Skip to main content
SpringerLink
Log in

Right Adrenal Venography Findings correlated with C-arm CT for Selection During C-arm CT-assisted Adrenal Vein Sampling in Primary Aldosteronism

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to evaluate retrospectively the efficacy of C-arm CT to confirm right adrenal vein catheterization during adrenal vein sampling (AVS) and to correlate adrenal venography findings with C-arm CT and/or biochemical results for right adrenal vein selection.

Methods

Forty-two consecutive primary aldosteronism patients (M:F = 21:21; age: 29–70 years) underwent C-arm CT assisted sequential AVS. After catheterization of right adrenal vein, C-arm CT was performed to confirm catheter position. Catheter was repositioned when right adrenal gland was not opacified. Radiological images, medical records, and biochemical results were reviewed for technical/biochemical success rates and complications. Right adrenal venography findings of pinnate pattern, visualization of renal capsular vein, and retroperitoneal vein other than renal capsular vein were correlated with C-arm CT and/or biochemical results for right adrenal vein selection.

Results

Both the technical and biochemical success of AVS was achieved in 40 patients (95.2 %). C-arm CT failed due to catheter instability in one, and adrenal/vena cava cortisol gradient was <3 in one patient. Catheter was repositioned in four patients (9.5 %) according to C-arm CT findings. Right adrenal venography finding of renal capsular vein significantly correlated with C-arm CT and/or biochemical results (100 %) for right adrenal vein selection (p = 0.011, χ 2 test), whereas pinnate pattern (p = 0.099) and other retroperitoneal veins (p = 0.347) did not. There was no procedure-related complication.

Conclusions

C-arm CT increases confidence of right adrenal vein catheterization during AVS. Visualization of renal capsular vein on adrenal venography suggests right adrenal vein catheterization and C-arm CT may not be required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rossi GP, Sacchetto A, Chiesura-Corona M, De Toni R, Gallina M, Feltrin GP, Pessina AC (2001) Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive patients. J Clin Endocrinol Metab 86(3):1083–1090

    Article  CAS  PubMed  Google Scholar 

  2. Doppman JL, Gill JR Jr (1996) Hyperaldosteronism: sampling the adrenal veins. Radiology 198(2):309–912

    Article  CAS  PubMed  Google Scholar 

  3. Sheaves R, Goldin J, Reznek RH, Chew SL, Dacie JE, Lowe DG, Ross RJ, Wass JA, Besser GM, Grossman AB (1996) Relative value of computed tomography scanning and venous sampling in establishing the cause of primary hyperaldosteronism. Eur J Endocrinol 134(3):308–313

    Article  CAS  PubMed  Google Scholar 

  4. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE Jr, Mantero F, Stowasser M, Young WF, Montori VM, Endocrine Society (2008) Case detection, diagnosis and treatment of patients with primary aldosteronism: an Endocrine Society Clinical Practice guideline. J Clin Endocrinol Metab 93(9):3266–3281. doi:10.1210/jc.2008-0104 Epub 2008 Jun 13

    Article  CAS  PubMed  Google Scholar 

  5. Oglevie SB, Bookstein JJ (1997) The roles of angiography in adrenal disease. In: Baum S (ed) Abrams’ angiography: vascular and interventional radiology, 4th edn. Little, Brown and Company, New York, pp 1352–1382

    Google Scholar 

  6. Daunt N (2005) Adrenal vein sampling: how to make it quick, easy and successful. Radiographics 25(Suppl 1):S143–S158

    Article  PubMed  Google Scholar 

  7. Georgiades CS, Hong K, Geschwind JF, Liddell R, Syed L, Kharlip J, Arepally A (2007) Adjunctive use of C-arm CT may eliminate technical failure in adrenal vein sampling. J Vasc Interv Radiol 18(9):1102–1105

    Article  PubMed  Google Scholar 

  8. Georgiades C, Kharlip J, Valdeig S, Wacker FK, Hong K (2009) Use of C-arm CT for improving the hit rate for selective blood sampling from adrenal veins. Radiologe 49(9):848–851. doi:10.1007/s00117-009-1865-4

