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Delaney FT, Chung R, Blake MA, Sweeney AT. Imaging of Adrenal Masses. Endocr Pract 2025:S1530-891X(25)00894-8. [PMID: 40419086 DOI: 10.1016/j.eprac.2025.05.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2025] [Revised: 05/16/2025] [Accepted: 05/20/2025] [Indexed: 05/28/2025]
Abstract
Adrenal lesions are common and require appropriate management when clinically relevant. The approach to the evaluation of an adrenal lesion is to exclude malignancy and hormone excess as these are associated with significant morbidity and mortality. Imaging of adrenal lesions primarily aims to identify features indicating benignity. Non-contrast CT is recommended as first-line imaging for adrenal lesions. Indeterminate lesions that require further characterization may proceed to adrenal protocol CT (with contrast) or MRI, with a trend in recent years towards increasing use of MRI. PET-CT may also be used to assess adrenal lesions in certain clinical scenarios. Clinical guidelines recommend that all adrenal incidentalomas require further dedicated imaging unless they are clearly benign on imaging. The imaging strategy of adrenal lesions depends upon a number of factors including patient history, nature of detection, imaging characteristics (size, heterogeneity, presence of intracellular lipid), and the presence or absence of hormone excess. Special considerations are given to pregnant patients, young patients < 40 years, and those with a history of an extra-adrenal malignancy. This review outlines the role of imaging for adrenal lesions, describes the various imaging options and investigation strategies, and highlights relevant imaging findings.
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Affiliation(s)
- Francis T Delaney
- Department of Radiology, Massachusetts General Hospital, Boston, MA.
| | - Ryan Chung
- Department of Radiology, Massachusetts General Hospital, Boston, MA; Instructor, Harvard Medical School, Boston, MA
| | - Michael A Blake
- Department of Radiology, Massachusetts General Hospital, Boston, MA; Associate Professor of Radiology, Harvard Medical School, Boston, MA
| | - Ann T Sweeney
- Department of Medicine, Division of Endocrinology, St Elizabeth's Medical Center, Brighton, MA; Associate Professor of Medicine, Tufts University School of Medicine, Boston, MA
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Haag F, Emmrich SS, Hertel A, Rink J, Vellala A, Komlen S, Nörenberg D, Schoenberg SO, Froelich MF. Quantitative PCCT imaging in differentiating adrenal adenomas from metastases: diagnostic performance and its clinical applications. Abdom Radiol (NY) 2025:10.1007/s00261-025-04987-9. [PMID: 40397127 DOI: 10.1007/s00261-025-04987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 04/29/2025] [Accepted: 05/03/2025] [Indexed: 05/22/2025]
Abstract
OBJECTIVES To evaluate the potential of Photon counting CT (PCCT) -derived iodine densities and Virtual-Non-Contrast (VNC) reconstructions for the differentiation between adrenal adenomas and adrenal metastases. MATERIALS AND METHODS This retrospective study enrolled 53 PCCT scans of patients with adrenal lesions (29 adenomas, 24 metastases) including early-arterial (ea) and portal-venous (pv) contrast phase. Iodine maps and VNC reconstructions were calculated from the acquired sequences. Using the measured values, several parameters such as relative enhancement (RE), normalized iodine density (NID), and iodine to VNC ratio (IVR) were calculated. In the acquired image series, iodine maps and VNC reconstructions density values were evaluated (adrenal lesion, ipsilateral adrenal tissue, contralateral adrenal tissue, portal vein, descending aorta, inferior vena cava, subcutaneous adipose tissue, in the first lumbar vertebral body, surrounding air, and in the psoas muscle) and compared. RESULTS In total, the measured structures showed significant variation in density values due to different contrast phases and reconstructions. VNC reconstructions of portal-venous contrast phase showed significant differences in measured density mean values between adrenal adenomas and adrenal metastases (21.64 HU vs. 28.26 HU, p: 0.027, AUC: 0.68). No significant differences between metastases and adenomas were observed in iodine concentration, RE of ea, NID of ea and pv, as IVR of ea. Significant alterations were observed in RE of pv (p: 0.023, AUC: 0.7) and IVR of pv (pv: 0.029, AUC: 0.69). CONCLUSION The recent study shows that PCCT derived VNC reconstructions of portal venous contrast phase can be used for reliable differentiation of adrenal adenomas and adrenal metastases and underlines the value of PCCT in oncological imaging.
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Affiliation(s)
- Florian Haag
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
| | - Shanice S Emmrich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Hertel
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Johann Rink
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Abhinay Vellala
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Sara Komlen
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
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Schmidt J, Strother M. Evaluation of the Adrenal Mass in Urologic Practice. Urol Clin North Am 2025; 52:181-192. [PMID: 40250886 DOI: 10.1016/j.ucl.2025.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2025]
Abstract
Adrenal masses are commonly encountered as incidental findings in urologic practice. Many of these lesions do not undergo appropriate testing, likely because guidelines have historically been complex and contradictory. However, the workup for the vast majority of these lesions is actually straightforward. Here we present a practical, guidelines-based approach to the workup of adrenal lesions. We focus on distinguishing between benign, nonhormonally active adenomas (which require no further imaging or intervention) from those which are concerning for malignancy or are hormonally active.
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Affiliation(s)
- Jackson Schmidt
- Department of Urology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Marshall Strother
- Department of Urology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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Yalon M, Navin PJ. Quantitative imaging biomarkers in the assessment of adrenal nodules. Abdom Radiol (NY) 2025; 50:2169-2180. [PMID: 39532734 DOI: 10.1007/s00261-024-04671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 10/28/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024]
Abstract
Incidental adrenal nodules provide a diagnostic conundrum. Current imaging techniques have demonstrated success in identifying lipid-rich adenomas, however, are limited in detecting malignancy and assessing for functionality. Imaging biomarkers are objective characteristics derived from imaging that may measure normal or pathological processes or assess response to therapy. Recent attempts have been made to standardize the measurement of the most common imaging biomarkers used in assessing the adrenal gland, offering a path to more uniform research in this area. The aim of this review is to describe the imaging biomarkers used in adrenal imaging and assess the evidence supporting their use.
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Leonard S, Smaldone MC. Rare Adrenal Tumors and Adrenal Metastasis. Urol Clin North Am 2025; 52:287-296. [PMID: 40250895 DOI: 10.1016/j.ucl.2025.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2025]
Abstract
This article covers rare adrenal tumors including functional adenomas, myelolipomas, ganglioneuromas and neuroblastomas, and metastasis to the adrenal gland. It explores their clinical presentation and behavior, hormonal activity, imaging features, other diagnostic considerations, and approaches to management. The variety of rare tumors and their unique behaviors covered in this article underscores the need to maintain up-to-date knowledge and surgical skills, as well as the importance of a multidisciplinary approach to patient care.
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Affiliation(s)
- Steven Leonard
- Drexel University College of Medicine, 705 Moyer Street, Philadelphia, PA 19125, USA
| | - Marc C Smaldone
- Department of Urologic Oncology, Fox Chase Cancer Center, 8 Huntingdon Pike, 3rd Floor, Rockledge, PA 19046, USA.
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Tüdös Z, Veverková L, Baxa J, Hartmann I, Čtvrtlík F. The current and upcoming era of radiomics in phaeochromocytoma and paraganglioma. Best Pract Res Clin Endocrinol Metab 2025; 39:101923. [PMID: 39227277 DOI: 10.1016/j.beem.2024.101923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
The topic of the diagnosis of phaeochromocytomas remains highly relevant because of advances in laboratory diagnostics, genetics, and therapeutic options and also the development of imaging methods. Computed tomography still represents an essential tool in clinical practice, especially in incidentally discovered adrenal masses; it allows morphological evaluation, including size, shape, necrosis, and unenhanced attenuation. More advanced post-processing tools to analyse digital images, such as texture analysis and radiomics, are currently being studied. Radiomic features utilise digital image pixels to calculate parameters and relations undetectable by the human eye. On the other hand, the amount of radiomic data requires massive computer capacity. Radiomics, together with machine learning and artificial intelligence in general, has the potential to improve not only the differential diagnosis but also the prediction of complications and therapy outcomes of phaeochromocytomas in the future. Currently, the potential of radiomics and machine learning does not match expectations and awaits its fulfilment.
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Affiliation(s)
- Zbyněk Tüdös
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Lucia Veverková
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Jan Baxa
- Department of Imaging Methods, Faculty Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Igor Hartmann
- Department of Urology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Filip Čtvrtlík
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
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Stanchev PE, Dimitrova M, Makakova D, Tilov B. Exploring the Differential Diagnosis of Adrenal Adenoma in the Context of Situs Ambiguous: A Clinical Case Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:2010. [PMID: 39768890 PMCID: PMC11727780 DOI: 10.3390/medicina60122010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 11/21/2024] [Accepted: 12/02/2024] [Indexed: 01/16/2025]
Abstract
Situs anomalies, including situs inversus and situs ambiguous (SAMB), are rare congenital conditions typically noted in pediatric populations, with SAMB being particularly uncommon in adults. This case study addresses the incidental discovery of situs ambiguous with polysplenia in a 65-year-old man evaluated for suspected adrenal adenoma. The patient's medical history included benign prostatic hyperplasia and tuberculous pleurisy. Methods included a thorough physical examination and laboratory tests, which showed normal cortisol levels and ACTH rhythm. Contrast-enhanced CT imaging revealed multiple spleens near the right adrenal region, altered liver positioning, a truncated pancreas, and a right-sided stomach, while the right adrenal gland was not visualized. Notably, the patient exhibited minimal symptoms despite these significant anatomical anomalies. The findings underscore the rarity of situs ambiguous in adults and its unexpected association with endocrine pathology. This case highlights the importance of comprehensive imaging and a multidisciplinary approach in managing patients with unusual anatomical presentations. It suggests that situs anomalies may be more prevalent in adult populations than previously recognized and emphasizes the need for increased clinical awareness and evaluation in similar cases.
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Affiliation(s)
- Pavel E. Stanchev
- Clinic of Endocrinology and Metabolic Diseases, St. George University Hospital, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Mariya Dimitrova
- Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Desislava Makakova
- Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Boris Tilov
- Medical College, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
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Phadte A, Krishnappa B, Memon SS, Patil V, Lila A, Badhe PV, Sarathi V, Fernandes G, Rege S, Prakash G, Menon S, Karlekar M, Barnabas R, Shah N, Thakkar H, Bandgar T. High Diagnostic Accuracy of Arterial Phase CT in Differentiating Pheochromocytoma in Good/Poor Washout Adrenal Masses. J Endocr Soc 2024; 9:bvae199. [PMID: 39606180 PMCID: PMC11590661 DOI: 10.1210/jendso/bvae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Indexed: 11/29/2024] Open
Abstract
Introduction Differentiating pheochromocytomas from other adrenal masses based on computed tomography (CT) characteristics remains challenging, particularly in lipid-poor lesions with variable washout patterns. This study evaluated CT features for distinguishing pheochromocytomas in good and poor washout subcohorts. Methods We prospectively analyzed 72 patients with unilateral lipid-poor adrenal masses. CT protocol included basal, bolus-tracked arterial, early venous (45 seconds postarterial), and delayed (15 minutes postarterial) phases. Masses were categorized into good and poor washout groups. Histopathology provided the final diagnosis. CT characteristics and calculated indices were compared between pheochromocytomas and other masses in each washout category. Results The cohort included pheochromocytomas (n = 35), adrenocortical carcinoma (ACC; n = 15), lipid-poor adenomas (n = 13), and metastatic infiltration/infection (n = 9). In the good washout group, pheochromocytomas (n = 15) showed larger diameters (6.00 vs 3.45 cm, P = .001), higher necrosis frequency (73.3% vs 30%, P = .049), and greater arterial attenuation (173.2 vs 74.5 HU, P < .001) compared to adenomas (n = 9). Arterial attenuation provided a high discriminatory value [area under the curve (AUC): 0.967], with 100% sensitivity at 87.6 Hounsfield unit (HU) and 100% specificity at 139.9 HU. In the poor washout group, pheochromocytomas (n = 20) exhibited higher arterial attenuation (99.2 vs 59.2 HU, P < .001; AUC: 0.844) compared to ACC (n = 14), metastatic infiltration (n = 9), and adenomas (n = 4), with 85% sensitivity and 78% specificity at 73.3 HU. Normetanephrine-secreting/nonsecretory pheochromocytomas showed higher arterial enhancement than metanephrine-secreting ones (132.0 vs 90.5 HU, P = .020) within the poor washout group. Conclusion Arterial phase attenuation on CT has good diagnostic accuracy for differentiating pheochromocytomas from other adrenal masses in both good and poor washout categories, potentially guiding hormonal workup.
