Oguro Sota, Tannai Hiromitsu, Ota Hideki, Seiji Kazumasa, Kamada Hiroki, Toyama Yoshitaka, Omata Kei, Tezuka Yuta, Ono Yoshikiyo, Satoh Fumitoshi, Ito Sadayoshi, Tanaka Tetsuhiro, Katagiri Hideki, Takase Kei
Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi 980-8574, Japan.
Department of Diagnostic Radiology, South Miyagi Medical Center, Miyagi 989-1253, Japan.
Endocr J. 2025 Feb 3;72(2):131-148. doi: 10.1507/endocrj.EJ24-0156. Epub 2024 Oct 10.
This study aimed to focus on the role of radiologists in the diagnosis and management of adrenal lesions, particularly primary aldosteronism (PA) and secondary hypertension. As hypertension affects more than one-third of the population in Japan, identifying secondary causes such as PA and adrenal lesions is crucial. Establishing a radiological differential diagnosis of adrenal lesions using advanced imaging techniques, such as computed tomography and magnetic resonance imaging, is crucial. Knowledge of the imaging findings of various benign and malignant adrenal lesions, such as adrenocortical adenomas, cortisol-producing lesions, pheochromocytomas, adrenocortical carcinoma, malignant lymphoma, and metastatic tumors, is necessary. Adrenal venous sampling (AVS) plays a crucial role in accurately localizing aldosterone hypersecretion in PA, especially when imaging fails to provide a clear diagnosis. This paper details the technical aspects of AVS, emphasizing catheterization techniques, anatomical considerations, and the importance of preprocedural imaging for successful sampling. Furthermore, we explore segmental adrenal venous sampling (SAVS), a more refined technique that samples specific adrenal tributary veins, offering enhanced diagnostic accuracy, particularly for microadenomas or challenging cases that may be missed with conventional AVS. The methodology for performing SAVS, along with the interpretation criteria for successful sampling and lateralization, is also outlined. Furthermore, radiologists have initiated treatments for unilateral PA, such as radiofrequency ablation, and play an integral role in the management of adrenal lesions. Collaborative approaches across clinical departments are required to enhance patient management in medical care involving the adrenal gland.
本研究旨在聚焦放射科医生在肾上腺病变诊断及管理中的作用，尤其是原发性醛固酮增多症（PA）和继发性高血压。由于高血压影响着日本超过三分之一的人口，识别诸如PA和肾上腺病变等继发性病因至关重要。运用先进成像技术（如计算机断层扫描和磁共振成像）建立肾上腺病变的放射学鉴别诊断至关重要。了解各种良性和恶性肾上腺病变的影像学表现，如肾上腺皮质腺瘤、分泌皮质醇的病变、嗜铬细胞瘤、肾上腺皮质癌、恶性淋巴瘤和转移性肿瘤，是必要的。肾上腺静脉采血（AVS）在准确定位PA中醛固酮分泌过多方面起着关键作用，尤其是在成像未能提供明确诊断时。本文详细介绍了AVS的技术方面，强调了插管技术、解剖学考量以及术前成像对成功采血的重要性。此外，我们探讨了节段性肾上腺静脉采血（SAVS），这是一种更精细的技术，可对特定肾上腺分支静脉进行采血，能提高诊断准确性，特别是对于微腺瘤或传统AVS可能漏诊的疑难病例。还概述了进行SAVS的方法以及成功采血和定位的解读标准。此外，放射科医生已开始对单侧PA进行诸如射频消融等治疗，并在肾上腺病变的管理中发挥不可或缺的作用。在涉及肾上腺的医疗护理中，需要跨临床科室的协作方法来加强患者管理。
