Initial experience with adrenal vein sampling using 3D cursor and preprocedural computed tomography (CT) scout image

To evaluate the success rate and learning curve of adrenal vein sampling (AVS) performed by a single interventional radiologist, using CT scout image marked with a 3D cursor.

The AVS procedure was conducted on 135 consecutive patients between January 2020 and December 2022 by a single interventional radiologist with no prior experience with AVS. Using a 3D cursor, the positions of the right adrenal vein (RAV), left adrenal vein (LAV), and left renal vein were marked on the CT scout image. AVS procedures were performed based on the marked scout image.

Of 135 AVS procedures, 123 (91.1%) were successful with success rates of 82.1% (23/28), 90.4% (47/52), and 96.4% (53/55) in the first, second, and third years, respectively. Among the 12 failures, 10 occurred on the right side and 2 on the left side. The reasons for failure were failure to locate the RAV (n=5), misidentification of a vessel as the adrenal vein (right, n=4; left, n=1), RAV sample haemolysis (n=1), and the absence of adrenocorticotrophic hormone (ACTH) stimulation (LAV, n=1). Three of the failed cases (misidentified RAV, n=1; sample haemolysis, n=1; and no ACTH stimulation, n=1) underwent repeat AVS, and all were successful.

AVS can be successfully performed by an operator without prior AVS experience using a 3D cursor and CT scout imaging. The success rate of AVS increases with the operator experience.