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Gündoğdu E, Aşılıoğlu BK, Yazıcı C. Whole-lesion CT histogram analysis as an advanced technique in the portal venous phase: differentiating lipid poor adrenal adenomas from pheochromocytomas. Abdom Radiol (NY) 2025; 50:1219-1227. [PMID: 39305291 DOI: 10.1007/s00261-024-04575-3] [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: 05/29/2024] [Revised: 08/31/2024] [Accepted: 09/04/2024] [Indexed: 02/14/2025]
Abstract
PURPOSE Adrenal computed tomography (CT) has limitation due to imaging overlaps inthe washout characteristics of pheochromocytomas and adenomas (especially lipid-poor). The aim of this study was to investigate the distinguishability of lipid-poor adrenal adenomas and pheochromocytomas using whole-lesion CT histogram analysis. MATERIALS AND METHODS Histopathologically proven 24 lipid-poor adenomas and 29 pheochromocytomas (total 53 lesions in 53 patients) were included in this retrospective study. Data obtained from standard and volumetric examinations of the lesions by dedicated adrenal CT were compared between the two groups using univariate analysis. Parameters that showed differences were further evaluated using multivariate logistic regression analysis. RESULTS Univariate analysis revealed significant differences between the two groups in terms of lesion size, lesion volume, percentage of relative wash out, peak HU values and the percentage of voxels with attenuation ≥ 100 HU, ≥ 110 HU and ≥ 120 HU (p = 0.0001, P = 0.0001, P = 0.01, P = 0.008, p = 0.04, p = 0.02, p = 0.02, respectively). Multivariate analysis revealed lesion size ≥ 22.05 mm (OR: 22; p < 0.0001), the percentage of voxels with attenuation ≥ 120 HU being ≥ 9% (OR: 3.27; p = 0.04), peak HU value ≥ 161.5 HU (OR: 4.40; p = 0.01) as risk factors for pheochromocytomas. CONCLUSIONS Whole lesion CT histogram analysis can be used to differentiate pheochromocytomas from lipid-poor adenomas. Lesion volume, the percentage of voxels with attenuation ≥ 120 HU and peak HU values are independent parameters that can assist in this differentiation. These findings may help avoid unnecessary biopsies and surgeries for lipid-poor adenomas, while identifying pheochromocytoma risk may improve perioperative patient management. Our results should be validated by future prospective studies.
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Affiliation(s)
| | | | - Celal Yazıcı
- Eskişehir Osmangazi University, Eskişehir, Turkey
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Oguro S, Tannai H, Ota H, Seiji K, Kamada H, Toyama Y, Omata K, Tezuka Y, Ono Y, Satoh F, Ito S, Tanaka T, Katagiri H, Takase K. Role of radiologists in the diagnosis and management of adrenal disorders. Endocr J 2025; 72:131-148. [PMID: 39384399 PMCID: PMC11850109 DOI: 10.1507/endocrj.ej24-0156] [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] [Received: 03/15/2024] [Accepted: 09/09/2024] [Indexed: 10/11/2024] Open
Abstract
This study aimed to focus on the role of radiologists in the diagnosis and management of adrenal lesions, particularly primary aldosteronism (PA) and secondary hypertension. As hypertension affects more than one-third of the population in Japan, identifying secondary causes such as PA and adrenal lesions is crucial. Establishing a radiological differential diagnosis of adrenal lesions using advanced imaging techniques, such as computed tomography and magnetic resonance imaging, is crucial. Knowledge of the imaging findings of various benign and malignant adrenal lesions, such as adrenocortical adenomas, cortisol-producing lesions, pheochromocytomas, adrenocortical carcinoma, malignant lymphoma, and metastatic tumors, is necessary. Adrenal venous sampling (AVS) plays a crucial role in accurately localizing aldosterone hypersecretion in PA, especially when imaging fails to provide a clear diagnosis. This paper details the technical aspects of AVS, emphasizing catheterization techniques, anatomical considerations, and the importance of preprocedural imaging for successful sampling. Furthermore, we explore segmental adrenal venous sampling (SAVS), a more refined technique that samples specific adrenal tributary veins, offering enhanced diagnostic accuracy, particularly for microadenomas or challenging cases that may be missed with conventional AVS. The methodology for performing SAVS, along with the interpretation criteria for successful sampling and lateralization, is also outlined. Furthermore, radiologists have initiated treatments for unilateral PA, such as radiofrequency ablation, and play an integral role in the management of adrenal lesions. Collaborative approaches across clinical departments are required to enhance patient management in medical care involving the adrenal gland.
