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European Radiology

, Volume 27, Issue 12, pp 5006–5014 | Cite as

Comparison of C-arm computed tomography and on-site quick cortisol assay for adrenal venous sampling: A retrospective study of 178 patients

  • Chin-Chen Chang
  • Bo-Ching Lee
  • Yeun-Chung Chang
  • Vin-Cent Wu
  • Kuo-How Huang
  • Kao-Lang Liu
  • on behalf of the TAIPAI Study Group
Vascular-Interventional

Abstract

Objectives

To compare the performance of on-site quick cortisol assay (QCA) and C-arm computed tomography (CT) assistance on adrenal venous sampling (AVS) without adrenocorticotropic hormone stimulation.

Methods

The institutional review board at our hospital approved this retrospective study, which included 178 consecutive patients with primary aldosteronism. During AVS, we used C-arm CT to confirm right adrenal cannulation between May 2012 and June 2015 (n = 100) and QCA for bilateral adrenal cannulation between July 2015 and September 2016 (n = 78). Successful AVS required a selectivity index (cortisoladrenal vein/cortisolperipheral) of ≥ 2.0 bilaterally.

Results

The overall success rate of C-arm CT-assisted AVS was 87%, which increased to 97.4% under QCA (P = .013). The procedure time (C-arm CT, 49.5 ± 21.3 min; QCA, 37.5 ± 15.6 min; P < .001) and radiation dose (C-arm CT, 673.9 ± 613.8 mGy; QCA, 346.4 ± 387.8 mGy; P < .001) were also improved. The resampling rate was 16% and 21.8% for C-arm CT and QCA, respectively. The initial success rate of the performing radiologist remained stable during the study period (C-arm CT 75%; QCA, 82.1%, P = .259).

Conclusions

QCA might be superior to C-arm CT for improving the performance of AVS.

Key Points

• Adrenal venous sampling (AVS) is a technically challenging procedure.

• C-arm CT and quick cortisol assay (QCA) are efficient for assisting AVS.

• QCA might outperform C-arm CT in enhancing AVS performance.

Keywords

Adrenal glands/blood supply Catheterisation/methods Hyperaldosteronism/diagnosis Phlebography Humans 

Abbreviations

ACTH

Adrenocorticotropic hormone

A/C

Aldosterone/cortisol

AVS

Adrenal venous sampling

CT

Computed tomography

IPCA

Intraprocedural cortisol assay

LI

Lateralisation index

SI

Selectivity index

PA

Primary aldosteronism

QCA

Quick cortisol assay

Notes

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Kao-Lang Liu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study has received funding by the Taiwan Ministry of Science and Technology (MOST 105-2314-B-002-092).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in: Lee et al.: Evaluation of right adrenal vein anatomy by Dyna computed tomography in patients with primary aldosteronism. Sci Rep. 2016;6:28305. Chang et al.: Non-stimulated adrenal venous sampling using Dyna computed tomography in patients with primary aldosteronism. Sci Rep. 2016;6:37143.

Methodology

• retrospective

• observational

• performed at one institution

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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Chin-Chen Chang
    • 1
  • Bo-Ching Lee
    • 1
  • Yeun-Chung Chang
    • 1
  • Vin-Cent Wu
    • 2
  • Kuo-How Huang
    • 3
  • Kao-Lang Liu
    • 1
  • on behalf of the TAIPAI Study Group
  1. 1.Department of Medical ImagingNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
  2. 2.Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
  3. 3.Department of UrologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan

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