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Povzetek: Background Adrenal vein sampling (AVS) is essential for diagnostics of primary aldosteronism, distinguishing unilateral from bilateral disease and determining treatment options. We reviewed the performance of AVS for primary aldosteronism at our center during first 15 years, comparing the initial period to the period after the introduction of a dedicated radiologist. Additionally, AVS outcomes were checked against CT findings and the proportion of operated patients with proven unilateral disease was estimated. Patients and methods A retrospective cross-sectional study conducted at the national endocrine referral center included all patients with primary aldosteronism who underwent AVS after its introduction in 2004 until the end of 2018. AVS was performed sequentially during Synacthen infusion. When the ratio of cortisol concentrations from adrenal vein and inferior vena cava was at least 5, AVS was considered successful. Results Data from 235 patients were examined (168 men; age 32%73, median 56 years; BMI 18%48, median 30.4 kg/ m2). Average number of annual AVS procedures increased from 7 in the 2004%2011 period to 29 in the 2012%2018 period (p < 0.001). AVS had to be repeated in 10% of procedures; it was successful in 77% of procedures and 86% of patients. The proportion of patients with successful AVS (92% in 2012%2018 vs. 66% in 2004%2011, p < 0.001) and of successful AVS procedures (82% vs. 61%, p < 0.001) was statistically significantly higher in the recent period. Conclusions Number of AVS procedures and success rate at our center increased over time. Introduction of a dedicated radiologist and technical advance expanded and improved the AVS practice.
Ključne besede: angiography, adrenal gland, endocrine disorders
Objavljeno v DiRROS: 15.07.2024; Ogledov: 46; Prenosov: 25
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Povzetek: Conventional ECG gated spin-echo (SE) magnetic resonance imaging (MR) and magnetic resonance angiography (MRA) are excellent methods for diagnosing thoracic aortic disease. SE image provides a good spatial resolution for defining aortic anatomy and relationships to adjacent tissues. MRA shows flow but temporal resolution is inferior to conventional MR images. Contrast-enhanced 3D (three-dimensional) MRA is very accurate for defining thoracic aortic anatomy and is particularly good for defining branch vessel abnormality. The sensitivity and specificity for diagnosing aortic dissection are the highest in comparison to other modalities (echocardiography, CT angiography) and range from 95% to 100% and 94% to 100%, respectively. MR can define clearly the full diameter of aortic aneurysm and also shows the amount of thrombi within it and its craniocaudal extent. A combination of SE and cineMRA is usually necessary. The same sequence with contrast enhancement provides all the required information on the congenital abnormalities of the aorta. MR is very reliable in congenital aortic abnormalities, aortic aneurysmand aortic dissection in hemodynamically stable patients. It should beused for all chronic thoracic aortic disease and postsurgical follow-up. Unstable patients that need intensive hemodynamic monitoring are unsuitable for MR.
Objavljeno v DiRROS: 24.01.2024; Ogledov: 345; Prenosov: 71
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Povzetek: Background. The introduction of helical CT scanners in combination with simultaneous opacification of vessels with contrast medium allows the demonstration of vessels within the chosen volume of interest. This examination is called CT angiography. Being a minimally invasive method, it has been quickly accepted in the spectrum of vessel-imaging modalities, as forexample: Doppler ultrasound, magnetic resonance angiography, transesophageal ultrasound etc. In the field of cardiovascular radiology, it has been used to demonstrate pathology of ascending and descending aorta, likethe aneurysms, dissection, traumatic rupture or congenital anomalies. It is also very useful in pre- and postoperative follow-up in the aortic stent-graft insertion, a method which has recently become popular. Also the CTangiography has greatly influenced the preoperative calculations and has clearly demonstrated the postoperative anatomical changes as well as complications (i.e. peristental leakage). Conclusions. In this context, it is comparable to intraarterial angiography and even offers some advantages over the latter. The only draw-back being somewhat lower spatial resolution and longer processing time, but with the advent of a new, so called multi-slice scanners and powerful workstations, these draw-backs will be minimized.
Objavljeno v DiRROS: 24.01.2024; Ogledov: 327; Prenosov: 78
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Objavljeno v DiRROS: 18.09.2023; Ogledov: 385; Prenosov: 119
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