Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.
Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany.
Rofo. 2021 Dec;193(12):1392-1402. doi: 10.1055/a-1535-2566. Epub 2021 Aug 12.
To determine radiation exposure associated with adrenal vein sampling and its reduction by implementing the rapid cortisol assay and modification of the sampling protocol.
A single-center retrospective study of adrenal vein sampling performed between August 2009 and March 2020 revealed data from 151 procedures. Three subgroups were determined. In group I, a sampling protocol including sampling from the renal veins without the rapid cortisol assay was applied. In group II, blood was sampled using the same protocol but applying the rapid cortisol assay. In group III, a modified sampling protocol was used, in which the additional sampling from the renal veins was dispensed with, while the rapid cortisol assay was retained. Primary endpoints were radiation exposure parameters with dose area product, fluoroscopy time, and effective dose. As secondary endpoints, procedural data including technical success, lateralization, the correlation between patient BMI and radiation exposure, and concordance of lateralization with cross-sectional imaging were investigated. Furthermore, the correlation of aldosterone-cortisol ratios between the adrenal and ipsilateral renal vein was calculated to assess the benefit of sampling from the renal veins.
For all procedures performed in the study collective, the median dose area product was 60.01 Gycm (5.71-789.31), the median fluoroscopy time was 14.90 min (3.27-80.90), and the calculated median effective dose was 12.60 mSv (1.20-165.76). Significant differences in radiation exposure parameters between the study subgroups could be revealed. Dose area product resulted in reductions of 57.94 % after implementation of the rapid cortisol assay and a further 40.44 % after revision of the sampling protocol. Fluoroscopy time was reduced by 40.48 % after integration of the rapid cortisol assay and a further 40.47 % after protocol refinement. Radiation doses were increased in cases of resampling (dose area product 51.31 vs. 118.11 Gycm, fluoroscopy time of 12.48 vs. 28.70 min). A strong correlation between patient BMI and procedural dose area product could be found. After the introduction of the rapid cortisol assay, successive improvement of the technical success rate could be found (33.33 % in group I, 90.22 % in group II and 92.11 % in group III). The correlation of aldosterone-cortisol ratios between adrenal and renal veins was poor.
The introduction of the rapid cortisol assay significantly decreased the radiation exposure and increased the technical success rate. Renal vein sampling did not provide further benefit in the evaluation of primary aldosteronism subtype and its omission resulted in a further reduction of radiation dose.
· The rapid cortisol assay significantly reduces the procedure-related radiation dose in adrenal vein sampling and increases the procedural technical success.. · Since additional sampling from the renal veins offers no further diagnostic benefit, a refinement of the sampling protocol can enable a further reduction of radiation dose.. · Resampling, technical unsuccessful procedures, and higher patients' BMI are associated with higher radiation exposures..
· Augustin A, Dalla Torre G, Fuss CT et al. Reduction of Radiation Exposure in Adrenal Vein Sampling: Impact of the Rapid Cortisol Assay. Fortschr Röntgenstr 2021; 193: 1392 - 1402.
通过实施快速皮质醇检测和修改采样方案，确定与肾上腺静脉采样相关的辐射暴露，并降低其辐射暴露。
对 2009 年 8 月至 2020 年 3 月间进行的肾上腺静脉采样的单中心回顾性研究显示了 151 例手术的数据。确定了三个亚组。在第 I 组中，应用包括从肾静脉采样但不进行快速皮质醇检测的采样方案。在第 II 组中，采用相同的方案进行采血，但采用快速皮质醇检测。在第 III 组中，采用改良的采样方案，放弃了从肾静脉的额外采样，同时保留了快速皮质醇检测。主要终点是剂量面积产物、透视时间和有效剂量的辐射暴露参数。作为次要终点，研究了包括技术成功率、侧化、患者 BMI 与辐射暴露的相关性以及侧化与横断面成像的一致性在内的手术数据。此外，还计算了肾上腺和同侧肾静脉之间醛固酮-皮质醇比值的相关性，以评估从肾静脉采样的益处。
在研究人群中进行的所有手术中，中位数剂量面积产物为 60.01 Gycm（5.71-789.31），中位数透视时间为 14.90 分钟（3.27-80.90），中位数有效剂量为 12.60 mSv（1.20-165.76）。研究亚组之间的辐射暴露参数存在显著差异。实施快速皮质醇检测后，剂量面积产物减少了 57.94%，修订采样方案后进一步减少了 40.44%。整合快速皮质醇检测后，透视时间减少了 40.48%，进一步修订方案后减少了 40.47%。在重新采样的情况下，辐射剂量增加（剂量面积产物 51.31 与 118.11 Gycm，透视时间 12.48 与 28.70 分钟）。可以发现患者 BMI 与手术剂量面积产物之间存在很强的相关性。引入快速皮质醇检测后，发现技术成功率不断提高（第 I 组为 33.33%，第 II 组为 90.22%，第 III 组为 92.11%）。肾上腺和肾静脉之间醛固酮-皮质醇比值的相关性较差。
快速皮质醇检测的引入显著降低了辐射暴露，并提高了技术成功率。肾静脉采样在评估原发性醛固酮增多症亚型方面没有进一步的益处，其省略导致辐射剂量进一步降低。
· 快速皮质醇检测可显著降低肾上腺静脉采样过程中的辐射剂量，并提高手术技术成功率。
· 由于从肾静脉额外采样没有进一步的诊断益处，因此可以改进采样方案，进一步降低辐射剂量。
· 重新采样、技术不成功的手术和较高的患者 BMI 与较高的辐射暴露相关。