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Affiliation(s)
- Aditya Phadte
- Department of Endocrinology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Brijesh Krishnappa
- Department of Endocrinology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Virendra Patil
- Department of Endocrinology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Anurag Lila
- Department of Endocrinology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Padma Vikram Badhe
- Department of Radiology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka 560066, India
| | - Gwendolyn Fernandes
- Department of Pathology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Sameer Rege
- Department of General Surgery, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Gagan Prakash
- Department of Uro-Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India
| | - Manjiri Karlekar
- Department of Endocrinology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Rohit Barnabas
- Department of Endocrinology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Nalini Shah
- Department of Endocrinology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Hemangini Thakkar
- Department of Radiology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth G.S Medical College & KEM Hospital, Mumbai, Maharashtra 4000012, India
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Liu SH, Nie P, Liu SL, Hao D, Zhang J, Sun R, Yang ZT, Zhang CY, Fu Q. Differentiation of pheochromocytoma and adrenal lipoid adenoma by radiomics: are enhanced CT scanning images necessary? Front Oncol 2024; 14:1339671. [PMID: 39324005 PMCID: PMC11422659 DOI: 10.3389/fonc.2024.1339671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 08/26/2024] [Indexed: 09/27/2024] Open
Abstract
Purpose To establish various radiomics models based on conventional CT scan images and enhanced CT images, explore their value in the classification of pheochromocytoma (PHEO) and lipid-poor adrenal adenoma (LPA) and screen the most parsimonious and efficient model. Methods The clinical and imaging data of 332 patients (352 lesions) with PHEO or LPA confirmed by surgical pathology in the Affiliated Hospital of Qingdao University were retrospectively analyzed. The region of interest (ROI) on conventional and enhanced CT images was delineated using ITK-SNAP software. Different radiomics signatures were constructed from the radiomics features extracted from conventional and enhanced CT images, and a radiomics score (Rad score) was calculated. A clinical model was established using demographic features and CT findings, while radiomics nomograms were established using multiple logistic regression analysis.The predictive efficiency of different models was evaluated using the area under curve (AUC) and receiver operating characteristic (ROC) curve. The Delong test was used to evaluate whether there were statistical differences in predictive efficiency between different models. Results The radiomics signature based on conventional CT images showed AUCs of 0.97 (training cohort, 95% CI: 0.95∼1.00) and 0.97 (validation cohort, 95% CI: 0.92∼1.00). The AUCs of the nomogram model based on conventional scan CT images and enhanced CT images in the training cohort and the validation cohort were 0.97 (95% CI: 0.95∼1.00) and 0.97 (95% CI: 0.94~1.00) and 0.98 (95% CI: 0.97∼1.00) and 0.97 (95% CI: 0.94∼1.00), respectively. The prediction efficiency of models based on enhanced CT images was slightly higher than that of models based on conventional CT images, but these differences were statistically insignificant(P>0.05). Conclusions CT-based radiomics signatures and radiomics nomograms can be used to predict and identify PHEO and LPA. The model established based on conventional CT images has great identification and prediction efficiency, and it can also enable patients to avoid harm from radiation and contrast agents caused by the need for further enhancement scanning in traditional image examinations.
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Affiliation(s)
- Shi he Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shun li Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dapeng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Juntao Zhang
- GE Healthcare, PDx GMS Advanced Analytics, Shanghai, China
| | - Rui Sun
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhi tao Yang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chuan yu Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qing Fu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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van Aswegen T, Trinh B, Jacques A, Lo G. Adrenal washout CT in patients with no history of cancer: a waste of time? Abdom Radiol (NY) 2024; 49:3117-3126. [PMID: 38772953 PMCID: PMC11335932 DOI: 10.1007/s00261-024-04333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE To validate the diagnostic performance of adrenal washout CT in patients without known malignancy in a Western Australian population. METHODS A radiology information system (RIS) search for CT reports containing "adrenal" and "washout" across six networked metropolitan public hospitals between January 2005 and November 2021. Homogenous nodules ≥ 1 cm, ≥ 10 HU without a suspected functional component in patients without a history of malignancy were included. Reported absolute and relative washout percentages were recorded and re-measured from unenhanced, 60-s portal venous and 15-min delayed phase imaging and compared to either histopathological or CT follow up for growth (≥ 12 months) reference standards. RESULTS 2653 studies were screened with 191 meeting inclusion criteria. 105 nodules underwent washout CT and then had either histopathological (12 patients) or CT follow up (93 patients) reference standards available. Reported absolute washout (aWO) estimated sensitivity and specificity for malignant/indeterminate nodules was low at 33% (95% CI 25-43%) and 77% (95% CI 68-84%) respectively. Reported relative washout (rWO) sensitivity and specificity were 56% (95% CI 46-65%) and 69% (95% CI 60-77%) respectively. Negative predictive values for both aWO and rWO were reassuring at 92% (95% CI 86-96%) and 94% (95%CI 88-97%). CONCLUSION Our study validates a recent report suggesting that adrenal washout has poor sensitivity for and consequent limited utility to exclude malignancy in patients with no cancer history. However, patients with incidental adrenal nodules < 4 cm in size with benign washout can be reassured by the high negative predictive value and worked up to exclude functional adenoma and re-imaged in a year to confirm no growth.
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Affiliation(s)
| | - Ben Trinh
- Department of Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Angela Jacques
- Institute for Health Research, The University of Notre Dame, Fremantle, WA, Australia
- Curtin University, Bentley, WA, Australia
| | - Glen Lo
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
- Diagnostic Imaging, Sir Charles Gairdner and Osborne Park Hospital Care Group, Hospital Avenue, Nedlands, WA, Australia.
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Corwin MT, Caoili EM, Elsayes KM, Garratt J, Hackett CE, Hudson E, Mohd Z, Navin PJ, Sharbidre K, Shehata M, Wang MX, Wilson MD, Yalon M, Remer EM. Performance of CT With Adrenal-Washout Protocol in Heterogeneous Adrenal Nodules: A Multiinstitutional Study. AJR Am J Roentgenol 2024; 222:e2330769. [PMID: 38415578 DOI: 10.2214/ajr.23.30769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND. CT with adrenal-washout protocol (hereafter, adrenal-protocol CT) is commonly performed to distinguish adrenal adenomas from other adrenal tumors. However, the technique's utility among heterogeneous nodules is not well established, and the optimal method for placing ROIs in heterogeneous nodules is not clearly defined. OBJECTIVE. The purpose of our study was to determine the diagnostic performance of adrenal-protocol CT to distinguish adenomas from nonadenomas among heterogeneous adrenal nodules and to compare this performance among different methods for ROI placement. METHODS. This retrospective study included 164 patients (mean age, 59.1 years; 61 men, 103 women) with a total of 164 heterogeneous adrenal nodules evaluated using adrenal-protocol CT at seven institutions. All nodules had an available pathologic reference standard. A single investigator at each institution evaluated the CT images. ROIs were placed on portal venous phase images using four ROI methods: standard ROI, which refers to a single large ROI in the nodule's center; high ROI, a single ROI on the nodule's highest-attenuation area; low ROI, a single ROI the on nodule's lowest-attenuation area; and average ROI, the mean of the three ROIs on the nodule's superior, middle, and inferior thirds using the approach for the standard ROI. ROIs were then placed in identical locations on unenhanced and delayed phase images. Absolute washout was determined for all methods. RESULTS. The nodules comprised 82 adenomas and 82 nonadenomas (36 pheochromocytomas, 20 metastases, 12 adrenocortical carcinomas, and 14 nodules with other pathologies). The mean nodule size was 4.5 ± 2.8 (SD) cm (range, 1.6-23.0 cm). Unenhanced CT attenuation of 10 HU or less exhibited sensitivity and specificity for adenoma of 22.0% and 96.3% for standard-ROI, 11.0% and 98.8% for high-ROI, 58.5% and 84.1% for low-ROI, and 30.5% and 97.6% for average-ROI methods. Adrenal-protocol CT overall (unenhanced attenuation ≤ 10 HU or absolute washout of ≥ 60%) exhibited sensitivity and specificity for adenoma of 57.3% and 84.1% for the standard-ROI method, 63.4% and 51.2% for the high-ROI method, 68.3% and 62.2% for the low-ROI method, and 59.8% and 85.4% for the average-ROI method. CONCLUSION. Adrenal-protocol CT has poor diagnostic performance for distinguishing adenomas from nonadenomas among heterogeneous adrenal nodules regardless of the method used for ROI placement. CLINICAL IMPACT. Adrenal-protocol CT has limited utility in the evaluation of heterogeneous adrenal nodules.
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Affiliation(s)
- Michael T Corwin
- Department of Radiology, University of California, Davis Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95817
| | | | - Khaled M Elsayes
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joanie Garratt
- Department of Radiology, Penn Medicine, Philadelphia, PA
| | - Caitlin E Hackett
- Department of Radiology, Ohio State University Medical Center, Columbus, OH
| | - Emma Hudson
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
| | - Zahid Mohd
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Kedar Sharbidre
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Mostafa Shehata
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mindy X Wang
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Machelle D Wilson
- Department of Public Health Sciences, University of California, Davis, CA
| | | | - Erick M Remer
- Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Nagayama Y, Hayashi H, Taguchi N, Yoshida R, Harai R, Kidoh M, Oda S, Nakaura T, Hirai T. Diagnostic performance of hepatic CT and chemical-shift MRI to discriminate lipid-poor adrenal adenomas from hepatocellular carcinoma metastases. Abdom Radiol (NY) 2024; 49:1626-1637. [PMID: 38456897 DOI: 10.1007/s00261-024-04228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To evaluate the diagnostic performance of multiphase hepatic CT parameters (non-contrast attenuation, absolute and relative washout ratios [APW and RPW, respectively], and relative enhancement ratio [RER]) and chemical-shift MRI (CS-MRI) for discriminating lipid-poor adrenal adenomas (with non-contrast CT attenuation > 10 HU) from metastases in patients with hepatocellular carcinoma (HCC). METHODS This retrospective study included HCC patients with lipid-poor adrenal lesions who underwent multiphase hepatic CT between January 2010 and December 2021. For each adrenal lesion, non-contrast attenuation, APW, RPW, RER, and signal-intensity index (SI-index) were measured. Each parameter was compared between adenomas and metastases. The area under the receiver operating characteristic curves (AUCs) and sensitivities to achieve 100% specificity for adenoma diagnoses were determined. RESULTS 104 HCC patients (78 men; mean age, 71.8 ± 9.6 years) with 63 adenomas and 48 metastases were identified; CS-MRI was performed in 66 patients with 49 adenomas and 21 metastases within one year of CT. Lipid-poor adenomas showed lower non-contrast attenuation (22.9 ± 7.1 vs. 37.9 ± 9.4 HU) and higher APW (40.5% ± 12.8% vs. 23.7% ± 17.4%), RPW (30.0% ± 10.2% vs. 12.4% ± 9.6%), RER (329% ± 152% vs. 111% ± 43.0%), and SI-index (43.3 ± 20.7 vs. 10.8 ± 13.4) than HCC metastases (all p < .001). AUC for non-contrast attenuation, APW, RPW, RER, and SI-index were 0.894, 0.786, 0.904, 0.969, and 0.902, respectively. The sensitivities to achieve 100% specificity were 7.9%, 25.4%, 30.2%, 63.5%, and 24.5%, respectively. Combined RER and APW achieved the highest sensitivity of 73.0%. CONCLUSION Multiphase hepatic CT allows for better discrimination between lipid-poor adrenal adenomas and metastases relative to CS-MRI, especially when combined with RER and washout parameters.
