Abstract
Purpose
We assessed whether image registration of cone-beam computed tomography (CT) (CBCT) and contrast-enhanced CT (CE-CT) images indicating the locations of the adrenal veins can aid in increasing the success rate of first-attempts adrenal vein sampling (AVS) and therefore decreasing patient radiation dose.
Materials and Methods
CBCT scans were acquired in the interventional suite (Philips Allura Xper FD20) and rigidly registered to the vertebra in previously acquired CE-CT. Adrenal vein locations were marked on the CT image and superimposed with live fluoroscopy and digital-subtraction angiography (DSA) to guide the AVS. Seventeen first attempts at AVS were performed with image registration and retrospectively compared with 15 first attempts without image registration performed earlier by the same 2 interventional radiologists. First-attempt AVS was considered successful when both adrenal vein samples showed representative cortisol levels. Sampling time, dose-area product (DAP), number of DSA runs, fluoroscopy time, and skin dose were recorded.
Results
Without image registration, the first attempt at sampling was successful in 8 of 15 procedures indicating a success rate of 53.3 %. This increased to 76.5 % (13 of 17) by adding CBCT and CE-CT image registration to AVS procedures (p = 0.266). DAP values (p = 0.001) and DSA runs (p = 0.026) decreased significantly by adding image registration guidance. Sampling and fluoroscopy times and skin dose showed no significant changes.
Conclusion
Guidance based on registration of CBCT and previously acquired diagnostic CE-CT can aid in enhancing localization of the adrenal veins thereby increasing the success rate of first-attempt AVS with a significant decrease in the number of used DSA runs and, consequently, radiation dose required.
References
Kempers MJ, Lenders JW, van Outheusden L et al (2009) Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med 151(5):329–337
Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA (2004) Role for adrenal venous sampling in primary aldosteronism. Surgery 136(6):1227–1235
Magill SB, Raff H, Shaker JL et al (2001) Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab 86(3):1066–1071
Young WF Jr, Stanson AW, Grant CS, Thompson GB, van Heerden JA (1996) Primary aldosteronism: adrenal venous sampling. Surgery 120(6):913–919
Sarlon-Bartoli G, Michel N, Taieb D et al (2011) Adrenal venous sampling is crucial before an adrenalectomy whatever the adrenal-nodule size on computed tomography. J Hypertens 29(6):1196–1202
Funder JW, Carey RM, Fardella C et al (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
Vonend O, Ockenfels N, Gao X et al (2011) Adrenal venous sampling: evaluation of the German Conn’s registry. Hypertension 57(5):955–990
Sacks BA, Brook OR, Brennan IM (2013) Adrenal venous sampling: promises and pitfalls. Curr Opin Endocrinol Diabetes Obes 20(3):180–185
Lau JH, Sze WC, Reznek RH et al (2012) A prospective evaluation of postural stimulation testing, computed tomography and adrenal vein sampling in the differential diagnosis of primary aldosteronism. Clin Endocrinol 76(2):182–188
White ML, Gauger PG, Doherty GM et al (2008) The role of radiologic studies in the evaluation and management of primary hyperaldosteronism. Surgery 144(6):926–933
Harvey A, Kline G, Pasieka JL (2006) Adrenal venous sampling in primary hyperaldosteronism: comparison of radiographic with biochemical success and the clinical decision-making with “less than ideal” testing. Surgery 140(6):847–853
Matsuura T, Takase K, Ota H et al (2008) Radiologic anatomy of the right adrenal vein: preliminary experience with MDCT. AJR Am J Roentgenol 191(2):402–408
Mengozzi G, Rossato D, Bertello C et al (2007) Rapid cortisol assay during adrenal vein sampling in patients with primary aldosteronism. Clin Chem 53(11):1968–1971
Auchus RJ, Michaelis C, Wians FH Jr et al (2009) Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism. Ann Surg 249(2):318–321
Betz MJ, Degenhart C, Fischer E et al (2011) Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates. Eur J Endocrinol 165(2):301–306
Georgiades CS, Hong K, Geschwind JF et al (2007) Adjunctive use of C-arm CT may eliminate technical failure in adrenal vein sampling. J Vasc Interv Radiol 18(9):1102–1105
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
Kahn SL, Angle JF (2010) Adrenal vein sampling. Tech Vasc Interv Radiol 13(2):110–125
Daunt N (2005) Adrenal vein sampling: how to make it quick, easy, and successful. Radiographics 25(Suppl 1):S143–S158
Doppman JL, Gill JR Jr (1996) Hyperaldosteronism: sampling the adrenal veins. Radiology 198(2):309–312
Orth RC, Wallace MJ, Kuo MD (2008) C-arm cone-beam CT: general principles and technical considerations for use in interventional radiology. J Vasc Interv Radiol 19(6):814–820
Conflict of interest
The authors declare that they have no conflicts of interest.
Statement of informed consent
For this retrospective study formal consent is not required. Obtaining informed consent was waived by the institutional review board.
Statement of Human Rights
In this retrospective study all procedures were performed according to clinical practice. All data analyses were performed according with the ethical standards of the institutional review board.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Busser, W.M.H., Arntz, M.J., Jenniskens, S.F.M. et al. Image Registration of Cone-Beam Computer Tomography and Preprocedural Computer Tomography Aids in Localization of Adrenal Veins and Decreasing Radiation Dose in Adrenal Vein Sampling. Cardiovasc Intervent Radiol 38, 993–997 (2015). https://doi.org/10.1007/s00270-014-0969-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-014-0969-z