Ultimately, the purpose of the test is to compare column three (Aldo/Cortisol ratio) in line 2 (L ADR) and line 3 (R ADR), representing the ratio of aldosterone to cortisol in the left adrenal vein and right adrenal vein, respectively. Using the A/C ratio provides "normalized" -- i.e. comparable -- aldosterone values for each gland. But before these normalized values can be compared, the full set of numbers must pass a number of quality/consistency checks to ensure that the values being compared are meaningful.
The issue here is that the R ADR and IVC are identical on Aldo, a vanishingly small probability in a successful test, and within 3% on the Cortisol, which is an even more serious problem (because the cortisol values must first pass certain tests before the aldosterone values can be considered meaningful). The implication is that the R ADR sample was not drawn from the vein principally draining the right adrenal gland.
Numerically speaking, R ADR Cortisol (46.5) divided by IVC Cortisol (45.2) should be much, much higher or lower. Different authorities cite different minimum ratios, but the actual result of 1.03 is nowhere close to acceptable. A ratio of 1.00 means "no difference whatsoever" and a ratio of 1.03 means "no meaningful difference." Thus the R ADR numbers do not qualify as saying anything at all about right adrenal secretion and cannot be compared to the L ADR values. Strictly speaking, the L ADR value set also fails a number of authorities' quality requirements, but it has redeeming traits lacking in the R ADR values.
It is also beyond puzzling that since this test was performed with ACTH stimulation, some of the cortisol levels are 1/10th to 1/30th of what one expects to see.
The radiologist and endocrinologist insist up, down, and sideways that this is a completely valid and usable result. The higher authorities who have chimed in say that it is the epitome of failure in sampling the right adrenal vein.
Insightful comments on these numbers are invited.
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