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Affiliation(s)
- Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Hidetaka Hayashi
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Narumi Taguchi
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Ryuya Yoshida
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Ryota Harai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Tu W, Badawy M, Carney BW, Caoili EM, Corwin MT, Elsayes KM, Mayo-Smith W, Glazer DI, Bagga B, Petrocelli R, Taffel MT, Schieda N. Multicenter Validation of a T2-Weighted MRI Calculator to Differentiate Adrenal Adenoma From Adrenal Metastases. AJR Am J Roentgenol 2024; 222:e2329727. [PMID: 37556601 DOI: 10.2214/ajr.23.29727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Wendy Tu
- University of Alberta, Edmonton, AB, Canada
| | - Mohamed Badawy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | - Barun Bagga
- New York University Grossman School of Medicine, New York, NY
| | | | - Myles T Taffel
- New York University Grossman School of Medicine, New York, NY
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Ma C, Feng B, Lin F, Lei Y, Xu K, Cui J, Liu Y, Long W, Cui E. Differentiating adrenal metastases from benign lesions with multiphase CT imaging: Deep learning could play an active role in assisting radiologists. Eur J Radiol 2023; 169:111169. [PMID: 37956572 DOI: 10.1016/j.ejrad.2023.111169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/05/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES To develop and externally validate multiphase CT-based deep learning (DL) models for differentiating adrenal metastases from benign lesions. MATERIALS AND METHODS This retrospective two-center study included 1146 adrenal lesions from 1059 patients who underwent multiphase CT scanning between January 2008 and March 2021. The study encompassed 564 surgically confirmed adenomas, along with 135 benign lesions and 447 metastases confirmed by observation. DL models based on multiphase CT images were developed, validated and tested. The diagnostic performance of the classification models, imaging phases and radiologists with or without DL were compared using accuracy (ACC) and receiver operating characteristic (ROC) curves. Integrated discrimination improvement (IDI) analysis and the DeLong test were used to compare the area under the curve (AUC) among models. Decision curve analysis (DCA) was used to assess the clinical usefulness of the predictive models. RESULTS The DL signature based on LASSO (DLSL) had a higher AUC than that of the other classification models (IDI > 0, P < 0.05). Furthermore, the precontrast phase (PCP)-based DLSL performed best in the independent external validation (AUC = 0.881, ACC = 82.9 %) and clinical test cohorts (AUC = 0.790, ACC = 70.4 %), outperforming DLSL based on the other single-phase or three-phase images (IDI > 0, P < 0.05). DCA demonstrated that PCP-based DLSL provided a higher net benefit (0.01-0.95). The diagnostic performance led to statistically significant improvements when radiologists incorporated the DL model, with the AUC improving by 0.056-0.159 and the ACC improving by 0.069-0.178 (P < 0.05). CONCLUSION The DL model based on PCP CT images performed acceptably in differentiating adrenal metastases from benign lesions, and it may assist radiologists in accurate tumor staging for patients with a history of extra-adrenal malignancy.
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Affiliation(s)
- Changyi Ma
- Department of Radiology, Jiangmen Central Hospital, 23 Beijie Haibang Street, Jiangmen 529030, PR China
| | - Bao Feng
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, 2 Jinji Road, Guilin 541000, PR China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen 518035, PR China
| | - Yan Lei
- Zunyi Medical University, 1 Xiaoyuan Road, Zunyi 563006, PR China
| | - Kuncai Xu
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, 2 Jinji Road, Guilin 541000, PR China
| | - Jin Cui
- Department of Radiology, Jiangmen Central Hospital, 23 Beijie Haibang Street, Jiangmen 529030, PR China
| | - Yu Liu
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, 2 Jinji Road, Guilin 541000, PR China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, 23 Beijie Haibang Street, Jiangmen 529030, PR China
| | - Enming Cui
- Department of Radiology, Jiangmen Central Hospital, 23 Beijie Haibang Street, Jiangmen 529030, PR China; Zunyi Medical University, 1 Xiaoyuan Road, Zunyi 563006, PR China; Guangdong Medical University, 2 Wenming East Road, 524023, PR China; Guangzhou Key Laboratory of Molecular and Functional Imaging for Clinical Translation, PR China.
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Alaghehbandan R, Remer EM, Berber E, McKenney JK. Anastomosing haemangioma of the adrenal gland: A clinicopathological series of seven cases. Histopathology 2023; 83:791-797. [PMID: 37553871 DOI: 10.1111/his.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
AIMS Anastomosing haemangioma is a rare benign vascular neoplasm that may histologically mimic angiosarcoma. We report the largest single institution series of anastomosing haemangioma in the adrenal gland with emphasis on clinical and radiological features. METHODS AND RESULTS Our laboratory information system was searched for a 25-year period (1999-2023), yielding seven cases confirmed as anastomosing haemangioma of the adrenal gland after pathological re-review. Clinical, radiological and pathological information was obtained from medical charts and submitting pathologists. Of a total of seven patients, four (57.1%) were men and three women, ranging in age from 37 to 75 years (mean = 61). Six of seven patients underwent adrenalectomies and one had radical nephrectomy. Tumours ranged from 0.7 to 6.4 cm (mean = 2.1 cm) and five of seven (71%) were grossly well-circumscribed. Five of seven lesions were found incidentally at imaging for other indications. All tumours were unifocal except one, which presented with multifocal disease with a concurrent adjacent retroperitoneal anastomosing haemangioma. Three of five tumours imaged with contrast enhancement were almost completely hyperenhancing with a small central non-enhancing portion, features overlapping with pheochromocytoma. One of seven tumours involved the peri-adrenal adipose tissue with a focally infiltrative pattern. There were no recurrences or metastases in six patients with available follow-up data (median = 95 months). CONCLUSIONS Benign anastomosing haemangiomas of the adrenal gland tend to occur in older patients, may mimic pheochromocytoma on imaging and must be distinguished from angiosarcoma pathologically. Better awareness of this entity by pathologists, radiologists and surgeons is crucial to appropriate work-up, diagnosis and management.
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Affiliation(s)
- Reza Alaghehbandan
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Erick M Remer
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jesse K McKenney
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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Cao L, Zhang D, Yang H, Xu W, Liu Y. 18F-FDG-PET/CT-based machine learning model evaluates indeterminate adrenal nodules in patients with extra-adrenal malignancies. World J Surg Oncol 2023; 21:305. [PMID: 37749562 PMCID: PMC10521561 DOI: 10.1186/s12957-023-03184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND To assess the value of an 18F-FDG-positron emission tomography/computed tomography (PET/CT)-based machine learning model for distinguishing between adrenal benign nodules (ABNs) and adrenal metastases (AMs) in patients with indeterminate adrenal nodules and extra-adrenal malignancies. METHODS A total of 303 patients who underwent 18F-FDG-PET/CT with indeterminate adrenal nodules and extra-adrenal malignancies from March 2015 to June 2021 were included in this retrospective study (training dataset (n = 182): AMs (n = 97), ABNs (n = 85); testing dataset (n = 121): AMs (n = 68), ABNs (n = 55)). The clinical and PET/CT imaging features of the two groups were analyzed. The predictive model and simplified scoring system for distinguishing between AMs and ABNs were built based on clinical and PET/CT risk factors using multivariable logistic regression in the training cohort. The performances of the predictive model and simplified scoring system in both the training and testing cohorts were evaluated by the areas under the receiver operating characteristic curves (AUCs) and calibration curves. The comparison of AUCs was evaluated by the DeLong test. RESULTS The predictive model included four risk factors: sex, the ratio of the maximum standardized uptake value (SUVmax) of adrenal lesions to the mean liver standardized uptake value, the value on unenhanced CT (CTU), and the clinical stage of extra-adrenal malignancies. The model achieved an AUC of 0.936 with a specificity, sensitivity and accuracy of 0.918, 0.835, and 0.874 in the training dataset, respectively, while it yielded an AUC of 0.931 with a specificity, sensitivity, and accuracy of 1.00, 0.735, and 0.851 in the testing dataset, respectively. The simplified scoring system had comparable diagnostic value to the predictive model in both the training (AUC 0.938, sensitivity: 0.825, specificity 0.953, accuracy 0.885; P = 0.5733) and testing (AUC 0.931, sensitivity 0.735, specificity 1.000, accuracy 0.851; P = 1.00) datasets. CONCLUSIONS Our study showed the potential ability of a machine learning model and a simplified scoring system based on clinical and 18F-FDG-PET/CT imaging features to predict AMs in patients with indeterminate adrenal nodules and extra-adrenal malignancies. The simplified scoring system is simple, convenient, and easy to popularize.
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Affiliation(s)
- Lixiu Cao
- Department of ECT, Tangshan People's Hospital, Tangshan, China
| | - Dejiang Zhang
- Department of Radiology, Tangshan People's Hospital, Tangshan, Hebei Province, China
| | - Haoxuan Yang
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
| | - Yongliang Liu
- Department of Neurosurgery, Tangshan People's Hospital, Tangshan, Hebei Province, China.
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Gulmez AO, Aydin S, Kantarci M. A complementary comment on primary hepatic angiosarcoma: A case report. World J Clin Cases 2023; 11:1814-1822. [PMID: 36969989 PMCID: PMC10037275 DOI: 10.12998/wjcc.v11.i8.1814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/01/2022] [Accepted: 01/20/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND This article examines primary hepatic angiosarcoma (PHA) and fat-poor angiomyolipoma (AML), two uncommon vascular cancers. Clinical decisions in these situations are frequently aided by pathology reports and imaging techniques. Uncommon malignant tumors of the vascular endothelium include PHA. Another diagnosis that should not be overlooked when employing contrast-enhanced MR and contrast-enhanced computed tomography (CT) imaging techniques is fat-poor AML, one of the uncommon vascular tumors of the liver. In both conditions, biopsy is the primary means of diagnosis.
CASE SUMMARY In our article, besides the diagnosis of PHA, fat-poor AML, one of the other rare vascular tumors of the liver, is mentioned. In the case, a 50-year-old female patient with VHL Syndrome was admitted to our hospital with nonspecific lesions such as right upper quadrant pain, weight loss, and nausea. Abdominal ultrasonography (US) revealed a hypoechoic heterogeneous lesion with occasional faint contours. In computed tomography, it was observed as a hyperdense nodular lesion in segment 4. Magnetic resonance imaging (MRI) revealed that the lesion did not contain fat. In connection with the known history of VHL Syndrome, we first evaluated the possibility of AML. Thereupon, a histopathological sample was taken and the diagnosis was made as fat-poor AML with 5% fat content.
CONCLUSION In conclusion, PHA in our case report and fat-poor AML in our clinic are two uncommon liver vascular malignancies with comparable incidences. Important imaging techniques like contrast-enhanced US (CEUS), CECT, and CEMRI give us substantial advantages in both cases. However, a biopsy is used to provide the final diagnosis.