    Article  CAS  PubMed  Google Scholar 

  9. Plank C, Wolf F, Langenberger H, Loewe C, Schoder M, Lammer J (2012) Adrenal venous sampling using Dyna-CT—a practical guide. Eur J Radiol 81(9):2304–2307. doi:10.1016/j.ejrad.2011.05.011 Epub 2011 May 28

    Article  PubMed  Google Scholar 

  10. Reardon MA, Angle JF, Abi-Jaoudeh N, Bruns DE, Haverstick DM, Matsumoto AH, Carey RM (2011) Intraprocedural cortisol levels in the evaluation of proper catheter placement in adrenal venous sampling. J Vasc Interv Radiol 22(11):1575–1580. doi:10.1016/j.jvir.2011.05.005 Epub 2011 Jun 22

    Article  PubMed  Google Scholar 

  11. Woods JJ, Sampson ML, Ruddel ME, Remaley AT (2000) Rapid intraoperative cortisol assay: design and utility for localizing adrenal tumors by venous sampling. Clin Biochem 33(6):501–503

    Article  CAS  PubMed  Google Scholar 

  12. Auchus RJ, Michaelis C, Wians FH Jr, Dolmatch BL, Josephs SC, Trimmer CK, Anderson ME, Nwariaku FE (2009) Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism. Ann Surg 249(2):318–321. doi:10.1097/SLA.0b013e3181961d77

    Article  PubMed  Google Scholar 

  13. Loh KC, Koay ES, Khaw MC, Emmanuel SC, Young WF Jr (2000) Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore. J Clin Endocrinol Metab 85(8):2854–2859

    CAS  PubMed  Google Scholar 

  14. Bernini G, Moretti A, Argenio G, Salvetti A (2002) Primary aldosteronism in normokalemic patients with adrenal incidentalomas. Eur J Endocrinol 146(4):523–529

    Article  CAS  PubMed  Google Scholar 

  15. Calhoun DA, Nishizaka MK, Zaman MA, Thakkar RB, Weissmann P (2002) Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension 40(6):892–896

    Article  CAS  PubMed  Google Scholar 

  16. Strauch B, Zelinka T, Hampf M, Bernhardt R, Widimsky J Jr (2003) Prevalence of primary hyperaldosteronism in the central Europe region. J Hum Hypertens 17(5):349–352

    Article  CAS  PubMed  Google Scholar 

  17. Veglio F, Morello F, Rabbia F, Leotta G, Mulatero P (2003) Recent advances in diagnosis and treatment of primary aldosteronism. Minerva Med 94(4):259–265

    CAS  PubMed  Google Scholar 

  18. Rossi GP, Seccia TM, Pessina AC (2008) Primary aldosteronism-Part I: prevalence, screening, and selection of cases for adrenal vein sampling. J Nephrol 21(4):447–454

    CAS  PubMed  Google Scholar 

  19. Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F, PAPY Study Investigators (2006) A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 48(11):2293–2300 Epub 2006 Nov 13

    Article  CAS  PubMed  Google Scholar 

  20. Gordon RD (1994) Mineralocorticoid hypertension. Lancet 344(8917):240–243

    Article  CAS  PubMed  Google Scholar 

  21. Gordon RD (1995) Primary aldosteronism. J Endocrinol Invest 18(7):495–511

    Article  CAS  PubMed  Google Scholar 

  22. Blumenfeld JD, Sealey JE, Schlussel Y, Vaughan ED Jr, Sos TA, Atlas SA, Müller FB, Acevedo R, Ulick S, Laragh JH (1994) Diagnosis and treatment of primary hyperaldosteronism. Ann Intern Med 121(11):877–885

