Bilateral inferior petrosal sinus sampling: Procedural data from a German single-center study

Abstract

Purpose To assess radiation exposure and diagnostic performance of bilateral inferior petrosal sinus sampling for the distinction of pituitary and ectopic adrenocorticotropin-dependent Cushingʼs syndrome.

Materials and Methods Procedural data of bilateral inferior petrosal sinus procedures were retrospectively evaluated. The analysis included the patients’ clinical and demographic data, procedural radiation exposure, and complication rates, sampling results, clinical course of the patients, and calculation of diagnostic performance data.

Results The cases of 46 patients diagnosed with adrenocorticotropin-dependent Cushingʼs syndrome were evaluated. Bilateral inferior petrosal sinus sampling was successfully performed in 97.8 % of the cases. The overall median procedure-related fluoroscopy time was 7.8 min. (range 3.2–36.2 min.), and the median procedural dose area product was 11.9 Gy*cm² (range 2.1–73.7 Gy*cm²). Radiation doses due to digital subtraction angiography series for visualization of the inferior petrosal sinus were 3.6 Gy*cm² (range 1.0–18.1 Gy*cm²). Radiation doses due to fluoroscopy had a higher impact on the overall radiation exposure and were significantly influenced by the patients’ habitus. The sensitivity, specificity, and positive and negative predictive values were 84 %, 100 %, 100 %, and 72 % before stimulation with corticotropin-releasing hormone, and 97 %, 100 %, 100 %, and 93 % after stimulation. Concordance between magnetic resonance imaging studies and bilateral inferior petrosal sinus sampling results was only found in 35.6 % of the cases. The periprocedural complication rate was 2.2 %, with one patient experiencing vasovagal syncope during catheterization.

Conclusion Bilateral inferior petrosal sinus sampling is a safe procedure with high technical success rates und excellent diagnostic performance. The procedure-related radiation exposure shows large variations and depends on the complexity of cannulation as well as the patients’ habitus. Fluoroscopy accounted for the largest proportion of radiation exposure. Acquisition of digital subtraction angiography series for the verification of correct catheter placement appears justified.

Key Points: 

• Bilateral inferior petrosal sinus sampling with CRH stimulation provides high diagnostic performance in the distinction of pituitary and ectopic Cushingʼs syndrome.

• The associated radiation exposure is not negligible and is significantly influenced by the use of fluoroscopy and the patients’ habitus.

• Digital subtraction angiography contributes less to the overall radiation dose and appears justified for the verification of correct catheter placement.

Citation Format

• Augustin A, Detomas M, Hartung V et al. Bilateral inferior petrosal sinus sampling: Procedural data from a German single-center study. Fortschr Röntgenstr 2023; 195: 1009 – 1017

Zusammenfassung

Ziel Bestimmung der Strahlenbelastung und diagnostischen Leistungsfähigkeit der Sinus-petrosus-Blutentnahme bei der Differenzierung von hypophysärem und ektopem Adrenocorticotropin-abhängigem Cushing-Syndrom.

Material und Methoden Prozedurbezogene unizentrische Daten der Sinus-petrosus-Blutentnahme wurden retrospektiv ausgewertet. Anhand klinischer und demografischer sowie prozedurbezogener Daten wurde neben der intraprozeduralen Strahlenbelastung die diagnostische Leistungsfähigkeit der Sinus-petrosus-Blutentnahme analysiert.

Ergebnisse Die Auswertung beinhaltete die Daten von 46 Patienten mit der Diagnose eines Adrenocorticotropin-abhängigen Cushing-Syndroms. Die bilaterale Blutentnahme gelang im ersten Versuch in 97,8 % der Fälle. Die mediane prozedurbezogene Durchleuchtungszeit belief sich auf 7,8 min (3,2–36,2 min), das Dosisflächenprodukt auf 11,9 Gy*cm² (2,1–73,7 Gy*cm²). Dabei entfielen im Median 3,6 Gy*cm² (1,0–18,1 Gy*cm²) auf die Akquisition von digitalen Subtraktionsangiografie-Serien. Die Strahlenbelastung durch Einsatz der Durchleuchtung hatte einen höheren Einfluss auf die Gesamtdosis und wurde signifikant durch den Habitus der Patienten beeinflusst. Sensitivität, Spezifität, positiver und negativer Vorhersagewert beliefen sich auf 84 %, 100 %, 100 %, und 72 % vor Corticotropin-Releasing-Hormon-Stimulation und auf 97 %, 100 %, 100 %, und 93 % danach. Eine Übereinstimmung der Ergebnisse der hypophysären Magnetresonanztomografie und der Sinus-petrosus-Blutentnahme-Ergebnisse lag in nur 35,6 % der Fälle vor. Die prozedurbezogene Komplikationsrate betrug 2,2 %, wobei ein Patient während der Katheterisierung eine vasovagale Synkope erlitt.

Schlussfolgerung Die Sinus-petrosus-Blutentnahme ist ein sicheres Verfahren mit hohen technischen Erfolgsraten und diagnostischer Leistungsfähigkeit. Die prozedurbezogene Strahlenbelastung zeigt eine breite Variabilität und wird durch die Komplexität der Sondierung sowie den Patientenhabitus beeinflusst. Die Akquisition von digitalen Subtraktionsangiografie-Serien zur Verifikation der korrekten Katheterplatzierung vor Blutentnahme kann basierend auf den vorliegenden Daten als gerechtfertigt bewertet werden.

Kernaussagen: 

• Die bilaterale Sinus-petrosus-Blutentnahme bietet hohe diagnostische Wertigkeit bei der Unterscheidung des hypophysären und ektopen Cushing-Syndroms.

• Die damit assoziierte Strahlenbelastung ist nicht zu vernachlässigen und wird maßgeblich durch den Einsatz der Durchleuchtung und den Patientenhabitus beeinflusst.

• Die digitale Subtraktionsangiografie trägt zu einem geringeren Anteil zur Gesamtdosis bei und kann vor dem Hintergrund der Verifikation der korrekten Katheterlage als gerechtfertigt bewertet werden.

Key words

Cushingʼs disease - diagnostic radiology - pituitary - interventional procedures - adenoma - bilateral inferior petrosal sinus sampling

Publication History

Received: 14 December 2022

Accepted: 23 April 2023

Article published online:
24 May 2023

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