Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
Eur Radiol. 2017 Dec;27(12):5006-5014. doi: 10.1007/s00330-017-4930-9. Epub 2017 Jul 4.
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.
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 (cortisol/cortisol) of ≥ 2.0 bilaterally.
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).
QCA might be superior to C-arm CT for improving the performance of AVS.
• 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.
比较无促肾上腺皮质激素刺激下现场快速皮质醇测定（QCA）和 C 臂计算机断层扫描（CT）辅助肾上腺静脉采样（AVS）的性能。
我院机构审查委员会批准了这项回顾性研究，共纳入 178 例原发性醛固酮增多症患者。在 AVS 期间，我们于 2012 年 5 月至 2015 年 6 月使用 C 臂 CT 确认右侧肾上腺插管（n = 100），并于 2015 年 7 月至 2016 年 9 月使用 QCA 进行双侧肾上腺插管（n = 78）。双侧成功 AVS 需要选择性指数（皮质醇/皮质醇）≥2.0。
C 臂 CT 辅助 AVS 的总体成功率为 87%，在 QCA 下增加至 97.4%（P =.013）。手术时间（C 臂 CT，49.5 ± 21.3 min；QCA，37.5 ± 15.6 min；P <.001）和辐射剂量（C 臂 CT，673.9 ± 613.8 mGy；QCA，346.4 ± 387.8 mGy；P <.001）也有所改善。C 臂 CT 和 QCA 的再采样率分别为 16%和 21.8%。在研究期间，执行放射科医生的初始成功率保持稳定（C 臂 CT 为 75%；QCA 为 82.1%，P =.259）。
QCA 可能优于 C 臂 CT，可提高 AVS 的性能。
AVS 是一项技术挑战性的程序。
C 臂 CT 和快速皮质醇测定（QCA）可有效地辅助 AVS。
QCA 在增强 AVS 性能方面可能优于 C 臂 CT。
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