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Kobayashi K, Alkukhun L, Rey E, Salaskar A, Acharya R. Adrenal Vein Sampling: Tips and Tricks. Radiographics 2024; 44:e230115. [PMID: 38662586 DOI: 10.1148/rg.230115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Adrenal vein sampling (AVS) is the standard method for distinguishing unilateral from bilateral sources of autonomous aldosterone production in patients with primary aldosteronism. This procedure has been performed at limited specialized centers due to its technical complexity. With recent advances in imaging technology and knowledge of adrenal vein anatomy in parallel with the development of adjunctive techniques, AVS has become easier to perform, even at nonspecialized centers. Although rare, anatomic variants of the adrenal veins can cause sampling failure or misinterpretation of the sampling results. The inferior accessory hepatic vein and the inferior emissary vein are useful anatomic landmarks for right adrenal vein cannulation, which is the most difficult and crucial step in AVS. Meticulous assessment of adrenal vein anatomy on multidetector CT images and the use of a catheter suitable for the anatomy are crucial for adrenal vein cannulation. Adjunctive techniques such as intraprocedural cortisol assay, cone-beam CT, and coaxial guidewire-catheter techniques are useful tools to confirm right adrenal vein cannulation or to troubleshoot difficult blood sampling. Interventional radiologists should be involved in interpreting the sampling results because technical factors may affect the results. In rare instances, bilateral adrenal suppression, in which aldosterone-to-cortisol ratios of both adrenal glands are lower than that of the inferior vena cava, can be encountered. Repeat sampling may be necessary in this situation. Collaboration with endocrinology and laboratory medicine services is of great importance to optimize the quality of the samples and for smooth and successful operation. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Katsuhiro Kobayashi
- From the Department of Radiology, Division of Interventional Radiology (K.K., L.A., E.R., A.S.) and Department of Medicine, Division of Endocrinology (R.A.), State University of New York, Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Leen Alkukhun
- From the Department of Radiology, Division of Interventional Radiology (K.K., L.A., E.R., A.S.) and Department of Medicine, Division of Endocrinology (R.A.), State University of New York, Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Emily Rey
- From the Department of Radiology, Division of Interventional Radiology (K.K., L.A., E.R., A.S.) and Department of Medicine, Division of Endocrinology (R.A.), State University of New York, Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Abhijit Salaskar
- From the Department of Radiology, Division of Interventional Radiology (K.K., L.A., E.R., A.S.) and Department of Medicine, Division of Endocrinology (R.A.), State University of New York, Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Runa Acharya
- From the Department of Radiology, Division of Interventional Radiology (K.K., L.A., E.R., A.S.) and Department of Medicine, Division of Endocrinology (R.A.), State University of New York, Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
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Zhou Y, Zhang H, Luo J, Hou J, Xue Q, Wang X, Guo H, Wang X, Wang P. Intraprocedural Cortisol Measurement Increases Adrenal Vein Cannulation Success Rate in Primary Aldosteronism: A Systematic Review and Meta-analysis. Am J Hypertens 2024; 37:134-142. [PMID: 37777871 DOI: 10.1093/ajh/hpad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/09/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND This study aimed to explore the effectiveness of intraprocedural cortisol measurement (IPCM) for the technical success rates of bilateral adrenal vein, right adrenal vein (RAV), and left adrenal vein (LAV) cannulation during adrenal vein sampling (AVS). METHODS Systematic searches of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were performed from database inception to May 10, 2023, without any restrictions. We estimated the overall effect estimates of outcomes using the Mantel-Haenszel random-effects model. We conducted subgroup analyses, meta-regression, and sensitivity analysis to explore the possible sources of between-study heterogeneity. RESULTS In total, 3,485 patients from 11 studies (three prospective and eight retrospective) were enrolled. Bilateral selectivity in patients who underwent IPCM during AVS was significantly higher than that in patients who underwent a routine AVS procedure (84% vs. 64%, RR 1.42, 95% confidence interval [CI]: 1.27-1.59, P < 0.01), with significant heterogeneity (I2 = 68%). A 42% relative risk reduction in the failure rate of bilateral adrenal vein cannulation was found in the IPCM group. Moreover, pooled analysis showed a significant increase in the success rates of RAV cannulation (84% vs. 72%, RR 1.21, 95% CI 1.12-1.31, P < 0.01, I2 = 33%) and LAV cannulation (89% vs. 84%, RR 1.05, 95% CI 1.02-1.08, P < 0.01, I2 = 4%) when IPCM was implemented during the AVS procedure compared to the routine AVS procedure. CONCLUSIONS An IPCM-based strategy during AVS appears to have a significant beneficial effect on improving the success rate of bilateral cannulation, RAV cannulation and LAV cannulation.
