Satoru Morita1, Hiroshi Yamazaki2, Yasuyuki Sonoyama2, Yu Nishina2, Atsuhiro Ichihara3, Shuji Sakai2. 1. Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. i@imodey.com. 2. Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. 3. Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Abstract
PURPOSE: To establish technical success rates and safety of adrenal venous sampling (AVS) performed by non-experts with reference to CT images. MATERIALS AND METHODS: 104 AVS procedures with adrenocorticotropic hormone stimulation were performed for patients with suspected primary aldosteronism. One of three radiology residents with 2nd, 5th, and 5th grade experience undertook the procedure under the guidance of an experienced, board-certified interventional radiologist with reference to contrast-enhanced CT images obtained in 102 cases. Successful catheterization of the adrenal veins was assessed using three criteria: an adrenal venous cortisol concentration of more than 200 μg/dL (criterion A); an adrenal vein/inferior vena cava cortisol ratio of more than 5:1 (criterion B); and an adrenal vein/inferior vena cava cortisol ratio of more than 10:1 (criterion C). RESULTS: The operators were aware of the anatomy of the left adrenal veins in 102 cases (98 %) and of the right adrenal veins in 99 cases (95 %) prior to the procedure. CT identified the correct position of the right adrenal vein orifice in 82 of 99 cases (83 %). The overall technical success rates for AVS from the right adrenal vein according to criteria A, B, and C, were 96, 96, and 94 %, respectively. Those for the left adrenal vein were 97, 98, and 94 %, respectively. No significant differences in success rates were observed between the operators (p = 0.922-0.984). No major complications, including adrenal vein rupture, were observed. CONCLUSIONS: When CT images are used to guide AVS, the procedure can be performed successfully and safely even by non-experts.
PURPOSE: To establish technical success rates and safety of adrenal venous sampling (AVS) performed by non-experts with reference to CT images. MATERIALS AND METHODS: 104 AVS procedures with adrenocorticotropic hormone stimulation were performed for patients with suspected primary aldosteronism. One of three radiology residents with 2nd, 5th, and 5th grade experience undertook the procedure under the guidance of an experienced, board-certified interventional radiologist with reference to contrast-enhanced CT images obtained in 102 cases. Successful catheterization of the adrenal veins was assessed using three criteria: an adrenal venous cortisol concentration of more than 200 μg/dL (criterion A); an adrenal vein/inferior vena cava cortisol ratio of more than 5:1 (criterion B); and an adrenal vein/inferior vena cava cortisol ratio of more than 10:1 (criterion C). RESULTS: The operators were aware of the anatomy of the left adrenal veins in 102 cases (98 %) and of the right adrenal veins in 99 cases (95 %) prior to the procedure. CT identified the correct position of the right adrenal vein orifice in 82 of 99 cases (83 %). The overall technical success rates for AVS from the right adrenal vein according to criteria A, B, and C, were 96, 96, and 94 %, respectively. Those for the left adrenal vein were 97, 98, and 94 %, respectively. No significant differences in success rates were observed between the operators (p = 0.922-0.984). No major complications, including adrenal vein rupture, were observed. CONCLUSIONS: When CT images are used to guide AVS, the procedure can be performed successfully and safely even by non-experts.
Authors: Min-On Tan; Troy Hai Kiat Puar; Saravana Kumar Swaminathan; Yu-Kwang Donovan Tay; Tar Choon Aw; David Yurui Lim; Haiyuan Shi; Lily Mae Quevedo Dacay; Meifen Zhang; Joan Joo Ching Khoo; Keng Sin Ng Journal: Singapore Med J Date: 2020-12-02 Impact factor: 3.331