title: Successful Adrenal Venous Sampling by Non-experts with Reference to CT Images.
abstract: OBJECTIVE
  To establish technical success rates and safety of adrenal venous sampling (AVS) performed by non-experts with reference to CT images.
  
  
  METHODS
  104 AVS procedures with adrenocorticotropic hormone stimulation were performed for patients with suspected primary aldosteronism. One of three radiology residents with 2nd, 5th, and 5th grade experience undertook the procedure under the guidance of an experienced, board-certified interventional radiologist with reference to contrast-enhanced CT images obtained in 102 cases. Successful catheterization of the adrenal veins was assessed using three criteria: an adrenal venous cortisol concentration of more than 200 μg/dL (criterion A); an adrenal vein/inferior vena cava cortisol ratio of more than 5:1 (criterion B); and an adrenal vein/inferior vena cava cortisol ratio of more than 10:1 (criterion C).
  
  
  RESULTS
  The operators were aware of the anatomy of the left adrenal veins in 102 cases (98 %) and of the right adrenal veins in 99 cases (95 %) prior to the procedure. CT identified the correct position of the right adrenal vein orifice in 82 of 99 cases (83 %). The overall technical success rates for AVS from the right adrenal vein according to criteria A, B, and C, were 96, 96, and 94 %, respectively. Those for the left adrenal vein were 97, 98, and 94 %, respectively. No significant differences in success rates were observed between the operators (p = 0.922-0.984). No major complications, including adrenal vein rupture, were observed.
  
  
  CONCLUSIONS
  When CT images are used to guide AVS, the procedure can be performed successfully and safely even by non-experts.
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. i@imodey.com.
authors.forename: Satoru
authors.initials: S
authors.lastname: Morita
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamazaki
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sonoyama
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Nishina
authors.affiliation: Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University Hospital, Tokyo, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Ichihara
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Sakai
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply* / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods*; D012082:Renal Veins / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: AVS; Adrenal venous sampling; Hypertension; Interventional radiology; Primary aldosteronism