases. CTCs were quantified in portal and peripheral venous blood samples collected simultaneously during pancreaticoduodenectomy in patients with presumed periampullary or pancreatic adenocarcinoma without image-discernible metastasis. Postoperatively patients were monitored for liver metastasis by abdominal magnetic resonance imaging or computed tomography every 3 months for 1 year. Sixty patients with a pathological diagnosis of periampullary or pancreatic adenocarcinoma were included in the study. Multivariate analysis indicated that portal CTC count was a significant predictor for liver metastases within 6 months after surgery. Eleven of 13 patients with a high portal CTCs count (defined as >112 CMx Platform estimated CTCs in 2 mL blood) developed liver metastases within 6 months after surgery. In contrast, only 6 of 47 patients with a low portal CTC count developed liver metastases (P < 0.0001). A value of 112 CMx Platform estimated CTCs had 64.7% sensitivity and 95.4% specificity to predict liver metastases within 6 months after surgery. We concluded that a high CTC count in portal venous blood collected during pancreaticoduodenectomy in patients with periampullary or pancreatic adenocarcinoma without metastases detected by currently available imaging tools is a significant predictor for liver metastases within 6 months after surgery.

Myocardial perfusion imaging (MPI) with single photon emission computer tomography (SPECT) is a well-established tool for the diagnosis of coronary artery disease (CAD). However, soft tissue attenuation is a common artifact which limits the diagnostic accuracy of MPI. The aim of this study was to determine whether attenuation correction (AC) improved diagnostic performance of MPI, using coronary angiography as reference standard. Methods: MEDLINE and EMBASE were searched until March 2015 for studies evaluating AC MPI for the diagnosis of CAD. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. For each study, the sensitivity, specificity, and diagnostic odds ratio, along with 95% confidence intervals (CIs), were calculated to determine the diagnostic accuracy of AC vs. non-attenuation corrected (NAC) MPI. A bivariate mixed-effect model was applied for pooling the data. Results: Out of 201 articles, 17 studies (1,701 patients) were identified including five studies which used computed tomography AC (CTAC), 12 studies which used radionuclide source AC (RAC), and 15 studies which reported NAC results. The pooled sensitivities across studies were 0.80 (95%CI, 0.64-0.91), 0.85 (0.81-0.88), 0.84 (0.79-0.88) and 0.80 (0.75-0.85) for CTAC, RAC, all AC, and NAC, respectively; and pooled specificities were 0.83 (0.71-0.91), 0.81 (0.73-0.86), 0.80 (0.74-0.85) and 0.68 (0.61-0.74). This resulted in a pooled diagnostic odds ratios of 20 (95%CI, 12-34), 24 (13- 43), 22 (13-35) and 9 (7-11). Significant differences in specificity and diagnostic odds ratios were noted when comparing AC (including CTAC, RAC and all AC) vs. NAC. Conclusion: The results from this study suggested that attenuation correction should be applied to myocardial perfusion imaging to improve the diagnosis of CAD, especially the specificity.