Management of Primary Aldosteronism: Should Adrenal Gland Computed Tomography be Replaced by Adrenal Venous Sampling?
CH Lam, HL Chow, SH Chiu, HY Cho, S Lau, CY Lui
Hong Kong J Radiol 2014;17:23-9
DOI: 10.12809/hkjr1413184
Objectives: To evaluate the accuracy of computed tomography (CT) in the management of primary aldosteronism by comparing the concordance between CT and adrenal venous sampling (AVS), and the feasibility of AVS as a standard component in the diagnostic workup.
Methods: From January 2009 to December 2012, 44 instances of AVS performed in 39 patients in Kwong Wah Hospital, Hong Kong were reviewed. All these patients had undergone CT of the adrenal glands before AVS. CT findings, and aldosterone and cortisol profiles of the left adrenal vein, right adrenal vein, and inferior vena cava during AVS were compared. Successful cannulation was defined by achieving an adrenal vein to the inferior vena cava cortisol level ratio of higher than 1.1. The positive predictive value of CT and concordance between CT and AVS were calculated. The pathology reports of patients who underwent adrenalectomy were reviewed.
Result: AVS was successful in 35 (90%) of the patients on the first attempt, and concordance between CT and AVS was observed in 23 (59%) patients. CT yielded a positive predictive value of 73% and 44% in unilateral disease and bilateral disease, respectively. A total of 27 patients with unilateral disease underwent adrenalectomy. Pathology confirmed cortical adenoma in all specimens.
Conclusion: CT is not an accurate tool for the management of primary aldosteronism, especially in bilateral disease. AVS as a standard procedure in the workup is feasible but depends on proper technique and radiologists with adequate experience.
中文摘要
原發性醛固酮增多症的診斷：應否讓腎上腺靜脈取樣代替其電腦斷層掃描？
林卓恆、仇鴻烈、趙修軒、曹慶恩、柳洵、呂振英
目的：藉着比較電腦斷層掃描（CT）及腎上腺靜脈取樣（AVS）的結果是否達一致性來評估CT診斷原發性醛固酮增多症的準確性，並探討AVS作為診斷檢查中作為標準項目的可行性。
方法：回顧研究2009年1月至2012年12月期間，於香港廣華醫院的39名病人中完成的44例AVS。所有患者在進行AVS之前均已接受腎上腺CT掃描。把CT檢查結果與經AVS獲得的左腎上腺靜脈、右腎上腺靜脈和下腔靜脈的醛固酮及皮質醇水平作比較。如果腎上腺靜脈與下腔靜脈的皮質醇水平比值高於1.1，即代表插管成功。然後計算CT的陽性預測值，以及CT和AVS之間的一致性。並回顧接受腎上腺切除術的患者的病理報告。
結果：35例（90%）患者的AVS一次成功，23例（59%）可觀察到CT和AVS的結果一致。CT在單側和雙側腎上腺病變中的陽性預測值分別為73%和44%。總計27例單側發病患者接受腎上腺切除術，所有標本經病理學證實為皮質腺瘤。
結論：CT並非原發性醛固酮增多症的準確診斷工具，尤其是雙側腎上腺病變的檢查。AVS可作為診斷檢查的標準流程，但依賴於合適的技術和經驗充足的放射科醫生。