Adrenal Venous Sampling in Patients with Primary Aldosteronism: Which Is the Best Evaluation Method for Laterality Assessments?

• 作者: Akira Yogi Hideaki Nakamura Hiroaki Masuzaki Joichi Heianna Kimei Azama Masahiro Okada Sadayuki Murayama Tomomi Koga Yuko Iraha
• 来源期刊: 放射学期刊(英文)
• 学科: 医学
• 关键词: ADRENAL VENOUS Sampling Primary ALDOSTERONISM Hypertension ADRENAL GRAND
• 年，卷（期）: 2017,（4）
• 页码范围: 219-227
• 页数: 9页
• 分类号: R5

摘要

Purpose: The purpose was to investigate the most accurate method of adrenal venous sampling to diagnose unilateral primary aldosteronism (PA) prior to laterality assessment. Materials and Methods: Sixty-four consecutive PA patients were enrolled in this retrospective study. A catheter was placed in the common-trunk-vein (CTV), below the confluence of the inferior-phrenic-vein and the central-adrenal-vein (CAV) and the right-adrenal-vein (RAV). Blood-sampling was performed both pre- and post-adrenocorticotropic hormone stimulation. Lateralized ratio [LR;aldosterone/cortisol ratio (ACR) on high-value side/ACR on low-value side], contralateral ratio (CR;ACR on low-value side/ACR on inferior-vena-cava ratio), and plasma aldosterone concentration (PAC) were evaluated. The diagnostic accuracy of LR, CR and PAC in CTV/ CAV/RAV during pre- and post-ACTH was compared by receiver-operating-characteristic (ROC) analysis. Results: LR-CAV post-ACTH showed the highest detection rate for unilateral adrenal lesions (93.3%;14/15), with a sensitivity of 0.93 and a specificity of 0.84 at a cut-off value of 2.5. CR-post-ACTH had the highest Az value (0.89), with a detection rate of 86.7% (13/14), a sensitivity of 0.98, and a specificity of 0.88 at a cut-off value of 0.8. Conclusion: CR-post-ACTH and LR-CAV-post-ACTH are accurate predictors for laterality assessment in PA.