Daunt Nicholas
X-Ray Department, Greenslopes Private Hospital, Newdegate Street, Greenslopes, Queensland 4120, Australia.
Radiographics. 2005 Oct;25 Suppl 1:S143-58. doi: 10.1148/rg.25si055514.
Adrenal vein sampling has a reputation as a difficult procedure. However, it is being performed more frequently at some institutions due to the realization that primary aldosteronism is more common than previously believed. At the author's institution, adrenal vein sampling with computed tomographic (CT) and laboratory correlation has been performed more than 800 times in the past 10 years. Adrenal vein sampling is used to determine whether autonomous hormone production is unilateral or bilateral; unilateral secretion can be treated with surgery. The venous drainage of each adrenal gland is predominantly via a central vein. Recognition of the right adrenal vein is the crux of adrenal vein sampling. CT is useful in planning adrenal vein sampling by demonstrating the anatomy and positions of the adrenal veins. A small amount of contrast material is injected gently and slowly into the adrenal vein; it is not necessary to perform formal venography to outline the entire gland. To confirm that the vein is draining the majority of adrenal cortical blood, the adrenal vein sample should have a significantly higher level of cortisol than a peripheral sample. Adrenal glands that are producing aldosterone demonstrate an aldosterone-cortisol ratio that is higher than the peripheral value.
肾上腺静脉采血术素有操作难度大的名声。然而，由于认识到原发性醛固酮增多症比之前认为的更为常见，在一些机构该操作的执行频率正越来越高。在作者所在的机构，过去10年里已进行了800多次结合计算机断层扫描（CT）及实验室相关性的肾上腺静脉采血。肾上腺静脉采血用于确定自主性激素分泌是单侧还是双侧；单侧分泌可通过手术治疗。每个肾上腺的静脉引流主要通过一条中央静脉。识别右肾上腺静脉是肾上腺静脉采血的关键。CT通过显示肾上腺静脉的解剖结构和位置，有助于规划肾上腺静脉采血。将少量造影剂缓慢轻柔地注入肾上腺静脉；无需进行正式的静脉造影来勾勒整个腺体。为确认该静脉引流了大部分肾上腺皮质血液，肾上腺静脉样本的皮质醇水平应显著高于外周样本。分泌醛固酮的肾上腺显示出醛固酮与皮质醇的比值高于外周值。
