Hara Junko, Ishii Shiro, Tanabe Hayato, Yamakuni Ryo, Suenaga Hiroki, Kono Teruyuki, Kuroiwa Daichi, Sekino Hirofumi, Shimabukuro Michio, Ito Hiroshi
From the Department of Radiology and Nuclear Medicine, Fukushima Medical University.
Department of Diabetes, Endocrinology and Metabolism School of Medicine, Fukushima Medical University, Fukushima City, Japan.
J Comput Assist Tomogr. 2024;48(6):882-888. doi: 10.1097/RCT.0000000000001625. Epub 2024 May 2.
The aim of the study is to reveal the respiratory displacement of the right adrenal vein (RAV) to predict the exact location of the RAV during adrenal venous sampling (AVS).
Computed tomography (CT) scans obtained 45 seconds (breath-hold at inhalation) and 70 seconds (breath-hold at exhalation) after contrast material injection were compared to venograms of the RAV of patients with primary aldosteronism who underwent AVS between January 2016 and December 2020. The craniocaudal distance between the center of the Th11/12 disc and the RAV orifice was measured; the craniocaudal location of the RAV orifice was also specified relative to vertebral bodies and intervertebral discs on inspiratory phase CT (In-CT), expiratory phase CT (Ex-CT), and catheter venography. The transverse and vertical angles of the RAV and the position of the RAV orifice on the inferior vena cava (IVC) circumference were measured on In-CT and Ex-CT.
In total, 51 patients (30 males, 21 females; mean age, 54.9 ± 11.1 years) were included. Craniocaudal distances between the center of the Th11/12 disc and RAV orifice were significantly different among the following 3 acquisitions: catheter venography versus In-CT (15.2 ± 8.4 mm); venography versus Ex-CT (5.6 ± 4.1 mm); and In-CT versus Ex-CT (19.6 ± 8.0 mm) (all, P < 0.001). The craniocaudal location of the RAV orifice on venography was significantly closer to that on Ex-CT than on In-CT ( P < 0.001); measurements using venograms compared with In-CT and Ex-CT scans were within 1 level difference in 18 (35.3%) and 47 (92.2%) patients, respectively ( P < 0.001). The vertical angle of the RAV was significantly more likely to be smaller on In-CT than on Ex-CT ( P < 0.001).
RAV locations and angles change with respiratory motion. It is crucial to consider the respiratory phase of CT because it can enable a more accurate prediction of the location of the RAV during AVS.
本研究旨在揭示右肾上腺静脉（RAV）的呼吸位移，以预测肾上腺静脉采样（AVS）期间RAV的准确位置。
将2016年1月至2020年12月期间接受AVS的原发性醛固酮增多症患者在注射造影剂后45秒（吸气屏气）和70秒（呼气屏气）获得的计算机断层扫描（CT）与RAV静脉造影进行比较。测量第11/12胸椎间盘中心与RAV开口之间的头尾距离；还在吸气期CT（In-CT）、呼气期CT（Ex-CT）和导管静脉造影上相对于椎体和椎间盘确定RAV开口的头尾位置。在In-CT和Ex-CT上测量RAV的横向和垂直角度以及RAV开口在下腔静脉（IVC）圆周上的位置。
共纳入51例患者（男性30例，女性21例；平均年龄54.9±11.1岁）。在以下3种采集方式中，第11/12胸椎间盘中心与RAV开口之间的头尾距离存在显著差异：导管静脉造影与In-CT（15.2±8.4mm）；静脉造影与Ex-CT（5.6±4.1mm）；以及In-CT与Ex-CT（19.6±8.0mm）（均P<0.001）。静脉造影上RAV开口的头尾位置比In-CT上更接近Ex-CT上的位置（P<0.001）；与In-CT和Ex-CT扫描相比，使用静脉造影测量时，分别有18例（35.3%）和47例（92.2%）患者的测量结果在1个水平差异以内（P<0.001）。In-CT上RAV的垂直角度明显比Ex-CT上更小（P<0.001）。
RAV的位置和角度随呼吸运动而变化。考虑CT的呼吸期至关重要，因为它能够在AVS期间更准确地预测RAV的位置。
