Diagnostic and Interventional Radiology
Interventional Radiology - Original Article

Radiological characteristics and diagnostic impact of duplicated right adrenal veins on adrenal venous sampling in primary aldosteronism

1.

Department of Radiology, Yokohama Rosai Hospital, Yokohama, Japan

2.

Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

3.

Department of Radiology, Nerima Hikarigaoka Hospital, Tokyo, Japan

4.

Department of Interventional Radiology at Saiseikai Yokohama City Nanbu Hospital, Yokohama, Japan

5.

Endocrinology and Diabetes Center Yokohama Rosai Hospital, Yohama, Japan

Diagn Interv Radiol 2021; 27: 754-761
DOI: 10.5152/dir.2021.21388
Read: 228 Downloads: 64 Published: 13 October 2021

PURPOSE
We aimed to analyze the prevalence and radiological characteristics of duplicated right adrenal veins (DRAVs) and evaluate the diagnostic impact of adrenal venous sampling (AVS) in primary aldosteronism.

METHODS
DRAVs were retrospectively identified among patients who underwent segmental AVS between April 2017 and March 2020. DRAVs were defined as main or accessory according to the drainage area. The diameter, position, hormone levels, and treatment plan based on AVS were compared between main and accessory RAVs, using the Wilcoxon rank-sum test.

RESULTS
Fourteen of 432 patients (3.2%) were diagnosed with DRAVs. On venography, the mean diameters of the main and accessory side were 3±0.63 mm and 2.1±0.41 mm, respectively, and were significantly different (p < 0.001). The mean relative position in craniocaudal direction of main and accessory veins from the adrenal caudal edge on computed tomography was 65.5%±16.0%, and 48.1%±16.8%, respectively, which was significantly different (p = 0.007). The left–right positions and hormone levels were not significantly different. Based on conventional AVS, the treatment plan between DRAVs was not changed in six of eight patients, but changed from surgery to medication in two patients with right aldosterone-producing adenoma (APA)/microadenoma based on segmental AVS findings.

CONCLUSION
DRAVs, in which the main RAV was thicker and more cranially located than the accessory RAV were rare. Depending on blood sampled from either of DRAVs, the diagnosis made through conventional AVS might change treatment approach from surgery to medication, especially with right APA. Hence, their identification is important to make an accurate subtyping by AVS.

You may cite this article as: Tannai H, Makita K, Matsui S, Koike Y, Tsurutani Y, Saito J. Radiological characteristics and diagnostic impact of duplicated right adrenal veins on adrenal venous sampling in primary aldosteronism. Diagn Interv Radiol 2021; 27:754–761.

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