From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
Radiology. 2015 Dec;277(3):887-94. doi: 10.1148/radiol.2015142413. Epub 2015 May 26.
To assess the sensitivity and specificity for ratios of adrenal vein cortisol level (Ca) to peripheral vein cortisol level (Cp), adrenal vein aldosterone level (Aa) to peripheral vein aldosterone level (Ap), and combined cortisol and aldosterone levels ("combined ratio") for the detection of successful adrenal vein catheterization ("selectivity") in adrenal vein sampling (AVS) without adrenocorticotropic hormone (ACTH) injection at different cutoff values.
This retrospective study was approved by the institutional review board, and informed consent was waived. AVS was performed in 160 consecutive patients (49 women and 111 men; mean age, 53.6 years) between December 1989 and January 2014. Cortisol and aldosterone levels were measured in samples from the adrenal veins and left iliac vein every 5 minutes, two times before (basal) and three times after intravenous cosyntropin (ACTH 1-24) injection. Selectivity was defined by Ca/Cp or Aa/Ap ratio of at least 5 in at least one sampling after ACTH administration. Sensitivity and specificity for the detection of selective adrenal vein catheterization were calculated for basal Ca/Cp ratio, Aa/Ap ratio, and combined ratios for three cutoff values reported in the literature. The McNemar test was used to assess differences in sensitivity and specificity to detect selective adrenal vein catheterization.
The sensitivity and specificity for the cutoff values of at least 3, at least 2, and at least 1.1 for the detection of AVS selectivity were respectively 50.4% and 100%, 70.8% and 100%, and 98.5% and 76.9% for Ca/Cp ratio; 61.3% and 100%, 70.8% and 100%, and 94.2% and 53.8% for Aa/Ap ratio; and 75.2% and 100%, 88.3% and 100%, and 99.3% and 46.2% for combined ratios (sensitivity at the ≥2 cutoff value: P < .0001 for combined ratio vs Ca/Cp ratio and for combined ratio vs Aa/Ap ratio).
Basal combined ratio has the best sensitivity for the detection of AVS selectivity at all cutoff values, and for all ratios, the cutoff value of at least 2 has the best sensitivity for 100% specificity.
评估在不使用促肾上腺皮质激素（ACTH）注射的情况下，不同临界值下肾上腺静脉皮质醇水平（Ca）与外周静脉皮质醇水平（Cp）、肾上腺静脉醛固酮水平（Aa）与外周静脉醛固酮水平（Ap）比值以及皮质醇和醛固酮联合比值（“联合比值”）用于检测肾上腺静脉采样（AVS）中成功的肾上腺静脉插管（“选择性”）的灵敏度和特异性。
这项回顾性研究得到了机构审查委员会的批准，并豁免了知情同意。1989 年 12 月至 2014 年 1 月，对 160 例连续患者（49 名女性和 111 名男性；平均年龄 53.6 岁）进行了 AVS。在 ACTH 1-24 静脉注射前和后两次，每 5 分钟从肾上腺静脉和左髂静脉采集样本，测量皮质醇和醛固酮水平。在 ACTH 给药后至少有一次采样中，Ca/Cp 或 Aa/Ap 比值至少为 5，则定义为选择性。对于文献中报道的三个临界值，计算基础 Ca/Cp 比值、Aa/Ap 比值和联合比值对检测选择性肾上腺静脉插管的灵敏度和特异性。采用 McNemar 检验评估检测选择性肾上腺静脉插管的灵敏度和特异性差异。
对于检测 AVS 选择性的至少 3、至少 2 和至少 1.1 的临界值，Ca/Cp 比值的灵敏度和特异性分别为 50.4%和 100%、70.8%和 100%以及 98.5%和 76.9%；Aa/Ap 比值分别为 61.3%和 100%、70.8%和 100%以及 94.2%和 53.8%；联合比值分别为 75.2%和 100%、88.3%和 100%以及 99.3%和 46.2%（在≥2 临界值时，Ca/Cp 比值和 Aa/Ap 比值与联合比值的灵敏度比较，P<0.0001）。
基础联合比值在所有临界值下均具有最佳的检测 AVS 选择性的灵敏度，对于所有比值，至少 2 的临界值具有最佳的 100%特异性的灵敏度。