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Affiliation(s)
- Sota Oguro
- Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi 980-8574, Japan
| | - Hiromitsu Tannai
- Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi 980-8574, Japan
| | - Kazumasa Seiji
- Department of Diagnostic Radiology, South Miyagi Medical Center, Miyagi 989-1253, Japan
| | - Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi 980-8574, Japan
| | - Yoshitaka Toyama
- Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi 980-8574, Japan
| | - Kei Omata
- Department of Diabetes, Metabolism and Endocrinology, Tohoku University Hospital, Miyagi 980-8574, Japan
- Division of Nephrology, Rheumatology and Endocrinology, Tohoku University, Miyagi 980-8574, Japan
| | - Yuta Tezuka
- Department of Diabetes, Metabolism and Endocrinology, Tohoku University Hospital, Miyagi 980-8574, Japan
- Division of Nephrology, Rheumatology and Endocrinology, Tohoku University, Miyagi 980-8574, Japan
| | - Yoshikiyo Ono
- Department of Diabetes, Metabolism and Endocrinology, Tohoku University Hospital, Miyagi 980-8574, Japan
- Division of Nephrology, Rheumatology and Endocrinology, Tohoku University, Miyagi 980-8574, Japan
| | - Fumitoshi Satoh
- Division of Nephrology, Rheumatology and Endocrinology, Tohoku University, Miyagi 980-8574, Japan
| | - Sadayoshi Ito
- Department of Nephrology, Katta General Hospital, Miyagi 989-0231, Japan
| | - Tetsuhiro Tanaka
- Division of Nephrology, Rheumatology and Endocrinology, Tohoku University, Miyagi 980-8574, Japan
| | - Hideki Katagiri
- Department of Diabetes, Metabolism and Endocrinology, Tohoku University Hospital, Miyagi 980-8574, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi 980-8574, Japan
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Chen PT, Li PY, Liu KL, Wu VC, Lin YH, Chueh JS, Chen CM, Chang CC. Machine Learning Model with Computed Tomography Radiomics and Clinicobiochemical Characteristics Predict the Subtypes of Patients with Primary Aldosteronism. Acad Radiol 2024; 31:1818-1827. [PMID: 38042624 DOI: 10.1016/j.acra.2023.10.015] [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: 04/04/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 12/04/2023]
Abstract
RATIONALE AND OBJECTIVES Adrenal venous sampling (AVS) is the primary method for differentiating between primary aldosterone (PA) subtypes. The aim of study is to develop prediction models for subtyping of patients with PA using computed tomography (CT) radiomics and clinicobiochemical characteristics associated with PA. MATERIALS AND METHODS This study retrospectively enrolled 158 patients with PA who underwent AVS between January 2014 and March 2021. Neural network machine learning models were developed using a two-stage analysis of triple-phase abdominal CT and clinicobiochemical characteristics. In the first stage, the models were constructed to classify unilateral or bilateral PA; in the second stage, they were designed to determine the predominant side in patients with unilateral PA. The final proposed model combined the best-performing models from both stages. The model's performance was evaluated using repeated stratified five-fold cross-validation. We employed paired t-tests to compare its performance with the conventional imaging evaluations made by radiologists, which categorize patients as either having bilateral PA or unilateral PA on one side. RESULTS In the first stage, the integrated model that combines CT radiomic and clinicobiochemical characteristics exhibited the highest performance, surpassing both the radiomic-alone and clinicobiochemical-alone models. It achieved an accuracy and F1 score of 80.6% ± 3.0% and 74.8% ± 5.2% (area under the receiver operating curve [AUC] = 0.778 ± 0.050). In the second stage, the accuracy and F1 score of the radiomic-based model were 88% ± 4.9% and 81.9% ± 6.2% (AUC=0.831 ± 0.087). The proposed model achieved an accuracy and F1 score of 77.5% ± 3.9% and 70.5% ± 7.1% (AUC=0.771 ± 0.046) in subtype diagnosis and lateralization, surpassing the accuracy and F1 score achieved by radiologists' evaluation (p < .05). CONCLUSION The proposed machine learning model can predict the subtypes and lateralization of PA. It yields superior results compared to conventional imaging evaluation and has potential to supplement the diagnostic process in PA.
