Cone-beam Computed Tomography is Not a Mandatory Procedure in Adrenal Venous Sampling for Primary Hyperaldosteronism

Objectives: To investigate the necessity of cone-beam computed tomography (CBCT) in adrenal venous sampling (AVS). Methods: This retrospective study included 120 consecutive patients with primary hyperaldosteronism who underwent AVS. Based on the learning curve of the interventional radiologists, the patients were divided into the learning (n=36) and proficiency (n=84) groups chronologically. Based on the imaging pattern of the right adrenal vein (RAV), the patients were divided into the typical (n=36) and atypical (n=84) groups. The success rate, radiation dose, and sampling time were compared among the entire study population and each subgroup. Results: A total of 69 patients underwent CBCT, whereas 51 patients did not. The overall success rate was 85.8%, and no difference was noted between patients with and without CBCT (P=0.347). However, radiation dose (P=0.018) and sampling time (P=0.001) were significantly higher in patients who underwent CBCT than in patients who did not. In learning group, CBCT improved success rate from 62.5% to 96.4% (P=0.028), whereas it was not found in the proficiency group (P=0.693). Additionally, success rate in patients with an atypical RAV imaging pattern was significantly higher when CBCT was used than when it was not used (P=0.041), whereas no difference was noted in patients with typical RAV imaging pattern (P=0.511). Conclusion: For physicians not very experienced doing AVS, there is a clear significant improvement in success rate when CBCT is used. However, CBCT only has minimal benefit for experienced operators, meanwhile CBCT may take an extra time and increase the radiation dose during AVS.