TY - JOUR
T1 - Does Intraprocedural CT Improve the Success Rate of Adrenal Venous Sampling? A Systematic Review and Meta-Analysis of Data from 809 Patients
AU - Hafezi-Nejad, Nima
AU - Gullotti, David M.
AU - Bailey, Christopher R.
AU - Lessne, Mark L.
AU - Holly, Brian P.
N1 - Publisher Copyright:
© 2021, Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
PY - 2022/1
Y1 - 2022/1
N2 - Purpose: To perform a systematic review and meta-analysis to quantify the technical success rate of adrenal venous sampling (AVS) with and without intraprocedural computed tomography (CT). Methods: A systematic search of the Medline, Scopus, EMBASE, and Web of Science databases for comparative studies using intraprocedural CT was undertaken. More than 1,000 records were screened using titles and abstracts. Full texts of 121 studies were reviewed and 14 eligible studies were identified. Nine studies had adequate comparative data and were included in the meta-analysis. Results: A research synthesis was performed and data from 809 patients were pooled in multiple random effect models. Overall success rate of AVS without and with intraprocedural CT was 72.7% (59.3–83.0%) and 92.5% (86.6–95.9), respectively. The addition of intraprocedural CT increased the technical success rate by 19.8% (P < 0.001), with an odds ratio (OR) of 5.5 (3.3–9.2; P < 0.01). In meta-regression, odds of success with intraprocedural CT was associated with younger age (beta: 0.16 ± 0.05; P:0.001), higher body mass index (BMI; beta:0.08 ± 0.03; P:0.002), and higher selectivity index (defined as the ratio of cortisol in the adrenal vein to that in the inferior vena cava; beta:0.35 ± 0.08, P < 0.001). We found a linear inverse association between operator’s success without CT and improved success with intraprocedural CT (R2: 0.86). Conclusions: Intraprocedural CT is not required for every case, but can be performed in difficult cases or when operators' success is limited. The benefit was more pronounced in younger patients with higher BMI, female gender, and with higher selectivity. Level of evidence: III Systematic review and meta-analysis of non-randomized clinical trials.
AB - Purpose: To perform a systematic review and meta-analysis to quantify the technical success rate of adrenal venous sampling (AVS) with and without intraprocedural computed tomography (CT). Methods: A systematic search of the Medline, Scopus, EMBASE, and Web of Science databases for comparative studies using intraprocedural CT was undertaken. More than 1,000 records were screened using titles and abstracts. Full texts of 121 studies were reviewed and 14 eligible studies were identified. Nine studies had adequate comparative data and were included in the meta-analysis. Results: A research synthesis was performed and data from 809 patients were pooled in multiple random effect models. Overall success rate of AVS without and with intraprocedural CT was 72.7% (59.3–83.0%) and 92.5% (86.6–95.9), respectively. The addition of intraprocedural CT increased the technical success rate by 19.8% (P < 0.001), with an odds ratio (OR) of 5.5 (3.3–9.2; P < 0.01). In meta-regression, odds of success with intraprocedural CT was associated with younger age (beta: 0.16 ± 0.05; P:0.001), higher body mass index (BMI; beta:0.08 ± 0.03; P:0.002), and higher selectivity index (defined as the ratio of cortisol in the adrenal vein to that in the inferior vena cava; beta:0.35 ± 0.08, P < 0.001). We found a linear inverse association between operator’s success without CT and improved success with intraprocedural CT (R2: 0.86). Conclusions: Intraprocedural CT is not required for every case, but can be performed in difficult cases or when operators' success is limited. The benefit was more pronounced in younger patients with higher BMI, female gender, and with higher selectivity. Level of evidence: III Systematic review and meta-analysis of non-randomized clinical trials.
KW - Adrenal gland
KW - Adrenal vein sampling
KW - Angiography
KW - Cone-beam CT
KW - Interventional CT
KW - Primary hyperaldosteronism
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U2 - 10.1007/s00270-021-02954-7
DO - 10.1007/s00270-021-02954-7
M3 - Article
C2 - 34518912
AN - SCOPUS:85114863007
SN - 0174-1551
VL - 45
SP - 29
EP - 40
JO - Cardiovascular and interventional radiology
JF - Cardiovascular and interventional radiology
IS - 1
ER -