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Affiliation(s)
- Po-Ting Chen
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan (P.T.C, P.Y.L., C.M.C.); Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (P.T.C., K.L.L., C.C.C.); Department of Medical Imaging, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei, Taiwan (P.T.C., K.L.L.); Department of Medical Imaging, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan (P.T.C.)
| | - Pei-Yan Li
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan (P.T.C, P.Y.L., C.M.C.)
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (P.T.C., K.L.L., C.C.C.); Department of Medical Imaging, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei, Taiwan (P.T.C., K.L.L.)
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (V.C.W.)
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (Y.H.L.)
| | - Jeff S Chueh
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (J.S.C.)
| | - Chung-Ming Chen
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan (P.T.C, P.Y.L., C.M.C.)
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (P.T.C., K.L.L., C.C.C.).
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Yang YH, Chang YL, Lee BC, Lu CC, Wang WT, Hu YH, Liu HW, Lin YH, Chang CC, Wu WC, Tseng FY, Lin YH, Wu VC, Hwu CM. Strategies for subtyping primary aldosteronism. J Formos Med Assoc 2024; 123 Suppl 2:S114-S124. [PMID: 37202237 DOI: 10.1016/j.jfma.2023.05.004] [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] [Received: 03/13/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023] Open
Abstract
Adrenal venous sampling (AVS) is a crucial method for the lateralization of primary aldosteronism (PA). It is advised to halt the use of the patient's antihypertensive medications and correct hypokalemia prior to undergoing AVS. Hospitals equipped to conduct AVS should establish their own diagnostic criteria based on current guidelines. If the patient's antihypertensive medications cannot be discontinued, AVS can be performed as long as the serum renin level is suppressed. The Task Force of Taiwan PA recommends using a combination of adrenocorticotropic hormone stimulation, quick cortisol assay, and C-arm cone-beam computed tomography to maximize the success of AVS and minimize errors by using the simultaneous sampling technique. If AVS is not successful, an NP-59 (131 I-6-β-iodomethyl-19-norcholesterol) scan can be used as an alternative method to lateralize PA. We depicted the details of the lateralization procedures (mainly AVS, and alternatively NP-59) and their tips and tricks for confirmed PA patients who would consider to undergo surgical treatment (unilateral adrenalectomy) if the subtyping shows unilateral disease.
