Adrenal Vein Sampling in Primary Aldosteronism: Sensitivity and Specificity of Basal Adrenal Vein to Peripheral Vein @entity701 and XXXX Ratios to Confirm Catheterization of the Adrenal Vein.

@entity1 @entity4545 @entity1369 @entity701 @entity9495
UNASSIGNED: Purpose To assess the sensitivity and specificity for ratios of adrenal vein @entity701 level ( @entity9495 ) to peripheral vein @entity701 level (Cp), adrenal vein @entity1369 level (Aa) to peripheral vein @entity1369 level (Ap), and combined @entity701 and @entity1369 levels ("combined ratio") for the detection of successful adrenal vein catheterization ("selectivity") in adrenal vein sampling (AVS) without @entity4545 (ACTH) injection at different cutoff values. Materials and Methods This retrospective study was approved by the institutional review board, and informed consent was waived. AVS was performed in 160 consecutive @entity1 (49 @entity1 and 111 @entity1 ; mean age, 53.6 years) between December 1989 and January 2014. @entity701 and @entity1369 levels were measured in samples from the adrenal veins and left iliac vein every 5 minutes, two times before (basal) and three times after intravenous cosyntropin (ACTH 1-24) injection. Selectivity was defined by @entity9495 /Cp or Aa/Ap ratio of at least 5 in at least one sampling after ACTH administration. Sensitivity and specificity for the detection of selective adrenal vein catheterization were calculated for basal @entity9495 /Cp ratio, Aa/Ap ratio, and combined ratios for three cutoff values reported in the literature. The McNemar test was used to assess differences in sensitivity and specificity to detect selective adrenal vein catheterization. Results The sensitivity and specificity for the cutoff values of at least 3, at least 2, and at least 1.1 for the detection of AVS selectivity were respectively 50.4% and 100%, 70.8% and 100%, and 98.5% and 76.9% for @entity9495 /Cp ratio; 61.3% and 100%, 70.8% and 100%, and 94.2% and 53.8% for Aa/Ap ratio; and 75.2% and 100%, 88.3% and 100%, and 99.3% and 46.2% for combined ratios (sensitivity at the >= 2 cutoff value: P < .0001 for combined ratio vs @entity9495 /Cp ratio and for combined ratio vs Aa/Ap ratio). Conclusion Basal combined ratio has the best sensitivity for the detection of AVS selectivity at all cutoff values, and for all ratios, the cutoff value of at least 2 has the best sensitivity for 100% specificity. (  ) RSNA, 2015.
