Author(s)

Kimei Azama¹, Masahiro Okada², Akira Yogi¹, Tomomi Koga³, Yuko Iraha¹, Joichi Heianna¹, Hideaki Nakamura⁴, Hiroaki Masuzaki⁴, Sadayuki Murayama¹

¹Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan.
²Department of Radiology, Nihon University School of Medicine, Tokyo, Japan.
³Department of Radiology, Nakagami Hospital, Okinawa, Japan.
⁴Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan.

Purpose: The purpose was to investigate the most accurate method of adrenal venous sampling to diagnose unilateral primary aldosteronism (PA) prior to laterality assessment. Materials and Methods: Sixty-four consecutive PA patients were enrolled in this retrospective study. A catheter was placed in the common-trunk-vein (CTV), below the confluence of the inferior-phrenic-vein and the central-adrenal-vein (CAV) and the right-adrenal-vein (RAV). Blood-sampling was performed both pre- and post-adrenocorticotropic hormone stimulation. Lateralized ratio [LR; aldosterone/cortisol ratio (ACR) on high-value side/ACR on low-value side], contralateral ratio (CR; ACR on low-value side/ACR on inferior-vena-cava ratio), and plasma aldosterone concentration (PAC) were evaluated. The diagnostic accuracy of LR, CR and PAC in CTV/ CAV/RAV during pre- and post-ACTH was compared by receiver-operating-characteristic (ROC) analysis. Results: LR-CAV post-ACTH showed the highest detection rate for unilateral adrenal lesions (93.3%; 14/15), with a sensitivity of 0.93 and a specificity of 0.84 at a cut-off value of 2.5. CR-post-ACTH had the highest Az value (0.89), with a detection rate of 86.7% (13/14), a sensitivity of 0.98, and a specificity of 0.88 at a cut-off value of 0.8. Conclusion: CR-post-ACTH and LR-CAV-post-ACTH are accurate predictors for laterality assessment in PA.

Adrenal Venous Sampling, Primary Aldosteronism, Hypertension, Adrenal Grand

Azama, K. , Okada, M. , Yogi, A. , Koga, T. , Iraha, Y. , Heianna, J. , Nakamura, H. , Masuzaki, H. and Murayama, S. (2017) Adrenal Venous Sampling in Patients with Primary Aldosteronism: Which Is the Best Evaluation Method for Laterality Assessments?. Open Journal of Radiology, 7, 219-227. doi: 10.4236/ojrad.2017.74024.