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Affiliation(s)
- Yun-Hsuan Yang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Yu-Ling Chang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ting Wang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Ya-Hui Hu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taipei, Taiwan
| | - Han-Wen Liu
- Division of Endocrine and Metabolism, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Yung-Hsiang Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Puzi, Chia-Yi, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan; Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Wan-Chen Wu
- Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Fen-Yu Tseng
- Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan
| | - Vin-Cent Wu
- Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chii-Min Hwu
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan; Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Liu Y, Zou X, Zhao W, Yao X, Wang L, Zhou L, Zhang R, Luo Y, Li M, Zhang X, Zhu Y, Cai X, Zhou X, Han X, Ji L. Adrenal limb thickness is associated with metabolism profiles in patients with diabetes: A cross-sectional study. J Diabetes 2024; 16:e13479. [PMID: 37751894 PMCID: PMC10859314 DOI: 10.1111/1753-0407.13479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The association between adrenal size and metabolic profiles in patients with diabetes mellitus (DM) is unclear. This study was conducted to determine whether the adrenal thickness measured by computed tomography (CT) is correlated with the metabolic profiles of patients with DM. METHODS This was a cross-sectional study including 588 Chinese hospitalized patients with DM without comorbidities or medications known to affect adrenal morphology or hormone secretion. Adrenal limb thickness was measured on unenhanced chest CT. Participants were stratified into tertiles according to their total adrenal limb thickness. Linear and logistic regression models were used to estimate the correlations. RESULTS After adjustment for sex and age, the adrenal thickness was positively associated with body mass index (BMI), waist circumference (WC), urinary albumin/creatinine ratio, and 24-h urinary free cortisol (UFC) and negatively correlated with high-density lipoprotein cholesterol. The sequential equation model (SEM) suggested UFC partially mediated the effect of adrenal limb thickness on WC by 12%. Adrenal thickness, but not UFC, was associated with a higher risk of existing hypertension (odds ratio [OR] = 3.78, 95% confidence interval [CI] 1.58, 9.02) and hyperlipidemia (OR = 2.76, 95% CI 1.03, 7.38), independent of age, gender, BMI, and WC. CONCLUSIONS The adrenal thickness is independently associated with BMI, WC, cortisol levels, urinary albumin/creatinine ratio, hypertension, and dyslipidemia but not glycemic parameters in patients with diabetes. Our study encourages further studies to investigate the role of adrenal physiology in patients with diabetes.
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Affiliation(s)
- Yingning Liu
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Xiantong Zou
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Wei Zhao
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
- Department of RadiologyPeking University People's HospitalBeijingChina
| | - Xun Yao
- Department of RadiologyPeking University People's HospitalBeijingChina
| | - Lexuan Wang
- School of Basic Medical SciencesPeking UniversityBeijingChina
| | - LingLi Zhou
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Rui Zhang
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Yingying Luo
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Meng Li
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Xiuying Zhang
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Yu Zhu
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Xiaoling Cai
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Xianghai Zhou
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Xueyao Han
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
| | - Linong Ji
- Department of Endocrinology and MetabolismPeking University People's HospitalBeijingChina
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Li J, Li H, Zhang Y, Wang Z, Zhu S, Li X, Hu K, Gao X. MCNet: A multi-level context-aware network for the segmentation of adrenal gland in CT images. Neural Netw 2024; 170:136-148. [PMID: 37979222 DOI: 10.1016/j.neunet.2023.11.028] [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: 06/13/2023] [Revised: 10/14/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023]
Abstract
Accurate segmentation of the adrenal gland from abdominal computed tomography (CT) scans is a crucial step towards facilitating the computer-aided diagnosis of adrenal-related diseases such as essential hypertension and adrenal tumors. However, the small size of the adrenal gland, which occupies less than 1% of the abdominal CT slice, poses a significant challenge to accurate segmentation. To address this problem, we propose a novel multi-level context-aware network (MCNet) to segment adrenal glands in CT images. Our MCNet mainly consists of two components, i.e., the multi-level context aggregation (MCA) module and multi-level context guidance (MCG) module. Specifically, the MCA module employs multi-branch dilated convolutional layers to capture geometric information, which enables handling of changes in complex scenarios such as variations in the size and shape of objects. The MCG module, on the other hand, gathers valuable features from the shallow layer and leverages the complete utilization of feature information at different resolutions in various codec stages. Finally, we evaluate the performance of the MCNet on two CT datasets, including our clinical dataset (Ad-Seg) and a publicly available dataset known as Distorted Golden Standards (DGS), from different perspectives. Compared to ten other state-of-the-art segmentation methods, our MCNet achieves 71.34% and 75.29% of the best Dice similarity coefficient on the two datasets, respectively, which is at least 2.46% and 1.19% higher than other segmentation methods.