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Affiliation(s)
- Ali Osman Gulmez
- Department of Radiology, Erzincan University, Erzincan 24100, Turkey
| | - Sonay Aydin
- Department of Radiology, Erzincan University, Erzincan 24100, Turkey
| | - Mecit Kantarci
- Department of Radiology, Erzincan University, Erzincan 24100, Turkey
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Nagayama Y, Hirai T. Letter to the editor on "diagnostic value of the relative enhancement ratio of the portal venous phase to unenhanced CT in the identification of lipid‑poor adrenal tumors". Abdom Radiol (NY) 2023; 48:1841-1842. [PMID: 36810706 DOI: 10.1007/s00261-023-03856-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 01/25/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
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Cao L, Zhang L, Xu W. Small hyperattenuating adrenal nodules in patients with lung cancer: Differentiation of metastases from adenomas on biphasic contrast-enhanced computed tomography. Front Oncol 2023; 13:1091102. [PMID: 36865810 PMCID: PMC9972082 DOI: 10.3389/fonc.2023.1091102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
Objective The objective of this study was to evaluate the value of biphasic contrast-enhanced computed tomography (CECT) in the differential diagnosis of metastasis and lipid-poor adenomas (LPAs) in lung cancer patients with unilateral small hyperattenuating adrenal nodule. Materials and methods This retrospective study included 241 lung cancer patients with unilateral small hyperattenuating adrenal nodule (metastases, 123; LPAs, 118). All patients underwent plain chest or abdominal computed tomography (CT) scan and biphasic CECT scan, including arterial and venous phases. Qualitative and quantitative clinical and radiological characteristics of the two groups were compared using univariate analysis. An original diagnostic model was developed using multivariable logistic regression, and then, according to odds ratio (OR) of the risk factors of metastases, a diagnostic scoring model was developed. The areas under the receiver operating characteristic curves (AUCs) of the two diagnostic models were compared by DeLong test. Results Compared with LAPs, metastases were older and showed more frequently irregular in shape and cystic degeneration/necrosis (all p < 0.05). Enhancement ratios on venous (ERV) and arterial (ERA) phase of LAPs were noticeably higher than that of metastases, whereas CT values in unenhanced phase (UP) of LPAs were noticeably lower than that of metastases (all p < 0.05). Compared with LAPs, the proportions of male and III/IV clinical stage and small-cell lung cancer (SCLL) were significantly higher for metastases (all p < 0.05). As for peak enhancement phase, LPAs showed relatively faster wash-in and earlier wash-out enhancement pattern than metastases (p < 0.001). Multivariate analysis revealed age ≥ 59.5 years (OR: 2.269; p = 0.04), male (OR: 3.511; p = 0.002), CT values in UP ≥ 27.5 HU (OR: 6.968; p < 0.001), cystic degeneration/necrosis (OR: 3.076; p = 0.031), ERV ≤ 1.44 (OR: 4.835; p < 0.001), venous phase or equally enhanced (OR: 16.907; p < 0.001 or OR: 14.036; p < 0.001), and clinical stage II or III or IV (OR: 3.550; p = 0.208 or OR: 17.535; p = 0.002 or OR: 20.241; p = 0.001) were risk factors for diagnosis of metastases. AUCs of the original diagnostic model and the diagnostic scoring model for metastases were 0.919 (0.883-0.955) and 0.914 (0.880-0.948), respectively. There was no statistical significance of AUC between the two diagnostic model (p = 0.644). Conclusions Biphasic CECT performed well diagnostic ability in differentiating metastases from LAPs. The diagnostic scoring model is easy to popularize due to simplicity and convenience.
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Affiliation(s)
- Lixiu Cao
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Department of Emission Computed Tomography, Tangshan People’s Hospital, Tangshan, Hebei, China
| | - Libo Zhang
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
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Kandasamy D, Gulati A, Simon B, John R, Goyal A. Imaging Recommendations for Diagnosis, Staging, and Management of Adrenal Tumors. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractAdrenal glands are affected by a wide variety of tumors apart from infective and inflammatory lesions and their noninvasive characterization on imaging is important for the management of these patients. Incidentalomas form the major bulk of adrenal tumors and differentiation of benign adenomas from other malignant lesions, especially in patients with a known malignancy, guide further management. Imaging is an integral part of management along with clinical and biochemical features. The cornerstone of clinical and biochemical evaluation of adrenal tumors is to determine whether the lesion is functional or nonfunctional. Computed tomography (CT) is considered as the workhorse for imaging evaluation of adrenal lesions. CT densitometry and CT contrast washout characteristics are quite reliable in differentiating adenomas from malignant lesions. CT is also the modality of choice for the evaluation of resectability and staging of primary adrenal tumors. Magnetic resonance imaging (MRI) has superior contrast resolution compared to other morphological imaging modalities and is generally used as a problem-solving tool. MRI chemical shift imaging can also be used to reliably detect adrenal adenomas. Ultrasonography (USG) is used as a screening tool that is usually followed by either CT or MRI to better characterize the tumor and it is not routinely used for assessing the resectability, staging, and characterization of adrenal tumors. Another important role of USG is in image-guided sampling of tumors. Fluorodeoxyglucose positron emission tomography-computed tomography and other nuclear medicine modalities are a valuable addition to morphological imaging modalities. Image-guided interventions also play an important role in obtaining tissue samples where diagnostic imaging is not able to characterize adrenal tumors. In the functioning of adrenal tumors, adrenal venous sampling is widely used to accurately lateralize the secreting tumor.
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Affiliation(s)
- Devasenathipathy Kandasamy
- Department of Radiodiagnosis & Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gulati
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Betty Simon
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reetu John
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Fernandes DA, Mourão JLV, Duarte JÁ, Dalaqua M, Reis F, Caserta NMG. Manifestações de imagem da doença de von Hippel-Lindau: um guia ilustrado das manifestações abdominais. Radiol Bras 2022; 55:317-323. [DOI: 10.1590/0100-3984.2021.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Resumo A doença de von Hippel-Lindau (VHL) é uma desordem autossômica dominante monogênica com mutações na linha germinativa do antioncogene VHL, no braço curto do cromossomo três (3p25-26). Afeta 1:36.000-50.000 indivíduos, com penetrância superior a 90% aos 65 anos de idade. Embora tenha início e apresentação variáveis, com pleiotropismo mesmo entre membros da mesma família que partilham uma mutação específica, usualmente manifesta-se de início em adultos jovens e predispõe ao desenvolvimento de tumores benignos e malignos no sistema nervoso central (SNC) e órgãos viscerais. Clinicamente, o diagnóstico pode ser realizado em uma das seguintes circunstâncias: a) em pacientes com história familiar de doença de VHL e pelo menos um dos tumores característicos relacionados à síndrome (como hemangioblastomas retinianos ou do SNC, carcinoma de células renais de células claras, tumores neuroendócrinos pancreáticos e tumores do saco endolinfático); b) dois ou mais hemangioblastomas do SNC; c) um hemangioblastoma retiniano ou do SNC mais pelo menos um tumor característico visceral relacionado à síndrome, excluindo-se cistos renais e epididimários. Nesse contexto, a imagem ocupa importante papel no diagnóstico e acompanhamento desses pacientes. Este ensaio iconográfico apresenta imagens características de manifestações abdominais de tumores relacionados à doença de VHL que todos os radiologistas devem conhecer.
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22
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Cao L, Xu W. Radiomics approach based on biphasic CT images well differentiate "early stage" of adrenal metastases from lipid-poor adenomas: A STARD compliant article. Medicine (Baltimore) 2022; 101:e30856. [PMID: 36197274 PMCID: PMC9509040 DOI: 10.1097/md.0000000000030856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to develop an optimal radiomics model based on abdominal contrast-enhanced computed tomography (CECT) for pre-operative differentiation of "early stage" adrenal metastases from lipid-poor adenomas (LPAs). This retrospective study included 188 patients who underwent abdominal CECT (training cohort: LPAs, 68; metastases, 64; validation cohort: LPAs, 29; metastases, 27). Abdominal CECT included plain, arterial, portal, and venous imaging. Clinical and CECT radiological features were assessed and significant features were selected. Radiomic features of the adrenal lesions were extracted from four-phase CECT images. Significant radiomics features were selected using the least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression. The clinical-radiological, unenhanced radiomics, arterial radiomics, portal radiomics, venous radiomics, combined radiomics, and clinical-radiological-radiomics models were established using a support vector machine (SVM). The DeLong test was used to compare the areas under the receiver operating characteristic curves (AUCs) of all models. The AUCs of the unenhanced (0.913), arterial (0.845), portal (0.803), and venous (0.905) radiomics models were all higher than those of the clinical-radiological model (0.788) in the testing dataset. The AUC of the combined radiomics model (incorporating plain and venous radiomics features) was further improved to 0.953, which was significantly higher than portal radiomics model (P = .033) and clinical-radiological model (P = .009), with the highest accuracy (89.13%) and a relatively stable sensitivity (91.67%) and specificity (86.36%). As the optimal model, the combined radiomics model based on biphasic CT images is effective enough to differentiate "early stage" adrenal metastases from LPAs by reducing the radiation dose.
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Affiliation(s)
- Lixiu Cao
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for China, Tianjin, China
- Department of ECT, Tangshan People’s Hospital, Tangshan, China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for China, Tianjin, China
- *Correspondence: Wengui Xu, Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for China, No. 1 Huanhu West Road, Hexi District, Tianjin 300060, China (e-mail: )
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Diagnostic value of the relative enhancement ratio of the portal venous phase to unenhanced CT in the identification of lipid-poor adrenal tumors. Abdom Radiol (NY) 2022; 47:3308-3317. [PMID: 35778569 DOI: 10.1007/s00261-022-03593-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Adrenal incidentalomas are common lesions found on abdominal imaging, most of which are lipid-rich adrenal adenomas. Imaging diagnoses differentiating lipid-poor adrenal adenomas (LPA) from non-adenomas (NA) are presently challenging to perform. The aim of the study was to investigate the diagnostic performance of the relative enhancement ratio parameter in identifying LPA from NA. METHODS We retrospectively evaluated consecutively presenting patients with lipid-poor adrenal lesions (January 2015 to August 2021). Lesions were divided into LPA and NA (including hyperenhancing and hypoenhancing NA). Kruskal-Wallis and Bonferroni tests were used to determine the differences in feature parameters between these three groups. Receiver operating characteristic curve analysis was performed to determine the sensitivity for diagnosing LPA and NA at 95% specificity; the parameters were compared using the McNemar test. RESULTS A total of 253 patients (mean age, 55 ± 12 years; 135 men), 121 with LPA and 132 with NA, were analyzed herein. The sensitivity (achieved at 95% specificity) of the relative enhancement ratio was higher than that of unenhanced attenuation in differentiating LPA from NA (60% vs. 52%, p = 0.064). The relative enhancement ratio yielded a higher sensitivity than unenhanced attenuation (79% vs. 59%, p < 0.001) in differentiating LPA from hypoenhancing NA, and a lower sensitivity (26% vs. 69%, p < 0.001) in differentiating LPA from hyperenhancing NA. CONCLUSION The relative enhancement ratio showed better diagnostic performance than unenhanced attenuation in differentiating LPA from hypoenhancing NA, while simultaneously showing poor diagnostic performance in identifying LPA from all NA.
