Advanced monoenergetic reconstruction technique in dual-energy computed tomography for evaluation of vascular anatomy before adrenal vein sampling

Abstract

Background In adrenal vein sampling, selecting the right adrenal vein is technically difficult and it is important to evaluate the right adrenal vein anatomy before adrenal vein sampling. The advanced monoenergetic reconstruction technique has recently become available and we hypothesized that this technique may be useful. Purpose To evaluate the usefulness of the advanced monoenergetic reconstruction technique in dual-energy computed tomography (CT; advanced monoenergetic images) for evaluation of vascular anatomy before adrenal vein sampling. Material and Methods Twenty-one patients underwent three-phase (20, 30, and 70 s) contrast-enhanced CT before adrenal vein sampling. Advanced monoenergetic images were reconstructed at 40 keV and analyzed objectively and subjectively in comparison with the standard 120-kVp images. As objective evaluation, the signal-to-noise ratio and contrast-to-noise ratio of the right adrenal vein were assessed. As subjective evaluation, two radiologists assessed the delineation of the right adrenal vein using a 5-point Likert scale (1 = poor, 5 = excellent). Furthermore, the technical success rate of adrenal vein sampling and procedure time were also evaluated. Results There was no difference in the signal-to-noise ratio between the two groups. The contrast-to-noise ratios of the right adrenal vein of advanced monoenergetic images were higher than those of the standard images ( P < 0.05). The Likert scores of advanced monoenergetic images were higher than those of the standard images ( P < 0.05). The technical success rate of adrenal vein sampling was 95% (20/21) and the median of procedure time was 103 min (range = 59–197 min). Conclusion Advanced monoenergetic imaging appears to be useful in the delineation of the right adrenal vein before adrenal vein sampling.

Usefulness of respiratory-triggered 3D-balanced steady-state free precession in assessing the anatomy of the right adrenal vein for adrenal vein sampling

“…In dual-energy CT, the voltage of the tube was set at 100 kV and 140 kV to obtain virtual monoenergetic images at 120 keV. The X-ray tube was set at 140 kV and equipped with a tin lter (9).…”

Pre-interventional assessment of right renal to right adrenal vein distance: Impact on procedure time and radiation dose in adrenal vein sampling

“…slice CT, dual adrenal venous phase CT or dual-energy CT [14,17,33]. Others compared preinterventional CT and MRI and sought to identify anatomic landmarks such as accessory hepatic veins or vertebrae to facilitate cannulation of the RAV during AVS [27,28].…”

“…Therefore, different techniques to improve adrenal vein sampling in general and sampling of the RAV in particular have been proposed [9,14,[17][18][19][20][21][22][23][24]. These strategies can be divided into pre-and peri-interventional approaches.…”

“…Pre-interventional approaches aim to improve delineation of adrenal veins by using improved cross-sectional imaging techniques, e.g. dualenergy CT for increased vascular contrast [17,25]. Peri-interventional techniques include the use of Dyna-CT or C-arm CT for validation of correct catheter placement [18,20,26], use of cortisol testing kits for fast validation of correct cannulation of the adrenal veins [19], adjustment of catheter-shape to RAV-anatomy during adrenal vein sampling [24] or identification of specific landmarks which may aide cannulation of the RAV [27,28].…”