Image Fusion Guidance with Pre-procedural CT with Real-Time Fluoroscopy for Adrenal Venous Sampling.

Abstract

To assess the effectiveness of image fusion guidance (IF) with pre-procedural computed tomography (CT) with intraprocedural fluoroscopy for adrenal venous sampling (AVS). AVS before and after ACTH stimulation including bilateral segmental sampling of effluent tributaries was performed in 62 patients with IF. A 3D volume rendering image, including adrenal glands and veins extracted from previously obtained contrast-enhanced CT images, was manually registered to the real-time X-ray fluoroscopy. The technical success rates, procedure time, radiation exposure, and volume of contrast medium used were compared with 49 patients who underwent AVS without IF. No significant differences in the technical success rates with and without IF were observed (98.4 vs. 91.8% for the right adrenal veins, p = 0.168, and 98.4 vs. 100% for the left adrenal veins, p = 1.000). The procedure time with IF was significantly shorter than that without IF (95.6 ± 18.8 vs. 108.4 ± 20.0min, p = 0.001). The total dose-area product with IF was significantly lower than that without IF (43.1 ± 30.7 vs. 72.2 ± 45.3Gycm2, p < 0.001). The contrast medium volume used with IF was significantly lower than that without IF (54.6 ± 21.9 vs. 65.7 ± 27.6mL, p = 0.020). Although the contribution to improving the technical success rates was small in our study, IF can effectively reduce procedure time, radiation exposure, and volume of contrast medium during AVS.