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Fernandes DA, Mourão JLV, Duarte JÁ, Dalaqua M, Reis F, Caserta NMG. Imaging manifestations of von Hippel-Lindau disease: an illustrated guide focusing on abdominal manifestations. Radiol Bras 2022; 55:317-323. [PMID: 36320367 PMCID: PMC9620840 DOI: 10.1590/0100-3984.2021.0121-en] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/07/2021] [Indexed: 02/08/2023] Open
Abstract
Von Hippel-Lindau (VHL) disease is a monogenic autosomal dominant disorder with germline mutations of the VHL anti-oncogene on the short arm of chromosome 3 (3p25-26). It affects 1:36,000-50,000 individuals, with a penetrance greater than 90% at 65 years of age. Although of variable onset and presentation, with pleiotropism even among members of the same family who share a specific mutation, VHL disease usually manifests initially in young adults. It predisposes to the development of benign and malignant tumors of the central nervous system (CNS) and visceral organs. The clinical diagnosis of VHL disease can be made in the following circumstances: a) in patients with a family history of the disease and at least one of the tumors characteristic of it (e.g., retinal or CNS hemangioblastomas, clear cell renal cell carcinoma, pancreatic neuroendocrine tumors, and endolymphatic sac tumors); b) in patients with two or more CNS hemangioblastomas; c) or in patients with a retinal or CNS hemangioblastoma plus at least one visceral tumor characteristic of the disease, excluding renal and epididymal cysts. Imaging plays an important role in the diagnosis and follow-up of patients with VHL disease. This pictorial essay presents characteristic images of abdominal manifestations of VHL disease-related tumors that all radiologists should be aware of.
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Affiliation(s)
- Daniel Alvarenga Fernandes
- Department of Radiology, Faculdade de Ciências
Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP,
Brazil
| | - João Luiz Veloso Mourão
- Department of Radiology, Faculdade de Ciências
Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP,
Brazil
| | - Juliana Ávila Duarte
- Department of Radiology and Diagnostic Imaging, Hospital de
Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Mariana Dalaqua
- Hôpitaux Universitaires de Genève, Service de
Radiologie, Geneva, Switzerland
| | - Fabiano Reis
- Department of Radiology, Faculdade de Ciências
Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP,
Brazil
| | - Nelson Marcio Gomes Caserta
- Department of Radiology, Faculdade de Ciências
Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP,
Brazil
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Inter-individual comparison of diagnostic accuracy of adrenal washout CT compared to chemical shift MRI plus the T2-weighted (T2W) adrenal MRI calculator in indeterminate adrenal masses: a retrospective non-inferiority study. Abdom Radiol (NY) 2022; 47:2453-2461. [PMID: 35536326 DOI: 10.1007/s00261-022-03533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To compare diagnostic accuracy of washout (WO)-CT to chemical shift (CS)-MRI + T2W adrenal MRI Calculator (T2W-Calculator) to diagnose adrenal adenoma in indeterminate adrenal masses. METHODS This retrospective, cross-sectional, non-inferiority study evaluated 40 consecutive indeterminate adrenal masses; each with WO-CT and MRI. Two blinded radiologists independently evaluated in mixed order: pre-contrast attenuation (Hounsfield Units, HU) and absolute WO ([Peak.HU-Delay.HU]/[Peak.HU-Pre.HU] × 100%), Chemical Shift Signal Intensity (CS-SI) Index, T2W SI ratio, and Entropy (which were imputed into the T2W-Calculator). Diagnostic accuracy for adrenal adenoma was tabulated using 2 × 2 tables. True -positive diagnoses of adenoma were CT = Pre-HU < 10 or absolute WO ≥ 60%, MRI = SI index ≥ 16.5% or T2W-Calculator < 0.631. RESULTS There were 73% (29/40) adenomas and 27% (11/40) other masses (5 pheochromocytoma, 3 solitary fibrous tumor, 1 metastasis, 1 cavernous hemangioma, and 1 adrenocortical carcinoma). Sensitivity, specificity, and accuracy for diagnosis of adenoma using CT-WO were 78% (95% confidence intervals [CI] 56-93%), 35% (14-62%), and 57% (42-71%) Reader 1 and 72% (53-87%), 46% (17-77%), and 59% (41-76%) Reader 2. Sensitivity, specificity, and accuracy for diagnosis of adenoma using MRI were 100% (88-100%), 64% (34-90%), and 82% (67-97%) Reader 1 and 86% (68-96%), 73% (39-94%), and 80% (64-95%) Reader 2. MRI had higher overall accuracy (p = 0.02 Reader 1, 0.05 Reader 2) compared to CT-WO. CONCLUSION Chemical shift MRI combined with the T2W adrenal MRI calculator is not inferior to CT Washout for diagnosis of adrenal adenoma among indeterminate adrenal masses.
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Corwin MT, Schieda N, Remer EM, Caoili EM. Management of incidental adrenal nodules: a survey of abdominal radiologists conducted by the Society of Abdominal Radiology Disease-Focused Panel on Adrenal Neoplasms. Abdom Radiol (NY) 2022; 47:1360-1368. [PMID: 35150313 DOI: 10.1007/s00261-022-03439-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 12/21/2022]
Abstract
Adrenal incidentalomas are common findings discovered at abdominal CT and MRI, yet the most appropriate management remains controversial and guidelines vary. The Society of Abdominal Radiology (SAR) Disease-Focused Panel on Adrenal Neoplasms sought to determine the practice patterns of abdominal radiologists regarding the interpretation and management of adrenal incidentalomas. An electronic survey consisting of eleven multiple choice questions about adrenal incidentalomas was developed and distributed to the email list of current and past SAR members. The response rate was 11.8% (423/3581) and most respondents were academic radiologists (80.6%). The 2017 American College of Radiology White Paper was the most used guideline, yet the management of indeterminate adrenal incidentalomas was highly variable with no single management option reaching a majority. Hormonal evaluation and endocrinology consultation was most often rarely or never recommended. The results of the survey indicate wide variability in the interpretation of imaging findings and management recommendations for incidental adrenal nodules among surveyed radiologists. Further standardization of adrenal incidentaloma guidelines and education of radiologists is needed.
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Cystic adrenal masses: spectrum of multimodality imaging features and pathological correlation. Clin Radiol 2022; 77:479-488. [DOI: 10.1016/j.crad.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
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Gargan ML, Lee E, O'Sullivan M, Egan M, Gibney J, Crowther S, Conlon K, Feeney J. Imaging features of atypical adrenocortical adenomas: a radiological-pathological correlation. Br J Radiol 2022; 95:20210642. [PMID: 34735299 PMCID: PMC8722240 DOI: 10.1259/bjr.20210642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Adrenal adenomas are frequently picked up incidentally on cross-sectional imaging and are known to have a classic imaging appearance on CT and MRI. However, not all adrenal adenomas have this typical radiologic appearance. Our aim is to present the radiological features of atypical adrenocortical adenomas with pathological correlation. METHODS All the imaging from the pathologically proven adrenal adenoma cases in our hospital (Tallaght University Hospital, Dublin, Ireland) database (from 2004 to 2019) was reviewed. 8 out of 48 cases (16%) had an atypical radiological appearance and were selected for presentation. RESULTS Eight cases demonstrated atypical radiological features including heterogeneous density, incomplete washout on post-contrast imaging, the presence of macroscopic fat and calcification. Lipomatous metaplasia was present in two of the cases pathologically. CONCLUSION Adrenocortical adenomas are the most common adrenal mass encountered on CT, however, may not always have classic imaging features. Radiologists should be familiar with both the typical and atypical imaging manifestations of these benign adrenal lesions. ADVANCES IN KNOWLEDGE This paper comprehensively describes the atypical features of adrenocortical adenomas with case examples and radiologic-pathologic correlation. Guidelines and an approach to the work-up of adrenal lesions with atypical appearances are also provided.
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Affiliation(s)
| | - Eimear Lee
- Tallaght University Hospital, Dublin, Ireland
| | | | - Marie Egan
- Tallaght University Hospital, Dublin, Ireland
| | | | | | - Kevin Conlon
- Tallaght University Hospital, St. Vincent’s University Hospital, Dublin, Ireland
| | - John Feeney
- Tallaght University Hospital, Dublin, Ireland
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Schloetelburg W, Ebert I, Petritsch B, Weng AM, Dischinger U, Kircher S, Buck AK, Bley TA, Deutschbein T, Fassnacht M. Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses. Eur J Endocrinol 2021; 186:183-193. [PMID: 34813495 PMCID: PMC8679842 DOI: 10.1530/eje-21-0650] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/23/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Reliable results of wash-out CT in the diagnostic workup of adrenal incidentalomas are scarce. Thus, we evaluated the diagnostic accuracy of delayed wash-out CT and determined thresholds to accurately differentiate adrenal masses. DESIGN Retrospective, single-center cohort study including 216 patients with 252 adrenal lesions who underwent delayed wash-out CT. Definitive diagnoses based on histopathology (n = 92) or comprehensive follow-up. METHODS Size, average attenuation values of the adrenal lesions in all CT scan phases, and absolute and relative percentage wash-out (APW/RPW) were determined by an expert radiologist blinded for clinical data. Adrenal lesions with unenhanced attenuation values >10 Hounsfield units (HU) built a subgroup (n = 142). Diagnostic accuracy was calculated. RESULTS The study group consisted of 171 adenomas, 32 other benign tumors, 11 pheochromocytomas, 9 adrenocortical carcinomas, and 29 other malignant tumors. All (potentially) malignant and 46% of benign lesions showed unenhanced attenuation values >10 HU. In this most relevant subgroup, the established thresholds of 60% for APW and 40% for RPW misclassified 35.9 and 35.2% of the masses, respectively. When we applied optimized cutoffs (APW >83%; RPW >58%) and excluded pheochromocytomas, we missed only one malignant tumor by APW and none by RPW. However, only 11 and 15% of the benign tumors were correctly identified. CONCLUSIONS Wash-out CT with the established thresholds for APW and RPW is insufficient to reliably diagnose adrenal masses. Using the proposed cutoff of 58% for RPW, malignant tumors will be correctly identified, but the added value is limited, namely 15% of patients with benign tumors can be prevented from additional imaging or even unnecessary surgery.
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Affiliation(s)
- Wiebke Schloetelburg
- Department of Radiology, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
- Department of Nuclear Medicine, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Ines Ebert
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Bernhard Petritsch
- Department of Radiology, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Andreas Max Weng
- Department of Radiology, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Ulrich Dischinger
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefan Kircher
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Andreas Konrad Buck
- Department of Nuclear Medicine, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Radiology, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
- Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
- Correspondence should be addressed to M Fassnacht;
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Gündoğdu E, Oğuzman M, Emekli E, Kebapçı M. Are the washout values currently accepted for lesion characterization in dedicated adrenal CT adequate for diagnosis? DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:694-702. [PMID: 34792022 DOI: 10.5152/dir.2021.20508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to investigate the accuracy of density characteristics and washout values of lesions detected on computed tomography (CT) at the cutoff values obtained from the literature by taking the pathological results of adrenalectomy specimens as reference and to determine the cutoff values of parameters evaluated on CT for the differentiation of adenoma and nonadenoma lesions in the study group. METHODS Hospital records and standard CT imaging data (noncontrast early phase [65 s] and late phase [15 min] ) of 84 patients with 87 lesions who underwent adrenalectomy between January 2012 and December 2018 were retrospectively reevaluated by two radiologists in consensus. The patients were categorized as having adenoma and nonadenoma lesions according to the pathology results. The sensitivity, specificity and diagnostic accuracy of CT parameters (density values and washout percentages) were evaluated. Differences in the CT parameters (size, noncontrast and early-late enhancement density and absolute and relative washout values) were investigated. The optimal cutoff values of CT parameters were determined by ROC analysis. RESULTS Noncontrast CT had a specificity of 87.75% and 95.9%, sensitivity of 60% and 48.6%, diagnostic accuracy of 77.7% and 89.47% for adenomas, at the cutoff values of ≤10 HU and ≤0 HU, respectively. For absolute washout value ≥ 60%, the sensitivity, specificity and accuracy were 64.7%, 52.38% and 56.75%, respectively; while these rates were 76.47%, 56.52% and 62.16%, respectively, for relative washout value ≥40%. Adenomas and nonadenomas showed significant difference in terms of size (p < 0.0001), unenhanced attenuation (p < 0.0001), relative washout (p = 0.020) and delay enhancement (p < 0.001). But there were no differences in terms of absolute washout (p = 0.230) and early enhancement (p = 0.264). The cutoff values for the differentiation of adenomas and nonadenomas were as follows: size ≤44 mm, noncontrast density <20 HU, early-phase density ≥45 HU, delayed-phase density ≤44 HU, absolute washout 74.83% and relative washout 57.76%. CONCLUSION The current washout criteria used in the differentiation of adenoma and nonadenoma lesions in dynamic CT imaging can give false negative and positive results. According to the existing criteria, the most reliable parameter in adenoma-nonadenoma differentiation is ≤ 0 HU noncontrast CT density value.
