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Non-stimulated adrenal venous sampling using Dyna computed tomography in patients with primary aldosteronism

View Article: PubMed Central - PubMed

ABSTRACT

In this retrospective study, we aimed to examine the effect of applying Dyna computed tomography (CT) on the success rate of adrenal venous sampling (AVS) without adrenocorticotropic hormone stimulation. A total of 100 consecutive patients with primary aldosteronism who underwent AVS between May 2012 and July 2015 were enrolled. In all the cases, Dyna CT was used in AVS to validate catheter position in the right adrenal vein. A selectivity index (cortisoladrenal vein /cortisolinferior vena cava) of ≥2.0 of both adrenal veins were required for successful AVS. Dyna CT indicated misplaced catheters in 16 patients; of these patients, 75% (12/16) eventually had successful right AVS after catheter repositioning. The success rate of initial sampling at the right adrenal vein was 76% (76/100), which increased to 88% (88/100) after Dyna CT was applied (p < 0.001). The most common inadvertently catheterised vessels detected using Dyna CT were the accessory hepatic veins (56.3%, 9/16), followed by the renal capsular veins (37.5%, 6/16). The overall success rate of non-stimulated AVS using Dyna CT was 87% (87/100). Thus, the application of Dyna CT further increased the success rate of non-stimulated AVS.

No MeSH data available.


Related in: MedlinePlus

A 60-year-old man with primary aldosteronism (PA) and a right adrenal nodule.The right adrenal gland was opacified on a maximum intensity projection image on Dyna computed tomography in the transverse plane (a) and coronal plane (b). Adrenal venous sampling was successful and the lateralisation examination indicated bilateral PA.
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f1: A 60-year-old man with primary aldosteronism (PA) and a right adrenal nodule.The right adrenal gland was opacified on a maximum intensity projection image on Dyna computed tomography in the transverse plane (a) and coronal plane (b). Adrenal venous sampling was successful and the lateralisation examination indicated bilateral PA.

Mentions: Dyna CT images were processed and interpreted on a Siemens workstation on site (Advantage workstation, Siemens, Erlangen, Germany). Three-dimensional multiplanar reconstructed images were used to verify right adrenal venous catheterisation, with free-adjustment of the window level, window centre, and magnification, as needed (Fig. 1). If the right adrenal vein was not opacified, the misplaced catheters were repositioned. To avoid excessive radiation exposure, Dyna CT was generally not repeated after catheter repositioning, and the position of the catheter was confirmed via venography. However, in cases with undetermined Dyna CT findings such as opacification of renal or adrenal capsular vein, repeated Dyna CT was performed at the radiologist’s discretion.


Non-stimulated adrenal venous sampling using Dyna computed tomography in patients with primary aldosteronism
A 60-year-old man with primary aldosteronism (PA) and a right adrenal nodule.The right adrenal gland was opacified on a maximum intensity projection image on Dyna computed tomography in the transverse plane (a) and coronal plane (b). Adrenal venous sampling was successful and the lateralisation examination indicated bilateral PA.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120298&req=5

f1: A 60-year-old man with primary aldosteronism (PA) and a right adrenal nodule.The right adrenal gland was opacified on a maximum intensity projection image on Dyna computed tomography in the transverse plane (a) and coronal plane (b). Adrenal venous sampling was successful and the lateralisation examination indicated bilateral PA.
Mentions: Dyna CT images were processed and interpreted on a Siemens workstation on site (Advantage workstation, Siemens, Erlangen, Germany). Three-dimensional multiplanar reconstructed images were used to verify right adrenal venous catheterisation, with free-adjustment of the window level, window centre, and magnification, as needed (Fig. 1). If the right adrenal vein was not opacified, the misplaced catheters were repositioned. To avoid excessive radiation exposure, Dyna CT was generally not repeated after catheter repositioning, and the position of the catheter was confirmed via venography. However, in cases with undetermined Dyna CT findings such as opacification of renal or adrenal capsular vein, repeated Dyna CT was performed at the radiologist’s discretion.

View Article: PubMed Central - PubMed

ABSTRACT

In this retrospective study, we aimed to examine the effect of applying Dyna computed tomography (CT) on the success rate of adrenal venous sampling (AVS) without adrenocorticotropic hormone stimulation. A total of 100 consecutive patients with primary aldosteronism who underwent AVS between May 2012 and July 2015 were enrolled. In all the cases, Dyna CT was used in AVS to validate catheter position in the right adrenal vein. A selectivity index (cortisoladrenal vein /cortisolinferior vena cava) of ≥2.0 of both adrenal veins were required for successful AVS. Dyna CT indicated misplaced catheters in 16 patients; of these patients, 75% (12/16) eventually had successful right AVS after catheter repositioning. The success rate of initial sampling at the right adrenal vein was 76% (76/100), which increased to 88% (88/100) after Dyna CT was applied (p < 0.001). The most common inadvertently catheterised vessels detected using Dyna CT were the accessory hepatic veins (56.3%, 9/16), followed by the renal capsular veins (37.5%, 6/16). The overall success rate of non-stimulated AVS using Dyna CT was 87% (87/100). Thus, the application of Dyna CT further increased the success rate of non-stimulated AVS.

No MeSH data available.


Related in: MedlinePlus