Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University, Shizuoka, Japan.
Br J Radiol. 2020 May 1;93(1109):20190636. doi: 10.1259/bjr.20190636. Epub 2020 Feb 28.
To evaluate the utility of microcatheter in adrenal venous sampling (AVS) for assessing aldosterone hypersecretion and the laterality in patients with primary aldosteronism.
This retrospective study was approved by the institutional review board of Gifu University Hospital, and written informed consent was waived. A total of 37 consecutive patients with primary aldosteronism underwent AVS by inserting a microcatheter into the right adrenal central vein (RCV), left adrenal central vein (LCV), and left adrenal common trunk (CT) followed by AVS with 5-French (5-Fr) catheter. The diagnosis of aldosterone hypersecretion was confirmed if the plasma aldosterone level after the administration of cosyntropin injection was ≥14,000 pg/ml. The laterality of aldosterone hypersecretion was determined based on the lateralized and contralateral ratios. Aldosterone hypersecretion and the laterality were diagnosed and compared based on the results obtained using 5-Fr catheter and microcatheter.
Plasma aldosterone levels were significantly higher in the RCV, LCV, and CT selected using microcatheter than in the right and left adrenal veins (LAVs) selected using 5-Fr catheter ( < 0.0001-0.029). More aldosterone hypersecretion from the left adrenal gland was observed in the LCV ( = 28) and CT ( = 25) selected using microcatheter compared to the LAV selected using 5-Fr catheter ( = 6) ( < 0.0001). Diagnostic changes in the laterality from unilateral to bilateral were noted in 3 (8%) patients using microcatheter.
Microcatheter can effectively assess aldosterone hypersecretion and the laterality, especially in the LAV.
Especially for the left adrenal venous sampling, the tip of microcatheter could certainly reach the left adrenal vein orifice compared with 5-Fr catheter, therefore correct diagnosis is made and this leads to appropriate treatment.
评估微导管在肾上腺静脉采样（AVS）中用于评估原发性醛固酮增多症患者醛固酮分泌过多和侧化的效用。
本回顾性研究得到岐阜大学医院机构审查委员会的批准，并豁免了书面知情同意。共 37 例原发性醛固酮增多症患者接受 AVS，将微导管插入右肾上腺中央静脉（RCV）、左肾上腺中央静脉（LCV）和左肾上腺总干（CT），然后用 5-French（5-Fr）导管进行 AVS。如果注射促皮质素后血浆醛固酮水平≥14000 pg/ml，则确诊为醛固酮分泌过多。根据侧化和对侧比值确定醛固酮分泌过多的侧化。根据使用 5-Fr 导管和微导管获得的结果诊断和比较醛固酮分泌过多和侧化。
与使用 5-Fr 导管选择的右肾上腺静脉（LAV）相比，使用微导管选择的 RCV、LCV 和 CT 中的血浆醛固酮水平显著更高（<0.0001-0.029）。与使用 5-Fr 导管选择的 LAV 相比，在使用微导管选择的 LCV（=28）和 CT（=25）中观察到更多来自左肾上腺的醛固酮分泌过多（<0.0001）。3 例（8%）患者使用微导管后侧化从单侧变为双侧。
微导管可有效评估醛固酮分泌过多和侧化，特别是在 LAV。
特别是对于左肾上腺静脉采样，与 5-Fr 导管相比，微导管的尖端肯定可以到达左肾上腺静脉口，因此可以做出正确的诊断，并进行适当的治疗。