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Affiliation(s)
- Elif Gündoğdu
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Mehmet Oğuzman
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Emre Emekli
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Mahmut Kebapçı
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
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Mody RN, Remer EM, Nikolaidis P, Khatri G, Dogra VS, Ganeshan D, Gore JL, Gupta RT, Heilbrun ME, Lyshchik A, Mayo-Smith WW, Purysko AS, Savage SJ, Smith AD, Wang ZJ, Wolfman DJ, Wong-You-Cheong JJ, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Adrenal Mass Evaluation: 2021 Update. J Am Coll Radiol 2021; 18:S251-S267. [PMID: 34794587 DOI: 10.1016/j.jacr.2021.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/24/2022]
Abstract
The appropriate evaluation of adrenal masses is strongly dependent on the clinical circumstances in which it is discovered. Adrenal incidentalomas are masses that are discovered on imaging studies that have been obtained for purposes other than adrenal disease. Although the vast majority of adrenal incidentalomas are benign, further radiological and biochemical evaluation of these lesions is important to arrive at a specific diagnosis. Patients with a history of malignancy or symptoms of excess hormone require different imaging evaluations than patients with incidentalomas. This document reviews imaging approaches to adrenal masses and the various modalities utilized in evaluation of adrenal lesions. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Rekha N Mody
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio.
| | - Erick M Remer
- Cleveland Clinic, Cleveland, Ohio; Chair, Gaps And Harmonization Committee, ACR Appropriateness Criteria; Portfolio Director, Society of Abdominal Radiology; Chair, Section Urinary Imaging, Scientific Program Committee, American Roentgen Ray Society
| | - Paul Nikolaidis
- Panel Chair, Northwestern University, Chicago, Illinois; Vice-Chair, Operations - Diagnostic Imaging, Northwestern University
| | - Gaurav Khatri
- Panel Vice-Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York; and Chair, Penile Performance Consensus Statement
| | | | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina; and Chair, ACR Meetings Sub-committee, Commission on Publications and Lifelong Learning
| | - Marta E Heilbrun
- Vice-Chair for Quality, Emory Radiology Department, Emory University School of Medicine, Atlanta, Georgia; and RSNA Structured Reporting Subcommittee Chair
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Board Member, ICUS
| | | | | | - Stephen J Savage
- Medical University of South Carolina, Charleston, South Carolina; American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California
| | - Darcy J Wolfman
- Clinical Director, Ultrasound Hopkins NCR; and Committee Chair, ACR US Accreditation Johns Hopkins University School of Medicine, Washington, District of Columbia
| | - Jade J Wong-You-Cheong
- University of Maryland School of Medicine, Baltimore, Maryland; and Vice-Chair Quality and Safety, Diagnostic Radiology, University of Maryland Medical Center
| | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mark E Lockhart
- Speciatly Chair, University of Alabama at Birmingham, Birmingham, Alabama; Chair, Radiology Departmental Appointments, Promotions, and Tenure Committee, and Departmental Chief, Genitourinary Imaging, University of Alabama at Birmingham, Birmingham, Alabama; Chair, ACR Appropriateness Committee; Chair, Society of Radiologists in Ultrasound, Annual Meeting Program Committee; and Chair, Research Committee of AIUM Future Fund
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Tu W, Gerson R, Abreu-Gomez J, Udare A, Mcphedran R, Schieda N. Comparison of MRI features in lipid-rich and lipid-poor adrenal adenomas using subjective and quantitative analysis. Abdom Radiol (NY) 2021; 46:4864-4872. [PMID: 34120206 DOI: 10.1007/s00261-021-03161-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare MR-imaging features in benign lipid-rich and lipid-poor adrenal adenomas. MATERIALS AND METHODS With institutional review board approval, we compared 23 consecutive lipid-poor adenomas (chemical shift [CS] signal intensity [SI] index < 16.5%) imaged with MRI to 29 consecutive lipid-rich adenomas (CS-SI index ≥ 16.5%) imaged during the same time period. A blinded radiologist measured T2-weighted (T2W) SI ratio (adrenal adenoma/psoas muscle), dynamic enhancement wash-in (WI) and wash-out (WO) indices, and T2W texture features. Two blinded Radiologists (R1/R2) assessed T2W-SI (relative to renal cortex) and T2W heterogeneity (using 5-Point Likert scales). Comparisons were performed between groups using independent t tests and Chi-square with Holm-Bonferroni correction. RESULTS There was no difference in age or gender between groups (p = 0.594, 0.051 respectively). Subjectively, all lipid-rich and lipid-poor adenomas were rated hypointense or isointense compared to renal cortex and T2W-SI did not differ between groups (p = 0.129, 0.124 for R1, R2). Agreement was substantial (Kappa = 0.67). There was no difference in T2W SI ratio (1.8 ± 0.9 [0.5-4.3] lipid rich versus 2.2 ± 1.0 [0.6-4.3] lipid poor, p = 0.139). Enhancement WI and WO did not differ comparing lipid-rich and lipid-poor adenomas (p = 0.759, 0.422 respectively). There was no difference comparing lipid-rich and lipid-poor adenomas T2W heterogeneity judged subjectively (p = 0.695, 0.139 for R1, R2; Kappa = 0.19) or by texture analysis (entropy, kurtosis, skewness; p = 0.134-0.191) with all adenomas except for one rated as mostly or completely homogeneous. CONCLUSIONS There is no difference in T2W signal intensity, enhancement pattern or T2W heterogeneity judged subjectively or by quantitative texture analysis comparing lipid-poor and lipid-rich adrenal adenomas.
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Affiliation(s)
- Wendy Tu
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Rosalind Gerson
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jorge Abreu-Gomez
- Joint Department of Medical Imaging, The University Health Network, Toronto, ON, Canada
| | - Amar Udare
- Juravinski Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Rachel Mcphedran
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
- C1 Radiology, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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Nagayama Y, Inoue T, Kato Y, Tanoue S, Kidoh M, Oda S, Nakaura T, Hirai T. Relative Enhancement Ratio of Portal Venous Phase to Unenhanced CT in the Diagnosis of Lipid-poor Adrenal Adenomas. Radiology 2021; 301:360-368. [PMID: 34463552 DOI: 10.1148/radiol.2021210231] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The development of an accurate, practical, noninvasive, and widely available diagnostic approach to characterize lipid-poor adrenal lesions (greater than 10 HU at unenhanced CT) remains an ongoing demand. Purpose To investigate whether combined assessment of unenhanced and portal venous phase CT allows for the differentiation of lipid-poor adrenal adenomas from nonadenomas. Materials and Methods Patients with lipid-poor adrenal lesions who underwent unenhanced and portal venous phase CT with a single-energy scanner between January 2016 and March 2020 were identified retrospectively. For each lesion, the unenhanced and contrast-enhanced attenuation were measured; the absolute enhancement (contrast-enhanced minus unenhanced attenuation [HU]) and relative enhancement ratio ([absolute enhancement divided by unenhanced attenuation] × 100%) were calculated. The sensitivity achieved at 95% specificity to distinguish adenomas from nonadenomas was determined with receiver operating characteristic curve analysis and compared among parameters with use of the McNemar test. Results A total of 220 patients (mean age ± standard deviation, 66 years ± 12; 134 men) with 131 lipid-poor adenomas and 89 nonadenomas were analyzed. The sensitivity (achieved at 95% specificity) of the relative enhancement ratio (86% [113 of 131 adenomas; 95% CI: 79, 92] at a threshold of >210%) was higher than that of unenhanced attenuation (50% [66 of 131 adenomas; 95% CI: 42, 59] at a threshold of ≤21 HU), contrast-enhanced attenuation (3% [four of 131 adenomas; 95% CI: 1, 8] at a threshold of >120 HU), and absolute enhancement (24% [32 of 131 adenomas; 95% CI: 17, 33] at a threshold of >74 HU; all P < .001). The sensitivities of the relative enhancement ratio were 100% (58 of 58 adenomas; 95% CI: 94, 100), 83% (52 of 63 adenomas; 95% CI: 71, 91), and 30% (three of 10 adenomas; 95% CI: 7, 65) for adenomas measuring unenhanced attenuation of more than 10 HU up to 20 HU, 21-30 HU, and more than 30 HU, respectively. Conclusion A relative enhancement ratio threshold of greater than 210%, measured at unenhanced and portal venous phase CT, accurately differentiated lipid-poor adenomas from nonadenomas, particularly for lesions with unenhanced attenuation of 10-30 HU. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Yasunori Nagayama
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Taihei Inoue
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuki Kato
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shota Tanoue
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Masafumi Kidoh
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Seitaro Oda
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takeshi Nakaura
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Toshinori Hirai
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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Mao Y, Ma W, Zhuo R, Ye L, Xu D, Wang W, Ning G, Sun F. COX4I2 is a novel biomarker of blood supply in adrenal tumors. Transl Androl Urol 2021; 10:2899-2909. [PMID: 34430392 PMCID: PMC8350245 DOI: 10.21037/tau-21-229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Previous study has been reported that COX4I2 expression level demonstrated a positive correlation with microvessel density in pheochromocytomas (PCC) samples, suggesting that the expression of COX4I2 maybe related to blood supply level in other adrenal tumors as well. The aim of this study is to clarify the correlation of COX4I2 expression and blood supply in adrenal tumors. Methods A total of 84 patients were recruited, among which 46 was diagnosed as adrenocortical adenoma (ACA) and 38 was diagnosed as PCC. Contrast-enhanced CT values were used to evaluate the blood supply levels in those patients. The expression of mRNA was examined by quantitative real-time polymerase chain reaction (qPCR) and protein was detected by immunohistochemistry (IHC). Results The COX4I2 expression level in PCC group is significantly higher than that in ACA group (P<0.01). The expression of angiogenesis-related genes EPAS1, VEGFA and KDR mRNA in PCC group is higher than that of ACA group (P<0.05). Correlation analysis shows COX4I2 expression level is correlated with CT values (P<0.001), intraoperative blood loss (P<0.05) and operation time (P<0.05), and the expression of COX4I2 mRNA is correlated with EPAS1, VEGFA and KDR mRNA (P<0.01). Conclusions The results displayed a distinct expression level of COX4I2 between ACA and PCC, suggesting that COX4I2 is a novel biomarker of blood supply in adrenal tumors. This research also opens the possibility for further research on COX4I2 as a novel target for anti-tumor angiogenesis.
