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Evaluation of right adrenal vein anatomy by Dyna computed tomography in patients with primary aldosteronism.

ABSTRACT: Primary aldosteronism (PA) is the most common cause of secondary hypertension and consists up to 11% of patients with hypertension. Adrenal venous sampling (AVS) is the recommended procedure for diagnosis of PA, but the technique is difficult and the right adrenal vein is especially hard to catheterize. We retrospectively examined the clinically relevant anatomy of the right adrenal vein in a sample of 66 PA patients with technically successful AVS and distinctly-opacified right adrenal veins in Dyna computed tomography (CT). In the majority of cases: the right adrenal veins were catheterized when the catheter tilted posterior and rightward (57/66, 86.4%), the transverse direction of the right adrenal vein from the inferior vena cava (IVC) was posterior and rightward (55/66, 83.3%), and the vertical direction of the right adrenal vein from the IVC was caudal (52/66, 78.8%). This study shows that Dyna CT is able to provide detailed anatomical information to the course and direction of the right adrenal vein.

SUBMITTER: Lee BC

PROVIDER: S-EPMC4917856 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Evaluation of right adrenal vein anatomy by Dyna computed tomography in patients with primary aldosteronism.

Lee Bo-Ching BC Chang Chin-Chen CC Liu Kao-Lang KL Chang Yeun-Chung YC Wu Vin-Cent VC Huang Kuo-How KH

Scientific reports 20160623

Primary aldosteronism (PA) is the most common cause of secondary hypertension and consists up to 11% of patients with hypertension. Adrenal venous sampling (AVS) is the recommended procedure for diagnosis of PA, but the technique is difficult and the right adrenal vein is especially hard to catheterize. We retrospectively examined the clinically relevant anatomy of the right adrenal vein in a sample of 66 PA patients with technically successful AVS and distinctly-opacified right adrenal veins in ...[more]

PMID: 27334209

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Project description:ObjectiveThis study aimed to investigate the feasibility of computed tomography (CT) texture analysis for distinguishing canine adrenal gland tumors and its usefulness in clinical decision-making.Materials and methodsThe medical records of 25 dogs with primary adrenal masses who underwent contrast CT and a histopathological examination were retrospectively reviewed, of which 12 had adenomas (AAs), 7 had adenocarcinomas (ACCs), and 6 had pheochromocytomas (PHEOs). Conventional CT evaluation of each adrenal gland tumor included the mean, maximum, and minimum attenuation values in Hounsfield units (HU), heterogeneity of the tumor parenchyma, and contrast enhancement (type, pattern, and degree), respectively, in each phase. In CT texture analysis, precontrast and delayed-phase images of 18 adrenal gland tumors, which could be applied for ComBat harmonization were used, and 93 radiomic features (18 first-order and 75 second-order statistics) were extracted. Then, ComBat harmonization was applied to compensate for the batch effect created by the different CT protocols. The area under the receiver operating characteristic curve (AUC) for each significant feature was used to evaluate the diagnostic performance of CT texture analysis.ResultsAmong the conventional features, PHEO showed significantly higher mean and maximum precontrast HU values than ACC (p < 0.05). Eight second-order features on the precontrast images showed significant differences between the adrenal gland tumors (p < 0.05). However, none of them were significantly different between AA and PHEO, or between precontrast images and delayed-phase images. This result indicates that ACC exhibited more heterogeneous and complex textures and more variable intensities with lower gray-level values than AA and PHEO. The correlation, maximal correlation coefficient, and gray level non-uniformity normalized were significantly different between AA and ACC, and between ACC and PHEO. These features showed high AUCs in discriminating ACC and PHEO, which were comparable or higher than the precontrast mean and maximum HU (AUC = 0.865 and 0.860, respectively).ConclusionCanine primary adrenal gland tumor differentiation can be achieved with CT texture analysis on precontrast images and may have a potential role in clinical decision-making. Further prospective studies with larger populations and cross-validation are warranted.

Project description:ImportanceAdrenal vein sampling (AVS) is the recommended procedure for subtyping primary aldosteronism (PA) as unilateral PA (UPA) or bilateral PA (BPA), with different treatment needed for each: adrenalectomy for UPA and medication for BPA. However, AVS is invasive and technically difficult, and how to subtype PA noninvasively is currently a great challenge.ObjectiveTo evaluate the accuracy of gallium-68 pentixafor positron emission tomography-computed tomography (PET-CT) in subtyping PA using AVS as a reference standard.Design, setting, and participantsThis diagnostic study was conducted at a tertiary hospital in China among patients diagnosed with PA. Enrollment was started in November 2021, with follow-up ending in May 2022.Exposures: Patients were recruited to undergo gallium-68 pentixafor PET-CT and AVS.Main outcomes and measuresMaximum standardized uptake value (SUVmax) of each adrenal gland during PET-CT was measured to calculate the lateralization index of SUVmax. Area under the receiver operating characteristic curve (AUROC), specificity, and sensitivity were used to analyze the accuracy of the lateralization index based on SUVmax for subtyping PA.ResultsAmong 100 patients with PA who completed the study (47 female [47.0%] and 53 male [53.0%]; median [IQR] age, 49 [38-56] years), 43 individuals had UPA and 57 individuals had BPA. Aldosterone-cortisol ratio (Spearman ρ = 0.26; P < .001) in adrenal veins was positively correlated with SUVmax of adrenal glands at 10 minutes during PET-CT. Using lateralization index based on SUVmax at 10 minutes to identify UPA, the AUROC was 0.90 (95% CI, 0.83-0.97). A cutoff value for lateralization index based on SUVmax at 10 minutes set at 1.65 conferred a specificity of 1.00 (95% CI, 0.94-1.00) and sensitivity of 0.77 (95% CI, 0.61-0.88). The diagnostic concordance rate of PET-CT and AVS was 90 patients (90.0%) compared with 54 patients (54.0%) between traditional CT and AVS.Conclusions and relevanceThis study found good diagnostic accuracy of gallium-68 pentixafor PET-CT in differentiating UPA from BPA. These findings suggest that gallium-68 pentixafor PET-CT may be used to avoid invasive AVS in some patients with PA.

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Evaluation of right adrenal vein anatomy by Dyna computed tomography in patients with primary aldosteronism.

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Evaluation of right adrenal vein anatomy by Dyna computed tomography in patients with primary aldosteronism.

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