Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA.
Division of Diagnostic Imaging, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA.
Abdom Radiol (NY). 2024 Jul;49(7):2401-2407. doi: 10.1007/s00261-024-04321-9. Epub 2024 May 13.
Adrenal venous sampling (AVS) is used for the diagnosis of primary hyperaldosteronism. Technical difficulties with right adrenal vein (RAV) catheterization can lead to erroneous results. Our purpose was to delineate the location of the RAV on pre-procedural CT imaging in relation to the location identified during AVS and to report on the impact of successful RAV cannulation with and without the use of intra-procedural CT scanning.
Retrospective case series including patients who underwent AVS from October 2000 to September 2022. Clinical and laboratory values were abstracted from the electronic medical record. Successful cannulation of the RAV was defined as a selectivity index > 3.
110 patients underwent 124 AVS procedures. Pre-AVS CT imaging was available for 118 AVS procedures. The RAV was identified in 61 (51.7%) CT datasets. Biochemical confirmation of successful RAV cannulation occurred in 98 (79.0%) of 124 AVS procedures. There were 52 (85.2%) procedures in which the RAV was identified on pre-AVS CT and there was biochemical confirmation of successful RAV sampling. Among these 52 procedures, the RAV was localized during AVS at the same anatomic level or within 1 vertebral body level cranial to the level identified on pre-AVS CT in 98.1% of cases. The rate of successful RAV cannulation was higher in patients who underwent intra-procedural CT (93.8% versus 63.9%), P < 0.01.
Pre-AVS and intra-procedural CT images provide an invaluable roadmap that resulted in a higher rate of accurate identification of the RAV and successful AVS procedures; in particular, search for the RAV orifice during AVS can be limited to 1 vertebral body cranial to the level identified on pre-AVS CT imaging and successful cannulation can be confidently verified with intra-procedural CT.
肾上腺静脉采样（AVS）用于原发性醛固酮增多症的诊断。右肾上腺静脉（RAV）置管的技术困难可能导致结果错误。我们的目的是在 AVS 前的 CT 成像中描绘 RAV 的位置，以及报告在没有和有术中 CT 扫描的情况下成功置管对 RAV 的影响。
回顾性病例系列，包括 2000 年 10 月至 2022 年 9 月期间接受 AVS 的患者。从电子病历中提取临床和实验室值。成功置管 RAV 的定义是选择性指数>3。
110 名患者进行了 124 次 AVS 手术。118 次 AVS 手术有术前 CT 成像。在 61 次（51.7%）CT 数据集识别出 RAV。在 124 次 AVS 手术中，有 98 次（79.0%）生化证实成功置管 RAV。在 52 次（85.2%）术前 CT 识别出 RAV 并生化证实成功 RAV 取样的手术中，RAV 在 AVS 期间位于与术前 CT 相同的解剖水平或在术前 CT 确定的水平上方 1 个椎体水平内的有 98.1%。在术中 CT 组（93.8%对 63.9%），成功置管 RAV 的比例更高，P<0.01。
AVS 前和术中 CT 图像提供了一个非常宝贵的路线图，使 RAV 的准确识别和成功的 AVS 手术的比例更高；特别是，在 AVS 期间可以将 RAV 口的搜索限制在术前 CT 成像确定的水平上方 1 个椎体，术中 CT 可以有信心地验证成功置管。