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Affiliation(s)
- Jinhao Li
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education, Xiangtan University, Xiangtan 411105, China
| | - Huying Li
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education, Xiangtan University, Xiangtan 411105, China
| | - Yuan Zhang
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education, Xiangtan University, Xiangtan 411105, China
| | - Zhiqiang Wang
- Key Laboratory of Medical Imaging and Artificial Intelligence of Hunan Province, Xiangnan University, Chenzhou 423000, China; College of Medical Imaging Laboratory and Rehabilitation, Xiangnan University, Chenzhou 423000, China.
| | - Sheng Zhu
- Department of Nuclear Medicine, Affiliated Hospital of Xiangnan University, Chenzhou 423000, China
| | | | - Kai Hu
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education, Xiangtan University, Xiangtan 411105, China; Key Laboratory of Medical Imaging and Artificial Intelligence of Hunan Province, Xiangnan University, Chenzhou 423000, China.
| | - Xieping Gao
- Hunan Provincial Key Laboratory of Intelligent Computing and Language Information Processing, Hunan Normal University, Changsha 410081, China
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Ahmed TM, Rowe SP, Fishman EK, Soyer P, Chu LC. Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management. Diagn Interv Imaging 2024; 105:5-14. [PMID: 37798191 DOI: 10.1016/j.diii.2023.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023]
Abstract
The adrenal gland is home to an array of complex physiological and neoplastic disease processes. While dedicated adrenal computed tomography (CT) is the gold standard imaging modality for adrenal lesions, there exists significant overlap among imaging features of adrenal pathology. This can often make radiological diagnosis and subsequent determination of the optimal surgical approach challenging. Cinematic rendering (CR) is a novel CT post-processing technique that utilizes advanced light modeling to generate highly photorealistic anatomic visualization. This generates unique prospects in the evaluation of adrenal masses. As one of the first large tertiary care centers to incorporate CR into routine diagnostic workup, our preliminary experience with using CR has been positive, and we have found CR to be a valuable adjunct during surgical planning. Herein, we highlight the unique utility of CR techniques in the workup of adrenal lesions and provide commentary on the opportunities and obstacles associated with the application of this novel display method in this setting.
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Affiliation(s)
- Taha M Ahmed
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Steven P Rowe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin-APHP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Linda C Chu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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8
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Kotelnikova LP, Zhizhilev YV. Computed tomography in the differential diagnosis of adrenal tumors. ENDOCRINE SURGERY 2022. [DOI: 10.14341/serg12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Modern methods of topical diagnostics have high accuracy and can determine the morphological structure of the adrenal tumor with high probability before surgery, but none of them has 100% sensitivity and specificity. Contrast-enhanced computed tomography is most commonly used by clinicians. The criteria for the malignancy of an adrenal tumor determined by this method continue to be discussed.The aim is to evaluate the effectiveness of contrast-enhanced computed tomography in the preoperative diagnosis of adrenal tumors and to analyze errors.Materials and methods. Contrast-enhanced computed tomography was performed in 69 patients with adrenal tumors. After morphological examination of the removed tumors, the effectiveness of preoperative diagnostics was evaluated with the determination of sensitivity and specificity of the method. If the pre- and postoperative diagnosis did not match, the causes of errors were analyzed.Results. The attenuation on unenhanced CT in adenomas ranged from 5 to 36 HU, in adrenocortical cancer — from 26 to 80 HU, in pheochromocytomas — from 25 to 99 HU. The attenuation of adenomas on unenhanced CT was significantly less than with pheochromocytomas (p=0.005) and adrenocortical cancer (p=0.012). In the venous phase, no significant differences were found, and in the delayed phase, the attenuation of adenomas was also significantly less than in malignant tumors (p=0.008, p=0.008). The median of absolute percent contrast washout in adenomas was 85%, in pheochromocytes — 59%, in adrenocortical cancer — 57%. When comparing the diagnosis before and after surgery, its non-coincidence was found in 8 cases (10.39%). Two patients (2.59%) with small tumors (diameter of 15 mm) were diagnosed with adenoma in combination with pheochromocytoma and adenoma before surgery. After morphological examination, the diagnosis was changed to adrenocortical cancer in combination with adenoma and «mute» pheochromocytoma.Conclusion. The sensitivity and specificity of contrast-enhanced CT in the diagnosis of adenomas was 95.61% and 94.82%, pheochromocytomas — 95% and 95.08%, adrenocortical cancer — 92.31 and 98.48%. Diagnostic errors of «mute» pheochromocytoma and adrenocortical cancer occurred with small sizes (15 mm) of adrenal tumors.
