Pre-procedural and intra-procedural computerized tomography: providing a roadmap for successful adrenal venous sampling procedures

Darius Jonasch; Peiman Habibollahi; A Kyle Jones; Rony Avritscher; Mouhammed Amir Habra; Nancy D Perrier; Paul H Graham; Steven Y Huang

doi:10.1007/s00261-024-04321-9

Pre-procedural and intra-procedural computerized tomography: providing a roadmap for successful adrenal venous sampling procedures

Abdom Radiol (NY). 2024 May 13. doi: 10.1007/s00261-024-04321-9. Online ahead of print.

Authors

Darius Jonasch¹, Peiman Habibollahi¹, A Kyle Jones^{1

2}, Rony Avritscher¹, Mouhammed Amir Habra³, Nancy D Perrier⁴, Paul H Graham⁴, Steven Y Huang⁵

Affiliations

¹ Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA.
² Division of Diagnostic Imaging, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA.
³ Division of Internal Medicine, Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA.
⁴ Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA.
⁵ Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA. syhuang@mdanderson.org.

PMID: 38740580
DOI: 10.1007/s00261-024-04321-9

Abstract

Background and purpose: Adrenal venous sampling (AVS) is used for the diagnosis of primary hyperaldosteronism. Technical difficulties with right adrenal vein (RAV) catheterization can lead to erroneous results. Our purpose was to delineate the location of the RAV on pre-procedural CT imaging in relation to the location identified during AVS and to report on the impact of successful RAV cannulation with and without the use of intra-procedural CT scanning.

Methods: Retrospective case series including patients who underwent AVS from October 2000 to September 2022. Clinical and laboratory values were abstracted from the electronic medical record. Successful cannulation of the RAV was defined as a selectivity index > 3.

Results: 110 patients underwent 124 AVS procedures. Pre-AVS CT imaging was available for 118 AVS procedures. The RAV was identified in 61 (51.7%) CT datasets. Biochemical confirmation of successful RAV cannulation occurred in 98 (79.0%) of 124 AVS procedures. There were 52 (85.2%) procedures in which the RAV was identified on pre-AVS CT and there was biochemical confirmation of successful RAV sampling. Among these 52 procedures, the RAV was localized during AVS at the same anatomic level or within 1 vertebral body level cranial to the level identified on pre-AVS CT in 98.1% of cases. The rate of successful RAV cannulation was higher in patients who underwent intra-procedural CT (93.8% versus 63.9%), P < 0.01.

Conclusions: Pre-AVS and intra-procedural CT images provide an invaluable roadmap that resulted in a higher rate of accurate identification of the RAV and successful AVS procedures; in particular, search for the RAV orifice during AVS can be limited to 1 vertebral body cranial to the level identified on pre-AVS CT imaging and successful cannulation can be confidently verified with intra-procedural CT.

Keywords: Adrenal vein sampling; Pre-procedural intra-procedural computed tomography.