Abstract 14932: Detection of Adrenal Vein on Selective Retrograde CT Adrenal Venography in Comparison with Digital Subtraction Angiography in Subjects with Established Diagnosis of Either Right or Left Adrenal Aldosterone Producing Tumor Confirmed by Adrenal Vein Sampling, Histopathology and Clinical Course
Purpose: Adrenal vein (AV) sampling (AVS) is considered the diagnostic gold standard for primary aldosteronism (PA), but right-sided AVS is especially difficult. We compared detection of the AV on selective retrograde CT adrenal CT venography (SRCTAV) with digital subtraction angiography (DSA) in subjects with an established diagnosis of either right or left aldosterone producing tumor (APT).
Materials and methods: 29 subjects (11 male, mean age 55 yrs) with increased plasma aldosterone concentrations (PAC), and a diagnosis of right or left APT on AVS who underwent adrenalectomy were retrospectively analyzed. Before AVS, visualization of the AV was attempted on DSA and SRCTAV (Aquilion, Toshiba Medical). After the adrenocorticotropic hormone loading test, if the plasma cortisol concentration (PCC) acquired from either left or right AV was > 200μg/dl, AVS was regarded as successful. If measurement of the PAC/ PCC ratio on 1 side was ≥4, we diagnosed a one-sided APT.
Results: The left and right AV could be visualized in 29 (100%) and 22 subjects (76%) in DSA and 29 (100%) and 28 subjects (97%) in SRCTAV, respectively, and detection of the right AV was significantly higher in SRCTAV than in DSA (p<0.05). Among the 28 subjects in whom both AV could be observed in SRCTAV, all were regarded as successful canulations. In one subject in whom the right AV could not be observed in SRCTAV, AVS did not fulfill the criteria for success, but the adrenocortical scintigram was positive and adrenalectomy was performed with a diagnosis of adenoma. Among the 28 subjects with successful AVS, histopathological diagnoses included adenoma (25 subjects), nodular hyperplasia (2 subjects) and normal (1 subject). After adrenalectomy, amount of diuretics was reduced or stopped with decreases in PAC in the 28 subjects.
Conclusions: Detection of the AV was significantly higher in SRCTAV than in DSA, especially on the right, in 29 subjects with an established diagnosis of one-sided APT.
- © 2011 by American Heart Association, Inc.