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Affiliation(s)
- Yaqiong Zhou
- Department of Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan 610500, China
| | - Huamin Zhang
- Department of Epidemiology and Statistics, Chengdu Medical College, Chengdu 610500, China
| | - Jie Luo
- Department of Health Care, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Jixin Hou
- Department of Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan 610500, China
| | - Qiang Xue
- Department of Cardiology, Yanan Hospital Affiliated to Kunming Medical University, Kunming, Yunnan 650051, China
| | - Xiaohan Wang
- Department of Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan 610500, China
| | - Hui Guo
- Department of Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan 610500, China
| | - Xinquan Wang
- Department of Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan 610500, China
| | - Peijian Wang
- Department of Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan 610500, China
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Aiga K, Kometani M, Karashima S, Konishi S, Higashitani T, Aono D, Mai X, Usukura M, Asano T, Wakayama A, Noda Y, Koda W, Minami T, Kobayashi S, Murayama T, Yoneda T. A clinical assessment of portable point-of-care testing for quick cortisol assay during adrenal vein sampling. Sci Rep 2023; 13:22429. [PMID: 38104216 PMCID: PMC10725449 DOI: 10.1038/s41598-023-49808-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
This study assessed the clinical performance of point-of-care testing (POCT) for quick cortisol assay (QCA) during adrenal vein sampling (AVS) using a newly invented portable quantitative assay instrument. An observational study was conducted prospectively at two centres in Japan. Forty-eight patients with primary aldosteronism considered for adrenalectomy were enrolled in this study and underwent AVS. Three basal adrenal vein samples from each adrenal vein and two from the inferior vena cava were collected sequentially. The cortisol concentration of adrenal vein samples was measured by routine method and QCA. A total of 338 adrenal vein samples were analysed from 250 sites to determine AVS success or failure. The distribution of turnaround time of the QCA for AVS success or failure followed a normal distribution with an average of 20.5 min. A positive correlation between the routine method and QCA was observed regarding cortisol concentration or selectivity index. No significant difference between the two methods was observed regarding the success rate of AVS. Using the routine method as a reference, the sensitivity and specificity of AVS success or failure were 99.1% (210/212) and 81.6% (31/38), respectively. Easy, quick, portable, and precise POCT-QCA demonstrated its compatibility with routine methods regarding clinical performance.
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Affiliation(s)
- Ko Aiga
- Department of Health Promotion and Medicine of Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8641, Japan
| | - Mitsuhiro Kometani
- Department of Health Promotion and Medicine of Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Shigehiro Karashima
- Department of Health Promotion and Medicine of Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8641, Japan
| | - Seigo Konishi
- Department of Health Promotion and Medicine of Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takuya Higashitani
- Department of Health Promotion and Medicine of Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8641, Japan
| | - Daisuke Aono
- Department of Health Promotion and Medicine of Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8641, Japan
| | - Xurong Mai
- Department of Health Promotion and Medicine of Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8641, Japan
| | - Mikiya Usukura
- Department of Internal Medicine, Houju Memorial Hospital, Nomi, Ishikawa, 923-1226, Japan
| | - Takahiro Asano
- Department of Internal Medicine, Houju Memorial Hospital, Nomi, Ishikawa, 923-1226, Japan
| | - Ayako Wakayama
- Department of Internal Medicine, Houju Memorial Hospital, Nomi, Ishikawa, 923-1226, Japan
| | - Yuko Noda
- Department of Health Promotion and Medicine of Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8641, Japan
| | - Wataru Koda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tetsuya Minami
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| | - Toshinori Murayama
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takashi Yoneda
- Department of Health Promotion and Medicine of Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8641, Japan
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