ADRENAL VENOUS SAMPLING SUCCESS RATE AND CONCORDANCE WITH IMAGING

A SINGLE CENTER EXPERIENCE IN MALAYSIA

Abstract

INTRODUCTION
The two most common subtypes of primary aldosteronism are aldosterone producing adenoma and bilateral adrenal hyperplasia. These require specific therapeutic approach consisting of either unilateral adrenalectomy or lifelong mineralocorticoid receptor antagonists. Adrenal venous sampling (AVS) is the gold standard for subtype diagnosis. However, it is technically challenging and has limited availability.

METHODOLOGY
This study describes the success rate at our centre, with implementation of the intraprocedural Quick Cortisol Assay (QCA). A total of 60 AVS procedures were performed by two radiologists consecutively at Institut Kanser Negara from January 2016 to February of 2019.

RESULTS
The overall success rate was 72% (43/60). The success rate of cases performed prior to QCA was 60% (9/15) compared to 79% (11/14) with use of QCA. Subsequent successful cannulation rates improved to 86% (12/14) despite discontinuation of QCA use with the same radiologist. Introduction of a different radiologist in 2018 resulted in success rates of 64% (9/14) without use of QCA. The most common cause of failure was inability to cannulate the right adrenal vein (76%, 13/17). Concordance rates between AVS and imaging findings were 79% (34/43) while discordance rates were 9% (4/43). The remaining patients had non-specific findings. The use of AVS potentially changed management in 23% (10/43) of patients.

CONCLUSION
This illustrates the benefit of QCA in improving the success rates and operator learning curve. The concordance rates were relatively high between AVS and imaging for our centre with most imaging findings showing unilateral lesion with concordant lateralization.