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Affiliation(s)
- Yongxin Mao
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenming Ma
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ran Zhuo
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Ye
- Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danfeng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fukang Sun
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Tang L, Wang Y, Yang X, Luo G, Zeng X, Wang R, Song B. Virtual or real: lifelike cinematic rendering of adrenal tumors. Quant Imaging Med Surg 2021; 11:3854-3866. [PMID: 34341754 PMCID: PMC8245928 DOI: 10.21037/qims-20-1282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/26/2021] [Indexed: 02/05/2023]
Abstract
The adrenal gland is small in size and hidden in location. Adrenal tumors are relatively difficult to diagnose due to the wide variety of tumors and partial overlap of image features. Cinematic rendering (CR) is a novel, three-dimensional post-processing technology that simulates how light propagates in the real world, providing high-resolution visualizations that truly present subtle anatomical details. We retrospectively collected a series of pathologically confirmed adrenal tumor cases, raw data was introduced into the post-processing workstation, and different tools and templates of CR software were used for reconstruction and rendering. Compared with traditional black and white two-dimensional images and three-dimensional volume rendering (VR) images, CR images were more colorful, layered, and closer to the truth. CR has potential in diagnosing and preoperative planning of adrenal tumors, allowing vivid and realistic visualization of tumor location, morphology, different components (solid, cystic, fat, calcification, etc.), the pattern of enhancement, and the relationship with surrounding tissues and organs.
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Affiliation(s)
- Lei Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiology, Guizhou Provincial People’s Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Yuquan Wang
- Department of Radiology, Guizhou Provincial People’s Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Xiushu Yang
- Department of Urological Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Guangheng Luo
- Department of Urological Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Xianchun Zeng
- Department of Radiology, Guizhou Provincial People’s Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Rongpin Wang
- Department of Radiology, Guizhou Provincial People’s Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Nandra G, Duxbury O, Patel P, Patel JH, Patel N, Vlahos I. Technical and Interpretive Pitfalls in Adrenal Imaging. Radiographics 2021; 40:1041-1060. [PMID: 32609593 DOI: 10.1148/rg.2020190080] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The adrenal gland may exhibit a wide variety of pathologic conditions. A number of imaging techniques can be used to characterize these, although it is not always possible to attain a definitive diagnosis radiologically. Incorrect diagnoses may be made if radiologists are not attentive to technical parameters and interpretive factors associated with adrenal gland imaging. Hence, an appreciation of the intricacies of adrenal imaging strategies and characterization is required; this can be aided by understanding the pitfalls of adrenal imaging. Technical pitfalls at CT may relate to the imaging parameters, including region of interest characteristics, tube voltage selection, and the timing of contrast material-enhanced imaging. With MRI, imaging acquisition technique and evaluation of the reference tissues used in chemical shift MRI are important considerations that can directly influence image interpretation. Interpretive errors may occur when evaluating adrenal washout at CT without considering other radiologic features, including the size of adrenal nodules, the presence of fat or calcification, the attenuation of nodules, and atypical imaging features. The characterization of an incidental adrenal lesion as benign or malignant does not end the role of the radiologist; consideration as to whether an adrenal lesion is associated with endocrine dysfunction is required. While imaging may not be optimal for establishing endocrine activity, there are imaging features from which radiologists may infer function. In cases of known endocrine activity, imaging can guide clinical management, including further investigations such as venous sampling. ©RSNA, 2020.
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Affiliation(s)
- Gurinder Nandra
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
| | - Oliver Duxbury
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
| | - Pawan Patel
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
| | - Jaymin H Patel
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
| | - Nirav Patel
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
| | - Ioannis Vlahos
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
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Abstract
Incidentally detected adrenal nodules are common, and prevalence increases with patient age. Although most are benign, it is important for the radiologist to be able to accurately determine which nodules require further testing and which are safely left alone. The American College of Radiology incidental adrenal White Paper provides a structured algorithm based on expert consensus for management of incidental adrenal nodules. If further diagnostic testing is indicated, adrenal computed tomography is the most appropriate test in patients for nodules less than 4 cm. In addition to imaging, biochemical testing and endocrinology referral is warranted to exclude a functioning mass.
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Affiliation(s)
- Daniel I Glazer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Michael T Corwin
- Department of Radiology, University of California, Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - William W Mayo-Smith
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Update on the Role of Imaging in Clinical Staging and Restaging of Renal Cell Carcinoma Based on the AJCC 8th Edition, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol 2021; 217:541-555. [PMID: 33759558 DOI: 10.2214/ajr.21.25493] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This article reviews the essential role of imaging in clinical staging and restaging of renal cell carcinoma (RCC). To completely characterize and stage an indeterminate renal mass, renal CT or MRI without and with IV contrast administration is recommended. The critical items for initial clinical staging of an indeterminate renal mass or of a known RCC according to the TNM staging system are tumor size, renal sinus fat invasion, urinary collecting system invasion, perinephric fat invasion, venous invasion, adrenal gland invasion, invasion of the perirenal (Gerota) fascia, invasion into other adjacent organs, the presence of enlarged or pathologic regional (retroperitoneal) lymph nodes, and the presence of distant metastatic disease. Larger tumor size is associated with higher stage disease and invasiveness, lymph node spread, and distant metastatic disease. Imaging practice guidelines for clinical staging of RCC, as well as the role of renal mass biopsy, are highlighted. Specific findings associated with response of advanced cancer to antiangiogenic therapy and immunotherapy are discussed, as well as limitations of changes in tumor size after targeted therapy. The accurate clinical staging and restaging of RCC using renal CT or MRI provides important prognostic information and helps guide the optimal management of patients with RCC.
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McDermott E, Kilcoyne A, O'Shea A, Cahalane AM, McDermott S. The role of percutaneous CT-guided biopsy of an adrenal lesion in patients with known or suspected lung cancer. Abdom Radiol (NY) 2021; 46:1171-1178. [PMID: 32945923 DOI: 10.1007/s00261-020-02743-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the sensitivity, specificity, and complication rate of percutaneous adrenal biopsy in patients with known or suspected lung cancer. METHODS This study was approved by the Institutional Review Board at our institution as a retrospective analysis; therefore, the need for informed consent was waived. All percutaneous adrenal biopsies performed between April 1993 and May 2019 were reviewed. 357 of 582 biopsies were performed on 343 patients with known or suspected lung cancer (M:F 164:179; mean age 66 years). The biopsy results were classified into malignant, benign, or non-diagnostic. The final diagnosis was established by pathology (biopsy and/or surgical resection) or imaging follow-up on CT for at least 12 months following the biopsy. Patients with less than 12 months follow-up were excluded (n = 44). Complications were recorded. RESULTS The final diagnosis was metastatic lung cancer in 235 cases (77.8%), metastasis from an extrapulmonary primary in 2 cases (0.7%), pheochromocytoma in 2 cases (0.7%), and benign lesions in 63 cases (20.9%). Percutaneous adrenal gland biopsy had a sensitivity of 97% and specificity of 100% for lung cancer metastases. The non-diagnostic rate was 0.6%. Larger lesions were more likely to be malignant (p = 0.0000) and to be correctly classified as a lung metastasis (p = 0.025). The incidence of minor complications was 1.1%. There were no major complications. CONCLUSION Over 20% of adrenal lesions in patients with known or suspected lung cancer were not related to lung cancer. Percutaneous adrenal gland biopsy is a safe procedure, with high sensitivity and specificity for lung cancer metastases.
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Affiliation(s)
- E McDermott
- Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - A Kilcoyne
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | - A O'Shea
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - A M Cahalane
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - S McDermott
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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Kang S, Oh YL, Park SY. Distinguishing pheochromocytoma from adrenal adenoma by using modified computed tomography criteria. Abdom Radiol (NY) 2021; 46:1082-1090. [PMID: 32951125 DOI: 10.1007/s00261-020-02764-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/22/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the performance of modified criteria to distinguish pheochromocytoma from adrenal adenoma by using adrenal protocol computed tomography (CT). METHODS We retrospectively included consecutive 199 patients who underwent adrenal CT and surgically proven pheochromocytoma (n = 66) or adenoma (n = 133). Two independent radiologists analyzed two CT criteria for pheochromocytoma. Conventional criteria were as follows: (a) lesion attenuation on unenhanced CT > 10 Hounsfield unit (HU); (b) absolute percentage washout < 60%; and (c) relative percentage washout < 40%. Modified criteria were as follows: (a) conventional criteria or (b) one of the following findings: (i) lesion attenuation on unenhanced CT ≥ 40 HU, (ii) 1-min enhanced CT ≥ 160 HU, (iii) 15-min enhanced CT ≥ 70 HU, , or (iv) intralesional cystic degeneration seen on both 1-min and 15-min enhanced CT. We analyzed area under the curve (AUC) and inter-reader agreement. RESULTS Proportion of pheochromocytoma was 33.2% (66/199). AUC of modified criteria was consistently higher than that of conventional criteria for distinguishing pheochromocytoma from adenoma (reader 1, 0.864 versus 0.746 for raw data set and 0.865 versus 0.746 for internal validation set; reader 2, 0.872 versus 0.758 for raw data set and 0.872 versus 0.757 for internal validation set) (p < 0.05 for all comparisons). Inter-reader agreement was excellent in interpreting any criteria (weighted kappa > 0.800). CONCLUSION Our modified criteria seem to improve diagnostic performance of adrenal CT in distinguishing pheochromocytoma from adrenal adenoma.
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Zhu F, Zhu X, Shi H, Liu C, Xu Z, Shao M, Tian F, Wang J. Adrenal metastases: early biphasic contrast-enhanced CT findings with emphasis on differentiation from lipid-poor adrenal adenomas. Clin Radiol 2021; 76:294-301. [PMID: 33509608 DOI: 10.1016/j.crad.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
AIM To evaluate the accuracy of unenhanced attenuation and early biphasic contrast-enhanced computed tomography (CT) in differentiating adrenal metastases (AMs) from lipid-poor adrenal adenomas (AAs). MATERIALS AND METHODS This retrospective study included 37 patients with 50 AMs and 86 patients with 89 lipid-poor AAs. Quantitative data including the longest diameter (LD), the shortest diameter (SD), LD/SD ratio, CT attenuation values (CTu, CTa, CTv), degree of enhancement (DEAP, DEPP, DEpeak, APW, RPW), and peak enhanced/unenhanced (PE/U) CT attenuation ratio were obtained. Qualitative data including enhancement pattern, location, shape, the presence of calcification or haemorrhage, and intra-lesion necrosis were analysed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated. RESULTS The PE/U ratio (≤1.25), CTu (≥32.2 HU), DEpeak (≤43.15 HU), DEPP (≤37.65 HU), presence of intralesional necrosis, location (bilateral adrenal glands), and irregular shape were significant variables for differentiating AMs from lipid-poor AAs (p<0.05). Among them, PE/U ratio (≤1.25) was of greater value in differentiating the two adrenal diseases, with sensitivity, specificity, area under the receiver operating curve (ROC) curve (AUC) of 92%, 84%, 0.933, respectively. When at least any three of above criteria were combined, the sensitivity, specificity, PPV, and NPV for diagnosing AMs were 88%, 93%, 88%, and 88%, respectively. CONCLUSIONS These seven CT criteria are conducive to differentiate AMs from lipid-poor AAs. Early biphasic contrast-enhanced CT is a high-efficient and practical imaging tool in differentiating them.
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Affiliation(s)
- F Zhu
- Department of Radiology, TongDe Hospital of ZheJiang Province, No.234, Gucui Road, Hangzhou, Zhejiang Province, 310012, China
| | - X Zhu
- Department of Radiology, TongDe Hospital of ZheJiang Province, No.234, Gucui Road, Hangzhou, Zhejiang Province, 310012, China
| | - H Shi
- Department of Radiology, Anqing Municipal Hospital, Anqing, Anhui, China
| | - C Liu
- Department of Radiology, TongDe Hospital of ZheJiang Province, No.234, Gucui Road, Hangzhou, Zhejiang Province, 310012, China
| | - Z Xu
- Department of Radiology, TongDe Hospital of ZheJiang Province, No.234, Gucui Road, Hangzhou, Zhejiang Province, 310012, China
| | - M Shao
- Department of Radiology, TongDe Hospital of ZheJiang Province, No.234, Gucui Road, Hangzhou, Zhejiang Province, 310012, China
| | - F Tian
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, China
| | - J Wang
- Department of Radiology, TongDe Hospital of ZheJiang Province, No.234, Gucui Road, Hangzhou, Zhejiang Province, 310012, China.
