Adrenal venous sampling in primary hyperaldosteronism: correlation of hormone indices and collimated C-arm CT findings

Abstract

Purpose To evaluate the feasibility and effect of an approach to adrenal venous sampling (AVS) analysis by combining established selective cortisol and aldosterone indices with the acquisition of a collimated C-arm CT(CACTColl). Methods Overall, 107 consecutive patients (45f,62 m; 54 ± 10 years) undergoing 111 AVS procedures without hormonal stimulation from 7/13 to 2/20 in a single institution were retrospectively analysed. Hormone levels were measured in sequential samples of the suspected adrenal veins and right iliac vein, and selectivity indices (SI) computed. Stand-alone SICortisol and/or SIAldosterone ≥ 2.0 as well as SICortisol and/or SIAldosterone ≥ 1.1 combined with positive right-sided CACTColl of the adrenals (n = 80; opacified right adrenal vein) were defined as a successful AVS procedure. Radiation exposure of CACT was measured via dose area product (DAP) and weighed against an age-/weight-matched cohort (n = 66). Results Preliminary success rates (SICortisol and/or SIAldosterone ≥ 2.0) were 99.1% (left) and 72.1% (right). These could be significantly increased to a 90.1% success rate on the right, by combining an adjusted SI of 1.1 with a positive CACTColl proving the correct sampling position. Sensitivity for stand-alone collimated CACT (CACTColl) was 0.93, with 74/80 acquired CACTColl confirming selective cannulation by adrenal vein enhancement. Mean DAPColl_CACT measured 2414 ± 958 μGyxm2, while mean DAPFull-FOV_CACT in the matched cohort measured 8766 ± 1956 μGyxm2 (p < 0.001). Conclusion Collimated CACT in AVS procedures is feasible and leads to a significant increase in success rates of (right-sided) selective cannulation and may in combination with adapted hormone indices, offer a successful alternative to previously published AVS analysis algorithms with lower radiation exposure compared to a full-FOV CACT.

Cone-beam computed tomography is not a mandatory procedure in adrenal venous sampling for primary hyperaldosteronism

“…The value of CBCT during AVS has long been investigated, and most studies have suggested that CBCT is a useful tool for identifying RAV, thereby improving the success rate of AVS [11][12][13][14][15][16][17]. However, the present study showed contrasting results, in which a similar success rate was noted in patients with or without the assistance of CBCT (88.4% vs. 82.3%, P = 0.347).…”

“…The main difficulty associated with AVS is the cannulation of the right adrenal vein (RAV), as it is often short and exhibits several anatomical variations [8][9][10]. In previous studies, cone-beam computed tomography (CBCT) was used, which may improve the overall success rate of AVS [11][12][13][14][15][16][17]. However, CBCT is a time-consuming procedure that requires additional radiation exposure.…”

Adrenal Vein Sampling: Does the Location of the Non-adrenal Venous Sample Matter?

“…In our institution, cortisol levels from the IVC have been utilised routinely for the SI calculation. Published studies using iliac venous samples, as a surrogate for a peripheral one, are limited [ 27 , 28 ]. Whilst the small difference in cortisol levels between the IVC and REIV samples had no impact on the outcomes, the use of a more peripheral sample (e.g.…”