Use of the upper pole of right adrenal gland as an anatomical landmark in adrenal vein sampling: A retrospective study

This study aimed to explore the relationship between the upper pole of right adrenal gland (RAG) and the orifice of right adrenal vein (RAV) and to evaluate the potential of using the RAG as an anatomic marker for localizing RAV in adrenal vein sampling (AVS). The images of 54 patients with primary aldosteronism with enhanced adrenal computed tomography and AVS findings were retrospectively analyzed. For data processing and analysis, each disc was considered as a separate segment, and each vertebral body was evenly divided into upper, middle, and lower segments. Therefore, the segment locations of both the upper pole of RAG and the RAV orifice with respect to the spine could be determined, as well as their horizontal distances to the spinal midline. T test and one-way ANOVA were conducted to assess intergroup differences in the distance between the RAV orifice and the upper pole of RAG. Statistical analysis revealed that 83.3% of RAV orifices (45 out of 54 patients) were located on the right side of the upper pole of the RAG, with 85.2% (46 out of 54 patients) positioned within a range from the third segment above to the first segment below the upper pole of the RAG. The mean vertical and horizontal distances between the RAV orifice and the upper pole of RAG were 1.0 ± 2.2 segments and 3.5 ± 5.0 mm, respectively. These dimensional parameters showed no significant differences among groups stratified by age, sex, osteoporosis, and BMI (all P > .05). These findings suggest that evaluating the location of the upper pole of RAG before the AVS procedure might narrow the exploration area for the RAV orifice, thereby increasing the success rate of RAV catheterization.