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A Novel Method: Super-selective Adrenal Venous Sampling
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Contralateral Suppression Index as a Surrogate Marker for Aldosterone Lateralization in Simulated Incomplete Adrenal

Derik J Basson1, Alfredo Páez-Carpio1, Amos Kalu1

  • 1Division of Interventional Radiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

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Summary

The contralateral suppression index (CSI) accurately predicts aldosterone lateralization, even with incomplete adrenal vein sampling (AVS). Specific CSI thresholds offer high diagnostic certainty, especially when combined with imaging findings.

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Area of Science:

  • Endocrinology
  • Surgical Innovation
  • Diagnostic Accuracy

Background:

  • Primary aldosteronism diagnosis relies on adrenal vein sampling (AVS).
  • Incomplete AVS can lead to misdiagnosis of aldosterone lateralization.
  • Novel tools are needed to improve diagnostic reliability.

Purpose of the Study:

  • To assess the contralateral suppression index (CSI) for predicting aldosterone lateralization.
  • To evaluate CSI performance under simulated incomplete AVS.
  • To determine the influence of adrenal nodules and patient age on CSI accuracy.

Main Methods:

  • Retrospective analysis of 362 primary aldosteronism patients undergoing AVS.
  • Simulated incomplete AVS by masking one adrenal side during reanalysis.
  • Calculated CSI and assessed performance metrics (PPV, sensitivity, specificity) at various thresholds (>1.0, >0.5, >0.2).
  • Stratified analysis by presence of adrenal nodules and age (<35 vs ≥35 years).

Main Results:

  • CSI was significantly lower in lateralized cases (mean 0.33) versus non-lateralized (mean 3.16).
  • CSI < 1 showed 70% PPV, 88% sensitivity, 94% specificity without nodules.
  • Thresholds CSI < 0.5 and < 0.2 achieved 98-100% PPV and specificity.
  • Performance remained robust across age groups and with concordant adrenal nodules.

Conclusions:

  • CSI is a reliable predictor of aldosterone lateralization during simulated incomplete AVS.
  • CSI thresholds of ≤0.5 and ≤0.2 provide high diagnostic accuracy.
  • Combining CSI with imaging data enhances diagnostic confirmation for aldosterone lateralization.