    Article  CAS  PubMed  Google Scholar 

  23. Doppman JL, Gill JR Jr, Miller DL, Chang R, Gupta R, Friedman TC, Choyke PL, Feuerstein IM, Dwyer AJ, Jicha DL et al (1992) Distinction between hyperaldosteronism due to bilateral hyperplasia and unilateral aldosteronoma: reliability of CT. Radiology 184(3):677–682

    Article  CAS  PubMed  Google Scholar 

  24. Harper R, Ferrett CG, McKnight JA, McIlrath EM, Russell CF, Sheridan B, Atkinson AB (1999) Accuracy of CT scanning and adrenal vein sampling in the preoperative localisation of aldosterone secreting adrenal adenomas. QJM 92(11):643–650

    Article  CAS  PubMed  Google Scholar 

  25. Magill SB, Raff H, Shaker JL, Brickner RC, Knechtges TE, Kehoe ME, Findling JW (2001) Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab 86(3):1066–1071

    CAS  PubMed  Google Scholar 

  26. Kim JY, Kim SH, Lee HJ, Kim YH, Kim MJ, Cho SH (2013) Adrenal venous sampling for stratifying patients for surgery of adrenal nodules detected using dynamic contrast enhanced CT. Diagn Interv Radiol. doi:10.5152/dir.2013.13144

    PubMed  Google Scholar 

  27. Oh EM, Lee KE, Yoon K, Kim SY, Kim HC, Youn YK (2012) Value of adrenal venous sampling for lesion localization in primary aldosteronism. World J Surg 36(10):2522–2527. doi:10.1007/s00268-012-1695-9

    Article  PubMed  Google Scholar 

  28. Walters NA, Thomson KR (1993) Urogenital venography. In: Rifkin MD, Thomson K, Rickards D, Jones S (eds) Practical interventional uroradiology. Edward Arnold, Edinburgh, p 11

    Google Scholar 

  29. Rossi GP, Barisa M, Allolio B, Auchus RJ, Amar L, Cohen D, Degenhart C, Deinum J, Fischer E, Gordon R, Kickuth R, Kline G, Lacroix A, Magill S, Miotto D, Naruse M, Nishikawa T, Omura M, Pimenta E, Plouin PF, Quinkler M, Reincke M, Rossi E, Rump LC, Satoh F, Schultze Kool L, Seccia TM, Stowasser M, Tanabe A, Trerotola S, Vonend O, Widimsky J Jr, Wu KD, Wu VC, Pessina AC (2012) The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab 97(5):1606–1614. doi:10.1210/jc.2011-2830 Epub 2012 Mar 7

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

Sung Il Park, Yumie Rhee, Jung Soo Lim, Sungha Park, Sang Wook Kang, Mu Sook Lee, Myungsu Lee, Shin Jae Lee, Il Jung Kim, Do Yun Lee, and June-Sik Cho have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Sung Il Park, Shin Jae Lee, Il Jung Kim & Do Yun Lee

  2. Department of Internal Medicine and Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Yumie Rhee

  3. Department of Internal Medicine, Wonju Christian Hospital, 20, Ilsan-ro, Wonju, Gangwon-do, 220-701, Republic of Korea

    Jung Soo Lim

  4. Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Sungha Park

  5. Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Sang Wook Kang

  6. Department of Radiology, Jeju National University Hospital, Aran 13gil 15 (Ara-1 Dong), Jeju, 690-767, Republic of Korea

    Mu Sook Lee

  7. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea

    Myungsu Lee

  8. Department of Radiology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea

    June-Sik Cho

Authors
  1. Sung Il Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yumie Rhee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jung Soo Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sungha Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sang Wook Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mu Sook Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Myungsu Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shin Jae Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Il Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Do Yun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. June-Sik Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to June-Sik Cho.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Park, S.I., Rhee, Y., Lim, J.S. et al. Right Adrenal Venography Findings correlated with C-arm CT for Selection During C-arm CT-assisted Adrenal Vein Sampling in Primary Aldosteronism. Cardiovasc Intervent Radiol 37, 1469–1475 (2014). https://doi.org/10.1007/s00270-013-0820-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-013-0820-y

Keywords

Search

Navigation