# Adrenal Vein Sampling: The Role of a Diagnostic Inspiratory Contrast-Enhanced CT Scan in Interventional Planning

## TL;DR

This study shows that inspiratory CT scans help plan adrenal vein sampling procedures by visualizing the right adrenal vein and accounting for its position during fluoroscopy.

## Contribution

The study demonstrates the effectiveness of inspiratory CT scans in interventional planning for adrenal vein sampling.

## Key findings

- Inspiratory CT scans visualized the right adrenal vein in 99.2% of patients.
- There was a median difference of three vertebral levels between CT and fluoroscopy positions.
- Fluoroscopy showed a more cranial position of the right adrenal vein in 91.7% of cases.

## Abstract

Background/Objectives: Adrenal vein sampling is the gold standard for differentiating between unilateral and bilateral primary aldosteronism and guiding treatment. This study evaluates the utility of inspiratory CT scans in interventional planning, specifically assessing the right adrenal vein visualization and positional discrepancies during fluoroscopy. Methods: A retrospective analysis of 133 patients who underwent adrenal vein sampling was performed. Pre-procedural inspiratory CT scans were reviewed for visualization and location of the right adrenal vein using vertebral body levels as reference. The position of the right adrenal vein was then compared with the fluoroscopic findings during adrenal veins sampling. Results: The right adrenal vein was visualized on CT scans in 99.2% of patients. Cohen’s kappa demonstrated almost perfect agreement for both visualization of the right adrenal vein and position measurement. A median difference of three vertebral levels was observed between the level of the right adrenal vein on CT and fluoroscopy, with fluoroscopy showing a more cranial position in 91.7% of cases. Conclusions: Inspiratory CT scans visualize the right adrenal vein effectively and aid the planning of adrenal vein sampling. Understanding the positional discrepancies caused by respiratory motion is crucial for successful cannulation of the right adrenal vein, minimizing procedure time and contrast consumption and ultimately enhancing patient outcomes in the management of primary aldosteronism.