Role of adrenal vein sampling in primary aldosteronism: Impact of imaging, localization, and age

Wachtel, Heather; Zaheer, Salman; Shah, Parth; Trerotola, Scott O.; Karakousis, Giorgos C.; Roses, Robert E.; Cohen, Debbie L.; Fraker, Douglas L.

doi:10.1002/jso.24182

Cited by 21 publications

(12 citation statements)

References 25 publications

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“…We obtained a high technical success rate of AVS (95%) with acceptable procedure time, owing to visualization of the right adrenal vein with AMI; this result is almost the same as in the literature (14,15). We think one reason for the difficulty of cannulation into the right adrenal vein may be the presence of the accessory hepatic vein.…”

Section: Discussionsupporting

confidence: 82%

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

et al. 2019

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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.

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Section: Discussionsupporting

confidence: 82%

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

et al. 2019

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“…The crucial role of the learning curve and growing experience in achievement of excellent results has also been demonstrated in other published reports [15,19,20]. As AVS still remains a demanding procedure, few studies have proposed various techniques enabling stable catheter position during blood sampling, like wire insertion or abdominal pressure manoeuvre [21][22][23].…”

Section: Discussionmentioning

confidence: 82%

A single-centre experience of the implementation of adrenal vein sampling procedure: the impact on the diagnostic work-up in primary aldosteronism

et al. 2017

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A b s t r a c tBackground: Primary aldosteronism is one of the most common causes of secondary hypertension. Adrenal vein sampling (AVS) remains a "gold standard" procedure in differentiation between unilateral (adenoma) and bilateral (hyperplasia) disease. Aim:The aim of this study was to present our single-centre experience in establishing and implementating the AVS procedure. Methods:All patients had primary aldosteronism confirmed in a salt-infusion test. AVS was performed sequentially during a continuous intravenous infusion of cosyntropin and was preceded by multislice contrast-enhanced computed tomography (CT) examination of adrenal glands performed a few weeks before AVS in the majority of patients. AVS was regarded as successful if the ratio of each adrenal vein cortisol to inferior vena cava cortisol levels (selectivity index [SI]) was higher than 3.0. In the case of failure, a second attempt was considered in a few weeks. Patients were divided into four groups according to the order of the procedure by quartiles.Results: Between 31 May, 2012 and 5 May, 2016, AVS was performed in 124 patients (69% males, aged 55.3 ± 10.3 years) and was successful in 120 (96.8%) patients. All failed cases were due to the failure of cannulation of the right adrenal vein. The first-attempt success rate was 94.3% (117 of 124 patients) and increased from 83.9% in the first 31 patients to 100% in the last 31 patients. Similarly, the overall success rate increased from 93.5% to 100%. The right SI was significantly higher than the left one (26.4 vs. 11.0, p < 0.0001). Both indices did not differ across quartiles of patients. No complications occurred during the procedure. Conclusions:The AVS procedure, preceded by adrenal CT, may be implemented into daily diagnostic practice safely with an excellent success rate.

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“…Adrenal vein sampling (AVS) is recommended to distinguish between unilateral and bilateral PA before adrenalectomy in patients older than 35 years old, and in patients younger than 35 years with bilateral normal adrenal glands or bilateral adrenal nodules [6][7][8][9][10][11][12]. Some centers prefer the selective use of AVS only when preoperative anatomic imaging cannot definitively lateralize the aldosteronoma (patients with bilateral normal adrenal glands or bilateral adrenal masses), because successful catheterization of both the right and left adrenal veins is technically challenging and may be associated with complications [11,13].…”

Section: Introductionmentioning

confidence: 99%

Adrenal Vein Sampling to Distinguish Between Unilateral and Bilateral Primary Hyperaldosteronism: To ACTH Stimulate or Not?

Sung

Alobuia

Tyagi

et al. 2020

JCM

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The aim of this study is to determine the accuracy of adrenal vein sampling (AVS) with and without adrenocorticotropic hormone (ACTH) stimulation to distinguish between unilateral and bilateral primary hyperaldosteronism (PA). Retrospective analysis of a prospective database from a referral center between 1984 and 2009, 76 patients had simultaneous cannulation of bilateral adrenal veins and AVS with and without ACTH stimulation. All patients had adrenalectomies. The selectivity index (SI, cut-off value ≥2) was used for confirmation of successful cannulation of the adrenal vein. The lateralization index (LI, cut-off value >2 and >4) was used for distinguishing between unilateral and bilateral PA. The SI ratio was higher with ACTH stimulation compared to without for the right adrenal vein (p = 0.027). The LI > 2 ratio was higher with ACTH stimulation compared to without (p = 0.007). For the LI > 4 ratio, there was no difference between with and without ACTH stimulation (p = 0.239). However, for a LI > 4, 7 patients (9.2%) were not lateralized with ACTH stimulation, but they did lateralize without ACTH stimulation. AVS with ACTH stimulation is associated with a higher SI ratio compared to AVS without ACTH stimulation. However, when using LI > 4 for AVS, samples without ACTH stimulation should also be included to detect a subset of patients with unilateral disease that are not detected with ACTH stimulation.

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Role of adrenal vein sampling in primary aldosteronism: Impact of imaging, localization, and age

Abstract: AVS changed management in a significant minority of patients regardless of age and imaging findings. AVS should be routinely recommended in all patients with PA, to direct operative therapy. J. Surg. Oncol. 2016;113:532-537. © 2016 Wiley Periodicals, Inc.

Cited by 21 publications

References 25 publications

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

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

A single-centre experience of the implementation of adrenal vein sampling procedure: the impact on the diagnostic work-up in primary aldosteronism

Adrenal Vein Sampling to Distinguish Between Unilateral and Bilateral Primary Hyperaldosteronism: To ACTH Stimulate or Not?

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