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Bracci B, De Santis D, Del Gaudio A, Faugno MC, Romano A, Tarallo M, Zerunian M, Guido G, Polici M, Polidori T, Pucciarelli F, Matarazzo I, Laghi A, Caruso D. Adrenal Lesions: A Review of Imaging. Diagnostics (Basel) 2022; 12:diagnostics12092171. [PMID: 36140572 PMCID: PMC9498052 DOI: 10.3390/diagnostics12092171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Adrenal lesions are frequently incidentally diagnosed during investigations for other clinical conditions. Despite being usually benign, nonfunctioning, and silent, they can occasionally cause discomfort or be responsible for various clinical conditions due to hormonal dysregulation; therefore, their characterization is of paramount importance for establishing the best therapeutic strategy. Imaging techniques such as ultrasound, computed tomography, magnetic resonance, and PET-TC, providing anatomical and functional information, play a central role in the diagnostic workup, allowing clinicians and surgeons to choose the optimal lesion management. This review aims at providing an overview of the most encountered adrenal lesions, both benign and malignant, including describing their imaging characteristics.
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Affiliation(s)
- Benedetta Bracci
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Domenico De Santis
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Antonella Del Gaudio
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Maria Carla Faugno
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Allegra Romano
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Mariarita Tarallo
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, 00185 Rome, Italy
| | - Marta Zerunian
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Gisella Guido
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Michela Polici
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Tiziano Polidori
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Francesco Pucciarelli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Iolanda Matarazzo
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
- Correspondence:
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10
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Corral de la Calle M, Encinas de la Iglesia J, Fernández-Pérez G, Repollés Cobaleda M, Fraino A. Adrenal pheochromocytoma: Keys to radiologic diagnosis. RADIOLOGIA 2022; 64:348-367. [DOI: 10.1016/j.rxeng.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/02/2022] [Indexed: 10/15/2022]
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11
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Kusunoki M, Nakayama T, Nishie A, Yamashita Y, Kikuchi K, Eto M, Oda Y, Ishigami K. A deep learning-based approach for the diagnosis of adrenal adenoma: a new trial using CT. Br J Radiol 2022; 95:20211066. [PMID: 35522787 PMCID: PMC10996310 DOI: 10.1259/bjr.20211066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 04/03/2022] [Accepted: 04/20/2022] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To develop and validate deep convolutional neural network (DCNN) models for the diagnosis of adrenal adenoma (AA) using CT. METHODS This retrospective study enrolled 112 patients who underwent abdominal CT (non-contrast, early, and delayed phases) with 107 adrenal lesions (83 AAs and 24 non-AAs) confirmed pathologically and with 8 lesions confirmed by follow-up as metastatic carcinomas. Three patients had adrenal lesions on both sides. We constructed six DCNN models from six types of input images for comparison: non-contrast images only (Model A), delayed phase images only (Model B), three phasic images merged into a 3-channel (Model C), relative washout rate (RWR) image maps only (Model D), non-contrast and RWR maps merged into a 2-channel (Model E), and delayed phase and RWR maps merged into a 2-channel (Model F). These input images were prepared manually with cropping and registration of CT images. Each DCNN model with six convolutional layers was trained with data augmentation and hyperparameter tuning. The optimal threshold values for binary classification were determined from the receiver-operating characteristic curve analyses. We adopted the nested cross-validation method, in which the outer fivefold cross-validation was used to assess the diagnostic performance of the models and the inner fivefold cross-validation was used to tune hyperparameters of the models. RESULTS The areas under the curve with 95% confidence intervals of Models A-F were 0.94 [0.90, 0.98], 0.80 [0.69, 0.89], 0.97 [0.94, 1.00], 0.92 [0.85, 0.97], 0.99 [0.97, 1.00] and 0.94 [0.86, 0.99], respectively. Model E showed high area under the curve greater than 0.95. CONCLUSION DCNN models may be a useful tool for the diagnosis of AA using CT. ADVANCES IN KNOWLEDGE The current study demonstrates a deep learning-based approach could differentiate adrenal adenoma from non-adenoma using multiphasic CT.
