title: Diagnostic performance of multidetector computed tomography in distinguishing unilateral from bilateral abnormalities in primary hyperaldosteronism: comparison of multidetector computed tomography with adrenal vein sampling.
abstract: OBJECTIVE
  The management of patients with primary hyperaldosteronism (PH) varies depending on whether the unregulated aldosterone secretion localizes to a single unilateral adrenal gland, traditionally determined using adrenal vein sampling (AVS). This study seeks to determine if the performance of multidetector computed tomography (MDCT) examinations performed using the latest scanner technology can reasonably match the results of AVS, and potentially avoid AVS in some patients.
  
  
  METHODS
  Computed tomographic scans in 56 patients with PH were independently reviewed by 2 radiologists for the presence of adrenal nodules and qualitative adrenal thickening. Results were correlated with AVS results.
  
  
  RESULTS
  Of 35 patients with MDCT evidence of unilateral nodules, the imaging findings correctly predicted AVS localization in only 23 (65.7%) cases. When stratified by size, MDCT was accurate in only 71.4% of cases for nodules measuring 10 mm or less, and only 55.0% of cases for nodules measuring 11 to 20 mm. Of the 12 cases where MDCT did not correctly localize, AVS localized to the contralateral adrenal gland in 4 cases, whereas AVS suggested no lateralization in 8 cases. In patients with normal bilateral adrenal glands on MDCT, 2/7 (28.6%) of cases demonstrated unilateral localization on AVS, and in patients with bilateral adrenal nodules, only 3/14 (21.4%) did not demonstrate lateralization on AVS.
  
  
  CONCLUSIONS
  Multidetector computed tomography, even when performed with the latest generation of MDCT scanners, does not offer sufficient diagnostic accuracy to replace AVS in patients with PH.
authors.affiliation: From the *Department of Radiology, Johns Hopkins University; †Division of Interventional Radiology, Department of Radiology, ‡Division of Endocrinology, Department of Medicine, and §Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Siva P
authors.initials: SP
authors.lastname: Raman
authors.forename: Mark
authors.initials: M
authors.lastname: Lessne
authors.forename: Satomi
authors.initials: S
authors.lastname: Kawamoto
authors.forename: Yifei
authors.initials: Y
authors.lastname: Chen
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvatori
authors.forename: Jason D
authors.initials: JD
authors.lastname: Prescott
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014680:Veins / Q000378:metabolism
chemical_list: D015415:Biomarkers; D000450:Aldosterone; D006854:Hydrocortisone