Comparison of C-arm computed tomography and on-site quick cortisol assay for adrenal venous sampling: A retrospective study of 178 patients

Abstract

Objectives

To compare the performance of on-site quick cortisol assay (QCA) and C-arm computed tomography (CT) assistance on adrenal venous sampling (AVS) without adrenocorticotropic hormone stimulation.

Methods

The institutional review board at our hospital approved this retrospective study, which included 178 consecutive patients with primary aldosteronism. During AVS, we used C-arm CT to confirm right adrenal cannulation between May 2012 and June 2015 (n = 100) and QCA for bilateral adrenal cannulation between July 2015 and September 2016 (n = 78). Successful AVS required a selectivity index (cortisol_{adrenal vein}/cortisol_peripheral) of ≥ 2.0 bilaterally.

Results

The overall success rate of C-arm CT-assisted AVS was 87%, which increased to 97.4% under QCA (P = .013). The procedure time (C-arm CT, 49.5 ± 21.3 min; QCA, 37.5 ± 15.6 min; P < .001) and radiation dose (C-arm CT, 673.9 ± 613.8 mGy; QCA, 346.4 ± 387.8 mGy; P < .001) were also improved. The resampling rate was 16% and 21.8% for C-arm CT and QCA, respectively. The initial success rate of the performing radiologist remained stable during the study period (C-arm CT 75%; QCA, 82.1%, P = .259).

Conclusions

QCA might be superior to C-arm CT for improving the performance of AVS.

Key Points

• Adrenal venous sampling (AVS) is a technically challenging procedure.

• C-arm CT and quick cortisol assay (QCA) are efficient for assisting AVS.

• QCA might outperform C-arm CT in enhancing AVS performance.