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

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

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.

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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

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Author notes

    Authors and Affiliations

    1. Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung-Shan South Road, Taipei, 100, Taiwan

      Chin-Chen Chang, Bo-Ching Lee, Yeun-Chung Chang & Kao-Lang Liu

    2. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung-Shan South Road, Taipei, 100, Taiwan

      Vin-Cent Wu

    3. Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung-Shan South Road, Taipei, 100, Taiwan

      Kuo-How Huang

    Authors
    1. Chin-Chen Chang
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    2. Bo-Ching Lee
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    3. Yeun-Chung Chang
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    on behalf of the TAIPAI Study Group

    Corresponding author

    Correspondence to Kao-Lang Liu.

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    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

    Additional information

    Chin-Chen Chang and Bo-Ching Lee contributed equally to this work.

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    Cite this article

    Chang, CC., Lee, BC., Chang, YC. et al. Comparison of C-arm computed tomography and on-site quick cortisol assay for adrenal venous sampling: A retrospective study of 178 patients. Eur Radiol 27, 5006–5014 (2017). https://doi.org/10.1007/s00330-017-4930-9

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    • DOI: https://doi.org/10.1007/s00330-017-4930-9

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