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Affiliation(s)
- Masaoki Kusunoki
- Department of Clinical Radiology, Kyushu
University, Fukuoka,
Japan
| | - Tomohiro Nakayama
- Department of Radiology, Saiseikai Fukuoka General
Hospital, Fukuoka,
Japan
| | - Akihiro Nishie
- Department of Clinical Radiology, Kyushu
University, Fukuoka,
Japan
| | - Yasuo Yamashita
- Department of Clinical Radiology, Kyushu
University, Fukuoka,
Japan
- Department of Medical Technology, Kyushu
University, Fukuoka,
Japan
| | - Kazufumi Kikuchi
- Department of Clinical Radiology, Kyushu
University, Fukuoka,
Japan
| | - Masatoshi Eto
- Department of Urology, Kyushu University,
Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Kyushu
University, Fukuoka,
Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Kyushu
University, Fukuoka,
Japan
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12
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Feocromocitoma adrenal. Claves para el diagnóstico radiológico. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Radiomics utilization to differentiate nonfunctional adenoma in essential hypertension and functional adenoma in primary aldosteronism. Sci Rep 2022; 12:8892. [PMID: 35614110 PMCID: PMC9132956 DOI: 10.1038/s41598-022-12835-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 05/12/2022] [Indexed: 11/08/2022] Open
Abstract
We performed the present study to investigate the role of computed tomography (CT) radiomics in differentiating nonfunctional adenoma and aldosterone-producing adenoma (APA) and outcome prediction in patients with clinically suspected primary aldosteronism (PA). This study included 60 patients diagnosed with essential hypertension (EH) with nonfunctional adenoma on CT and 91 patients with unilateral surgically proven APA. Each whole nodule on unenhanced and venous phase CT images was segmented manually and randomly split into training and test sets at a ratio of 8:2. Radiomic models for nodule discrimination and outcome prediction of APA after adrenalectomy were established separately using the training set by least absolute shrinkage and selection operator (LASSO) logistic regression, and the performance was evaluated on test sets. The model can differentiate adrenal nodules in EH and PA with a sensitivity, specificity, and accuracy of 83.3%, 78.9% and 80.6% (AUC = 0.91 [0.72, 0.97]) in unenhanced CT and 81.2%, 100% and 87.5% (AUC = 0.98 [0.77, 1.00]) in venous phase CT, respectively. In the outcome after adrenalectomy, the models showed a favorable ability to predict biochemical success (Unenhanced/venous CT: AUC = 0.67 [0.52, 0.79]/0.62 [0.46, 0.76]) and clinical success (Unenhanced/venous CT: AUC = 0.59 [0.47, 0.70]/0.64 [0.51, 0.74]). The results showed that CT-based radiomic models hold promise to discriminate APA and nonfunctional adenoma when an adrenal incidentaloma was detected on CT images of hypertensive patients in clinical practice, while the role of radiomic analysis in outcome prediction after adrenalectomy needs further investigation.
