title: Adjunctive use of C-arm CT may eliminate technical failure in adrenal vein sampling.
abstract: OBJECTIVE
  To examine whether the use of C-arm computed tomography (CT) during adrenal vein sampling improves the technical success rate of the procedure.
  
  
  METHODS
  Nine consecutive patients with suspected primary hyperaldosteronism underwent standard adrenal vein sampling that included cortisol stimulation. The procedure was augmented with multiplanar C-arm CT images reconstructed from data acquired during a 180 degrees C-arm rotation. Whenever C-arm CT images showed the sampling catheter to be in the wrong position, the catheter was repositioned. Cortisol response was correlated to C-arm CT findings.
  
  
  RESULTS
  All patients had successful and diagnostic adrenal vein sampling. C-arm CT showed sampling catheter malposition in two patients (22%). Repeat C-arm CT after repositioning showed proper catheter location. Cortisol stimulation results and C-arm CT findings were concordant in 100% of cases.
  
  
  CONCLUSIONS
  C-arm CT is reliable in confirming the location of sampling catheters during adrenal vein sampling. If the 100% concordance between cortisol stimulation and C-arm CT findings is found in larger groups, the technical success rate may approach 100%. Cortisol stimulation may become obsolete and repeat procedures unnecessary, with significant time and cost savings.
authors.affiliation: Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 545, Baltimore, Maryland 21287, USA. cgeorgi@jhmi.edu
authors.forename: Christos S
authors.initials: CS
authors.lastname: Georgiades
authors.forename: Kelvin
authors.initials: K
authors.lastname: Hong
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Geschwind
authors.forename: Robert
authors.initials: R
authors.lastname: Liddell
authors.forename: Labib
authors.initials: L
authors.lastname: Syed
authors.forename: Julia
authors.initials: J
authors.lastname: Kharlip
authors.forename: Aravind
authors.initials: A
authors.lastname: Arepally
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply* / Q000000981:diagnostic imaging; D000450:Aldosterone / Q000097:blood*; D001774:Blood Chemical Analysis / Q000379:methods; D002406:Catheterization, Peripheral / Q000379:methods*; D003951:Diagnostic Errors / Q000517:prevention & control; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000000981:diagnostic imaging*; D010690:Phlebography / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods