Impact of cone beam - CT on adrenal vein sampling in primary aldosteronism

Arcis, Elise; Delchier, Marie-Charlotte; Mokrane, Fatima-Zohra; Darcourt, Jean; Rousseau, Hervé; Bouhanick, Béatrice

doi:10.1016/j.ejrad.2019.108792

Cited by 19 publications

(10 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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).…”

Section: Discussionmentioning

confidence: 52%

“…The main di culty 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.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cone-beam Computed Tomography is Not a Mandatory Procedure in Adrenal Venous Sampling for Primary Hyperaldosteronism

Cai

2022

Preprint

View full text Add to dashboard Cite

Objectives: To investigate the necessity of cone-beam computed tomography (CBCT) in adrenal venous sampling (AVS).Methods: This retrospective study included 120 consecutive patients with primary hyperaldosteronism who underwent AVS. Based on the learning curve of the interventional radiologists, the patients were divided into the learning (n=36) and proficiency (n=84) groups chronologically. Based on the imaging pattern of the right adrenal vein (RAV), the patients were divided into the typical (n=36) and atypical (n=84) groups. The success rate, radiation dose, and sampling time were compared among the entire study population and each subgroup.Results: A total of 69 patients underwent CBCT, whereas 51 patients did not. The overall success rate was 85.8%, and no difference was noted between patients with and without CBCT (P=0.347). However, radiation dose (P=0.018) and sampling time (P=0.001) were significantly higher in patients who underwent CBCT than in patients who did not. In learning group, CBCT improved success rate from 62.5% to 96.4% (P=0.028), whereas it was not found in the proficiency group (P=0.693). Additionally, success rate in patients with an atypical RAV imaging pattern was significantly higher when CBCT was used than when it was not used (P=0.041), whereas no difference was noted in patients with typical RAV imaging pattern (P=0.511).Conclusion: For physicians not very experienced doing AVS, there is a clear significant improvement in success rate when CBCT is used. However, CBCT only has minimal benefit for experienced operators, meanwhile CBCT may take an extra time and increase the radiation dose during AVS.

show abstract

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Cone-beam Computed Tomography is Not a Mandatory Procedure in Adrenal Venous Sampling for Primary Hyperaldosteronism

Cai

2022

Preprint

View full text Add to dashboard Cite

show abstract

“…In our clinic the median fluoroscopy time and radiation exposure is 16 minutes and less than 4 mSv due to the native, standardized implementation in the lower range of the literature values (fluoroscopy times 16-27 min; effective dose 3.2-29 mSv) [38]. Some authors recommend performing a cone beam CT for easier probing of the adrenal veins, which, however, increases radiation exposure [44,45]. Significantly lower dose exposure can be achieved by means of pulsed fluoroscopy, which is particularly important in view of the sometimes younger patients.…”

Section: Discussionmentioning

confidence: 97%

“…Die mediane Durchleuchtungszeit und Strahlenexposition in unserer Klinik liegt mit 16 Minuten und unter 4 mSv aufgrund der nativen, standardisierten Durchführung im unteren Bereich der Literaturwerte (Durchleuchtungszeiten 16-27min; effektive Dosis 3,2-29 mSv) [38]. Einige Autoren empfehlen die Durchführung einer Cone-Beam-CT zur leichteren Sondierung der Nebennierenvenen, was jedoch die Strahlenexposition erhöht [44,45]. Mittels gepulster Durchleuchtung können deutlich niedrigere Dosisexpositionen erreicht werden, was insbesondere vor dem Hintergrund der teils jüngeren Patienten wichtig ist.…”

Section: Diskussionunclassified

Update: Selective adrenal venous sampling (AVS) – Indication, technique, and significance

Loberg

Antoch

Stegbauer

et al. 2020

Rofo

View full text Add to dashboard Cite

Background Primary aldosteronism (PA) is the most common detectable cause of secondary hypertension. The majority of patients have either an adrenal aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH) demanding different therapeutic approaches. Screening tests and imaging cannot reliably distinguish between a unilateral or bilateral PA. Methods This review article gives an overview concerning etiology, diagnostics, and therapeutic options of PA, and reviews the indication, the technique, and relevance of selective adrenal venous sampling (AVS) in the context of the current literature and the authors’ experience. Results AVS can verify or exclude a unilaterally dominated secretion with a high success rate. Patients with PA and a unilateral APA can be treated curatively by adrenalectomy. Conclusions AVS is an established diagnostic examination for differentiation of unilateral from bilateral adrenal disease in patients with PA. Key Points: Citation Format

show abstract

“…Using multi-detector CT (MDCT) with 3-dimensional reconstruction may reduce operation time and the quantity of contrast required and improve the success rate of catheterization. Previous studies have suggested that using Dyna CT, cone-beam CT during AVS could improve successful cannulation of the adrenal vein (25)(26)(27). Another study suggested that a 70-kilovoltage-peak (kVp) contrastenhanced CT scan may provide better visualization and identification of the right adrenal vein (8).…”

Section: Correct Right Adrenal Vein Catheterizationmentioning

confidence: 99%

Recent Advances in the Clinical Application of Adrenal Vein Sampling

Zhong

Zhang

et al. 2022

Front. Endocrinol.

View full text Add to dashboard Cite

We reviewed clinical research investigating the applications of adrenal vein sampling (AVS). AVS could be applied not only to primary aldosteronism (PA) but also to other endocrine diseases, such as adrenocorticotropic hormone (ACTH) independent Cushing syndrome (AICS) and hyperandrogenemia (HA). However, the AVS protocol requires improvements to increase its success rate. Using the computed tomography image fusion, coaxial guidewire technique, and fast intraprocedural cortisol testing (CCF) technique could improve the success rate of catheterization in AVS for PA. ACTH loading could be considered in medical centers with a low selectivity of AVS for PA but is not essential in those with mature AVS technology. The continuous infusion method should be recommended for ACTH stimulation in AVS for PA to reduce adverse events. AVS has not been routinely recommended before management decisions in AICS, but several studies verified that AVS was useful in finding out the source of excess cortisol, especially for distinguishing unilateral from bilateral disease. However, it is necessary to reassess the results of AVS in AICS with the use of reference hormones to fully normalize cortisol levels. In addition, it is essential to determine the optimal model that combines AVS results and mass size to guide the selection of surgical plans, including identifying the dominant gland and presenting the option of staged adrenalectomy, to minimize the impact of bilateral resection. For HA, AVS combined with ovarian intravenous sampling to locate excess androgens could be considered when imaging results are equivocal.

show abstract

Impact of cone beam - CT on adrenal vein sampling in primary aldosteronism

Cited by 19 publications

References 28 publications

Cone-beam Computed Tomography is Not a Mandatory Procedure in Adrenal Venous Sampling for Primary Hyperaldosteronism

Cone-beam Computed Tomography is Not a Mandatory Procedure in Adrenal Venous Sampling for Primary Hyperaldosteronism

Update: Selective adrenal venous sampling (AVS) – Indication, technique, and significance

Recent Advances in the Clinical Application of Adrenal Vein Sampling

Contact Info

Product

Resources

About