Nadeem Ibrahim Mohammad, Rahman Yusra, Nadeem Laiba, Manokaran Thulasie, Gow Rachel, Mathew Anna, Mironov Oleg, Mahmood Syed Umair
Department of Medical, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
J Vasc Interv Radiol. 2025 Aug;36(8):1268-1277.e3. doi: 10.1016/j.jvir.2025.04.020. Epub 2025 May 2.
To evaluate the effectiveness of metanephrine-based compared with cortisol-based measurements in assessing successful adrenal vein (AV) cannulation to determine diagnostic AV sampling (AVS) procedures.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a literature search was conducted using 3 electronic medical databases-PubMed, Embase, and MEDLINE-from inception to the third week of December 2024. Studies that compared metanephrine-based with cortisol-based measurements in adult patients with biochemically established primary aldosteronism undergoing AVS were included. The Methodological Index for Non-Randomized Studies appraisal tool was used for quality assessment. Cohen κ statistic, proportion differences, 95% confidence intervals (CIs), and 2-tailed P values using Z-test for paired proportions were calculated, where applicable.
Six studies evaluating a total of 531 patients were included. Metanephrine-based selectivity index (SI) demonstrated significantly higher successful cannulation rates than cortisol-based SI in unstimulated AVS procedures for almost all the comparisons (P < .05), whereas no significant difference was found in stimulated procedures (P > .05). There was excellent agreement between metanephrine-based and cortisol-based SI (κ = 0.876; 95% CI, 0.779-0.972; n = 117) and substantial agreement for lateralization index (LI) (κ = 0.773; 95% CI, 0.658-0.889; n = 115). In patients successfully treated with adrenalectomy, no significant difference was found between metanephrine-based and cortisol-based LIs in identifying dominant side (n = 28).
This study was limited by the quality of evidence and heterogeneity. Compared with cortisol-based SI, metanephrine-based SI significantly increased the proportion of diagnostic unstimulated AVS procedures, supporting the use of metanephrine-based measurements as a reliable alternative.
评估基于间甲肾上腺素与基于皮质醇的测量方法在评估肾上腺静脉（AV）插管成功以确定诊断性肾上腺静脉采样（AVS）程序方面的有效性。
按照系统评价和Meta分析的首选报告项目（PRISMA）声明，使用3个电子医学数据库——PubMed、Embase和MEDLINE，从数据库建立至2024年12月的第三周进行文献检索。纳入了在接受AVS的生化确诊原发性醛固酮增多症成年患者中比较基于间甲肾上腺素与基于皮质醇测量方法的研究。使用非随机研究方法学指数评估工具进行质量评估。在适用的情况下，计算Cohen κ统计量、比例差异、95%置信区间（CI）以及使用Z检验的配对比例的双侧P值。
纳入了6项评估总共531例患者的研究。在几乎所有比较中，基于间甲肾上腺素的选择性指数（SI）在未刺激的AVS程序中显示出比基于皮质醇的SI显著更高的插管成功率（P <.05），而在刺激程序中未发现显著差异（P >.05）。基于间甲肾上腺素的SI与基于皮质醇的SI之间具有极好的一致性（κ = 0.876；95% CI，0.779 - 0.972；n = 117），对于定位指数（LI）具有高度一致性（κ = 0.773；95% CI，0.658 - 0.889；n = 115）。在接受肾上腺切除术成功治疗的患者中，基于间甲肾上腺素的LI与基于皮质醇的LI在识别优势侧方面未发现显著差异（n = 28）。
本研究受到证据质量和异质性的限制。与基于皮质醇的SI相比，基于间甲肾上腺素的SI显著提高了诊断性未刺激AVS程序的比例，支持将基于间甲肾上腺素的测量方法作为一种可靠的替代方法使用。