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Szász P, Kučera P, Čtvrtlík F, Langová K, Hartmann I, Tüdös Z. Diagnostic Value of Unenhanced CT Attenuation and CT Histogram Analysis in Differential Diagnosis of Adrenal Tumors. MEDICINA-LITHUANIA 2020; 56:medicina56110597. [PMID: 33182333 PMCID: PMC7695290 DOI: 10.3390/medicina56110597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 01/13/2023]
Abstract
Background and Objectives: Our aim was to verify the optimal cut-off value for unenhanced CT attenuation and the percentage of negative voxels in the volume CT histogram analysis of adrenal masses. Materials and Methods: We retrospectively analyzed the CT data of patients who underwent an adrenalectomy in the period 2002-2019. In total, 413 adrenalectomies were performed. Out of these, 233 histologically verified masses (123 adenomas, 58 pheochromocytomas, 18 carcinomas, and 34 metastases) fulfilled the inclusion criteria and were selected for analysis. The mean unenhanced attenuation in Hounsfield units (HU) and the percentage of voxels with attenuation less than 0 HU (negative voxels) were measured in each mass. Results: The mean unenhanced attenuation with a cut-off value of 10 HU reached a sensitivity of 59.4% and a specificity of 99.1% for benign adenomas. The mean unenhanced attenuation with a cut-off value of 15 HU reached a sensitivity of 69.1% and a specificity of 98.2%. For the histogram analysis, a cut-off value of 10% of negative pixels reached a sensitivity of 82.9% and a specificity of 98.2%, whereas a cut-off value of 5% of negative pixels reached a sensitivity of 87.8% and a specificity of 75.5%. The percentage of negative voxels reached a slightly better area under the curve (0.919) than unenhanced attenuation (0.908). Conclusion: Mean unenhanced attenuation with a cut-off value of 10 HU represents a simple tool, and the most specific one, to distinguish adrenal adenomas from non-adenomas. CT histogram analysis with cut-off values of 10% of negative voxels improves sensitivity without any loss of specificity.
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Affiliation(s)
- Paulína Szász
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic; (P.S.); (P.K.); (F.Č.)
| | - Petr Kučera
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic; (P.S.); (P.K.); (F.Č.)
| | - Filip Čtvrtlík
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic; (P.S.); (P.K.); (F.Č.)
| | - Kateřina Langová
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University, 775 15 Olomouc, Czech Republic;
| | - Igor Hartmann
- Department of Urology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic;
| | - Zbyněk Tüdös
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic; (P.S.); (P.K.); (F.Č.)
- Correspondence: ; Tel.: +420-588-445-995
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Tu W, Abreu-Gomez J, Udare A, Alrashed A, Schieda N. Utility of T2-weighted MRI to Differentiate Adrenal Metastases from Lipid-Poor Adrenal Adenomas. Radiol Imaging Cancer 2020; 2:e200011. [PMID: 33778748 DOI: 10.1148/rycan.2020200011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022]
Abstract
Purpose To evaluate T2-weighted MRI features to differentiate adrenal metastases from lipid-poor adenomas. Materials and Methods With institutional review board approval, this study retrospectively compared 40 consecutive patients (mean age, 66 years ± 10 [standard deviation]) with metastases to 23 patients (mean age, 60 years ± 15) with lipid-poor adenomas at 1.5- and 3-T MRI between June 2016 and March 2019. A blinded radiologist measured T2-weighted signal intensity (SI) ratio (SInodule/SIpsoas muscle), T2-weighted histogram features, and chemical shift SI index. Two blinded radiologists (radiologist 1 and radiologist 2) assessed T2-weighted SI and T2-weighted heterogeneity using five-point Likert scales. Results Subjectively, T2-weighted SI (P < .001 for radiologist 1 and radiologist 2) and T2-weighted heterogeneity (P < .001, for radiologist 1 and radiologist 2) were higher in metastases compared with adenomas when assessed by both radiologists. Agreement between the radiologists was substantial for T2-weighted SI (Cohen κ = 0.67) and T2-weighted heterogeneity (κ = 0.62). Metastases had higher T2-weighted SI ratio than adenomas (3.6 ± 1.7 [95% confidence interval {CI}: 0.2, 8.2] vs 2.2 ± 1.0 [95% CI: 0.6, 4.3], P < .001) and higher T2-weighted entropy (6.6 ± 0.6 [95% CI: 4.9, 7.5] vs 5.0 ± 0.8 [95% CI: 3.5, 6.6], P < .001). At multivariate analysis, T2-weighted entropy was the best differentiating feature (P < .001). Chemical shift SI index did not differ between metastases and adenomas (P = .748). Area under the receiver operating characteristic curve (AUC) for T2-weighted SI ratio and T2-weighted entropy were 0.76 (95% CI: 0.64, 0.88) and 0.94 (95% CI: 0.88, 0.99). The logistic regression model combining T2-weighted SI ratio with T2-weighted entropy yielded AUC of 0.95 (95% CI: 0.91, 0.99) and did not differ compared with T2-weighted entropy alone (P = .268). There was no difference in logistic regression model accuracy comparing the data by either field strength, 1.5- or 3-T MRI (P > .05). Conclusion Logistic regression models combining T2-weighted SI and T2-weighted heterogeneity can differentiate metastases from lipid-poor adenomas. Validation of these preliminary results is required.Keywords: Adrenal, MR-Imaging, UrinarySupplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Wendy Tu
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.)
| | - Jorge Abreu-Gomez
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.)
| | - Amar Udare
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.)
| | - Abdulmohsen Alrashed
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.)
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.)
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Yalniz C, Morani AC, Waguespack SG, Elsayes KM. Imaging of Adrenal-Related Endocrine Disorders. Radiol Clin North Am 2020; 58:1099-1113. [PMID: 33040851 DOI: 10.1016/j.rcl.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Endocrine disorders associated with adrenal pathologies can be caused by insufficient adrenal gland function or excess hormone secretion. Excess hormone secretion may result from adrenal hyperplasia or hormone-secreting (ie, functioning) adrenal masses. Based on the hormone type, functioning adrenal masses can be classified as cortisol-producing tumors, aldosterone producing tumors, and androgen-producing tumors, which originate in the adrenal cortex, as well as catecholamine-producing pheochromocytomas, which originate in the medulla. Nonfunctioning lesions can cause adrenal gland enlargement without causing hormonal imbalance. Evaluation of adrenal-related endocrine disorders requires clinical and biochemical workup associated with imaging evaluation to reach a diagnosis and guide management.
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Affiliation(s)
- Ceren Yalniz
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Ajaykumar C Morani
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Khaled M Elsayes
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA.
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45
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Yang Y, Hu J, Zhang J, Wang F, He C, Yang Y, Lian J, Zhang T, Liu H. Angiomyolipoma of the adrenal gland: clinical experience and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:654. [PMID: 32566591 PMCID: PMC7290629 DOI: 10.21037/atm-20-3147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Angiomyolipomas, a type of benign mesenchymal tumor originating from perivascular epithelioid cells, are composed of mature adipose tissue, smooth muscle, and thick-walled vessels. With fewer than 20 cases reported in English literature, adrenal angiomyolipoma is extremely rare. In these cases, the patient is usually asymptomatic and the tumor is found incidentally. Adrenal angiomyolipoma has never been reported in association with lung cancer. A 62-year-old man presented with an enlarged mass in the left adrenal gland. The mass had persisted for two years previously and was first discovered during a routine follow-up CT examination after lung cancer resection in 2016. Subsequently, partial left adrenal resection was performed. Postoperative histopathology confirmed a benign angiomyolipoma comprising adipose tissue, blood vessels, and smooth muscle cells. At three months follow-up, the patient was alive and had experienced no recurrence after the operation. Eighteen cases were identified on literature review, among which no patients had a history of lung cancer. These cases occurred more often in females and lesions mostly located on the right side. All of the reported cases were nonfunctional, ranging in size from 0.2 to 16 cm (95% of the masses exceeding 4 cm). In this case report, we consider a rare case of a patient with an adrenal angiomyolipoma with a history of lung cancer. Adrenal angiomyolipoma should be considered as one of the differential diagnoses of adrenal metastasis for patients with a history of primary tumors.
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Affiliation(s)
- Yang Yang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Jie Hu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Jingjing Zhang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Fuqin Wang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Cheng He
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Yanli Yang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Jie Lian
- Department of Pathology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Tijiang Zhang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Heng Liu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
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46
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Response to letter to the editor. Abdom Radiol (NY) 2020; 45:903-904. [PMID: 31919645 DOI: 10.1007/s00261-019-02392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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47
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Freire G, Ramalho M. Chemical-shift Imaging: does it have a role in the management of adrenal masses? Abdom Radiol (NY) 2020; 45:901-902. [PMID: 31901954 DOI: 10.1007/s00261-019-02363-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Gonçalo Freire
- Radiology Department, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 3, 2674-514, Loures, Portugal.
| | - Miguel Ramalho
- Radiology Department, Hospital Garcia de Orta, Almada, Portugal
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Elbanan MG, Javadi S, Ganeshan D, Habra MA, Rao Korivi B, Faria SC, Elsayes KM. Adrenal cortical adenoma: current update, imaging features, atypical findings, and mimics. Abdom Radiol (NY) 2020; 45:905-916. [PMID: 31529204 DOI: 10.1007/s00261-019-02215-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Adrenal adenoma is the most common adrenal lesion. Due to its wide prevalence, adrenal adenomas may demonstrate various imaging features. Thus, it is important to identify typical and atypical imaging features of adrenal adenomas and to be able to differentiate atypical adrenal adenomas from potentially malignant lesions. In this article, we will discuss the diagnostic approach, typical and atypical imaging features of adrenal adenomas, as well as other lesions that mimic adrenal adenomas.
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Affiliation(s)
- Mohamed G Elbanan
- Department of Diagnostic Radiology, Yale New Haven Health System, Bridgeport Hospital, Bridgeport, CT, USA
| | - Sanaz Javadi
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Dhakshinamoorthy Ganeshan
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Brinda Rao Korivi
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Silvana C Faria
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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Abstract
Due to the widespread use of imaging, incidental adrenal masses are commonly encountered. A number of pitfalls can result in misdiagnosis of these lesions, including inappropriate choice of imaging technique, presence of pseudolesions, and overlap of imaging features of different adrenal lesions. This article explores the potential pitfalls in imaging of the adrenal glands, on computed tomography and magnetic resonance imaging, that can lead to misinterpretation. Clues to correct diagnoses are provided to evade potential misinterpretation.
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Chung AD. Extrahepatic Fat-Containing Lesions of the Abdomen and Pelvis: An Organ-Based Approach to Differential Diagnoses. Can Assoc Radiol J 2020; 71:19-29. [PMID: 32063003 DOI: 10.1177/0846537119887871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The presence of intralesional fat provides an invaluable tool for narrowing the differential diagnosis for both benign and malignant neoplasms of the abdomen and pelvis. The ability to characterize intralesional fat is further expanded by the ability of magnetic resonance imaging to detect small quantities (intravoxel) of fat. While the presence of intralesional fat can help to provide a relatively narrow set of diagnostic possibilities, depending on the type of fat (macroscopic vs intravoxel) that is present and the organ of origin, radiologists must be aware of uncommon mimickers of pathology, both benign and malignant.
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Affiliation(s)
- Andrew D Chung
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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