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Adrenal venous sampling for stratifying patients for surgery of adrenal nodules detected using dynamic contrast enhanced CT

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Affiliated Author(s)
김시형이희정김영환김미정
Alternative Author(s)
Kim, See HyungLee, Hee JungKim, Young HwanKim, Mi Jeong
Journal Title
Diagnostic and Interventional Radiology
ISSN
1305-3825
Issued Date
2014
Abstract
PURPOSE
We aimed to assess the value of adrenal venous sampling
(AVS) for diagnosing primary aldosteronism (PA) subtypes in
patients with a unilateral nodule detected on adrenal computed
tomography (CT) and scheduled for adrenalectomy.
MATERIALS AND METHODS
This retrospective study included 80 consecutive patients
with PA undergoing CT and AVS. Different lateralization indices
were assessed, and a cutoff established using receiver
operating characteristic curve analysis. The value of CT
alone versus CT with AVS for differentiating PA subtypes was
compared. The adrenalectomy outcome was assessed, and
predictors of cure were determined using univariate analysis.
RESULTS
AVS was successful in 68 patients. A cortisol-corrected aldosterone
affected-to-unaffected ratio cutoff of 2.0 and affected-
to-inferior vena cava ratio cutoff of 1.4 were the best
lateralization indices, with accuracies of 82.5% and 80.4%,
respectively. CT and AVS diagnosed 38 patients with aldosterone-
producing adenomas, five patients with unilateral
adrenal hyperplasia, and 25 patients with bilateral adrenal
hyperplasia. Of the 52 patients with a nodule detected on CT,
subsequent AVS diagnosed bilateral adrenal hyperplasia in 14
patients (27%). Compared to the results of combining CT
with AVS, the accuracy of CT alone for diagnosing aldosterone-
producing adenomas was 71.1% (P < 0.001). The cure
rate for hypertension after adrenalectomy was 39.2%, with
improvement in 53.5% of patients. On univariate analysis,
predictors of persistent hypertension were male gender and
preoperative systolic blood pressure.
CONCLUSION
To avoid inappropriate surgery, AVS is necessary for diagnosing
unilateral nodules with aldosterone hypersecretion detected
by CT.
Department
Dept. of Radiology (영상의학)
Publisher
School of Medicine
Citation
Jin Young Kim et al. (2014). Adrenal venous sampling for stratifying patients for surgery of
adrenal nodules detected using dynamic contrast enhanced CT. Diagnostic and Interventional Radiology, 20(1), 65–72. doi: 10.5152/dir.2013.13144
Type
Article
ISSN
1305-3825
DOI
10.5152/dir.2013.13144
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/35589
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Radiology (영상의학)
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