Adjunctive Use of C-Arm CT May Eliminate Technical Failure in Adrenal Vein Sampling

Purpose: To examine whether the use of C-arm computed tomography (CT) during adrenal vein sampling improves the technical success rate of the procedure. Materials and Methods: Nine consecutive patients with suspected primary hyperaldosteronism underwent standard adrenal vein sampling that included cortisol stimulation. The procedure was augmented with multiplanar C-arm CT images reconstructed from data acquired during a 180° C-arm rotation. Whenever C-arm CT images showed the sampling catheter to be in the wrong position, the catheter was repositioned. Cortisol response was correlated to C-arm CT findings. Results: All patients had successful and diagnostic adrenal vein sampling. C-arm CT showed sampling catheter malposition in two patients (22%). Repeat C-arm CT after repositioning showed proper catheter location. Cortisol stimulation results and C-arm CT findings were concordant in 100% of cases. Conclusions: C-arm CT is reliable in confirming the location of sampling catheters during adrenal vein sampling. If the 100% concordance between cortisol stimulation and C-arm CT findings is found in larger groups, the technical success rate may approach 100%. Cortisol stimulation may become obsolete and repeat procedures unnecessary, with significant time and cost savings.