Fig. 2: Primary outcomes.

a, Allocations to adrenalectomy and concordance of MTO and AVS. The number of patients scored as having a high probability of unilateral PA is shown for each independently scored investigation. The Venn diagram shows whether a high-probability score was achieved by one or both tests and includes the concordance between the investigations. 'Neither' indicates the number of patients who did not score as having a high probability of unilateral PA by either investigation and who were therefore recommended for medical therapy (total n = 128). b, Comparison of the accuracy of MTO and AVS in predicting a successful outcome from adrenalectomy. The four hierarchically analyzed measures of success (as outlined by the PASO consensus) are shown. The horizontal bars in the left panel are color coded as in a, reporting the proportion of high-probability scores for MTO or AVS, together or alone, that correctly predicted success. The middle panel shows the accuracy of each investigation, expressed as a percentage. The accuracy for each investigation was calculated as the number of patients who were scored as having a high probability of unilateral PA by that investigation (purple and gold bars for MTO and purple and green bars for AVS) and who achieved success, minus the number of patients in whom the investigation failed to predict a cure. The percentages exclude from the denominator the three patients who underwent adrenalectomy based on two medium-probability scores, on the basis of clinical grounds. The right panel shows the difference between the accuracies of MTO and AVS and the 95% CI around the difference, plotted for each outcome. All four sets of CI intervals cross zero, indicating that neither investigation was superior to the other. None of the lower bounds of the CI intervals cross the pre-specified margin of −17%, indicating that MTO is not inferior to AVS. The center of each error bar is the estimated difference in accuracy (%). P values for non-inferiority, from top to bottom, were: P = 0.00055, P = 0.0024, P = 0.0077 and P = 0.0091. The BinomDiffCI() function from R was used to calculate the 95% CI⁶¹ and to estimate the P values using a two-sided test (n = 78 for clinical success and n = 77 for biochemical success as post-operative biochemical data were not available for one patient; complete clinical success was achieved in this patient).