An Ancillary Method for Adrenal Venous Sampling in Cases in Which Right Adrenal Vein Sampling Is Difficult

Figures

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  Figure 1. Schematic diagram (a) and digital angiography (b,c) of the location of catheter placement in the S-rt. AdV. The catheter tip is placed at one vertebral level above the confluence of the IVC with the right AdV, and its orientation is adjusted so that it is pointing toward the right dorsal side in the same way as the right AdV.

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  Figure 2. Schematic diagram in case of hormone-producing lesion in the right adrenal gland (a), hormone-producing lesions in both adrenal glands (b) and hormone-producing lesion in the left adrenal gland (c). To explain the modified LI in simple terms, assume that a hormone-producing lesion produces 10 units of hormones, and a normal adrenal gland produces 1 unit. Taking no account of hormone dilution. In case of (a), total of 11 units of hormone will be detected in the blood sampled from the S-rt. AdV by the 10 units of oversecreted by the lesion in right adrenal gland and the 1 unit secreted normal left adrenal gland. In case of (b), total of 20 units of hormone will be detected in the blood sampled from the S-rt. AdV by the 10 unit oversecreted by the lesion in both adrenal glands. In case of (c), total of 11 units of hormone will be detected in the blood sampled from the S-rt. AdV by the one unit secreted normal left adrenal gland and the 10 units of oversecreted by the lesion in right adrenal gland. Substituting these values into the formula for calculating the modified LI, in case of (a) (Rt. UAPA), the modified LI = 1/11 = 0.1, in case of (b) (IHA), the modified LI = 10/20 = 0.5 and…

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  Figure 3. Conventional LIs of right APA (23.3 ± 25.8) and left APA (7.0 ± 5.3) were significantly higher than that of IHA (1.8 ± 2.5) (p = 0.003 and p < 0.001).

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  Figure 4. The modified LI of right APA (0.4 ± 0.4) was significantly lower than those of IHA (1.4 ± 0.7) (p < 0.001) and left APA (3.5 ± 2.0) (p < 0.001). The modified LI of left APA was significantly higher than those of IHA (p < 0.001) and right APA (p < 0.001).

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  Figure 5. ROC curve analysis for the diagnostic performance of the modified LI, the AUC was 0.92 in right APA (a) and 0.81 in left APA (b). To diagnose right APA and left APA using the modified LI, likelihood were 27.0, and 18.6, respectively, with threshold values of 0.7 and 2.2, respectively.