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14
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Role of 18F-FDG PET/CT in management of adrenocortical carcinoma: a comprehensive review of the literature. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00485-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Buryakina SA, Tarbaeva NV, Volevodz NN, Karmazanovsky GG, Kovalevich LD, Shestakova MV, Dedov II. Adrenal incidentaloma. Part 2. Modern concepts of computed tomography semiotics of adrenal gland incidentalomas: algorithm of differential diagnosis. TERAPEVT ARKH 2021; 93:1381-1388. [DOI: 10.26442/00403660.2021.11.201169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
Abstract
While accidentally detecting an adrenal gland lesion (incidentaloma) during a routine computed tomography (CT) scan, the radiologist should correctly interpret revealed changes. The most common lesion is adenoma with high lipid content, but a lipid poor adenoma, pheochromocytoma, adrenocortical cancer, metastasis and other less common adrenal diseases are also worth of attention and require detailed knowledge of their CT semiotics. The article presents criteria of differential diagnosis of the adrenal incidentalomas on the basis of which an algorithm of differential diagnosis was proposed for the most common adrenal lesions.
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16
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Evaluation of Normal Adrenal Gland Volume and Morphometry and Relationship with Waist Circumference in an Adult Population Using Multidetector Computed Tomography. SISLI ETFAL HASTANESI TIP BULTENI 2021; 55:333-338. [PMID: 34712074 PMCID: PMC8526233 DOI: 10.14744/semb.2021.96462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/27/2021] [Indexed: 12/15/2022]
Abstract
Objectives: This study aims to determine the normal range of values of the right, left, and total volume and shape of the adrenal gland (AG) and to evaluate its relationship with gender, age, height, weight, body mass index (BMI), and waist circumference (WC) in multidetector computed tomography (MDCT) images. Methods: The study included 115 MDCT scans, of which 56 were men and 59 were women. For volume measurement, the outlines of the AG were drawn semi-automatically for all patients. Then, collecting the area in each slice, the volumes were automatically measured. The intraclass correlation coefficient (ICC) test was used to analyze intraobserver reliability for repeated measurements with a 95% confidence interval. Participant’s age, gender, weight, height, BMI, and WC were obtained. p<0.05 was considered statistically significant. Results: The mean age of participants was 49.5±17.7 (19–81). The average right AGV (RAGV), left AGV (LAGV), and total AGV were 3.47±1.33, 4.77±1.33, and 8.25±2.74, respectively. The ICC values for all measurements were >0.80–0.90, indicating good and excellent agreement. LAGV was measured as higher than the RAGV. A positive moderate correlation of the AGVs with BMI and WC was observed. Conclusion: The increase in BMI and WC, which are indicators of obesity, correlates with the increase in AGV, we think that the findings will be valuable in evaluating the pathophysiology of the hypothalamic-pituitary-adrenal axis.
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17
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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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Sharaf M, Al-Saqqa R, Kourabi M. ACTH-independent Cushing's syndrome due to bilateral adrenocortical adenoma: A case report. Radiol Case Rep 2021; 16:3168-3171. [PMID: 34484512 PMCID: PMC8405925 DOI: 10.1016/j.radcr.2021.07.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022] Open
Abstract
The chronic excess of glucocorticoids results in Cushing's syndrome. Cushing's syndrome presents with a variety of signs and symptoms including: central obesity, proximal muscle weakness, fatigue striae, poor wound healing, amenorrhea, and others. ACTHindependent Cushing's syndrome is usually due to unilateral adenoma. A rare cause of it is bilateral adrenal adenomas. In this paper we report a case of a 43-year-old woman with Cushing's syndrome due to bilateral adrenal adenoma.
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Affiliation(s)
- Majd Sharaf
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rama Al-Saqqa
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mouhammad Kourabi
- Department of General Surgery, Al-Mouwasat University Hospital, Damascus, Syria
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19
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Reginelli A, Vacca G, Belfiore M, Sangiovanni A, Nardone V, Vanzulli A, Grassi R, Cappabianca S. Pitfalls and differential diagnosis on adrenal lesions: current concepts in CT/MR imaging: a narrative review. Gland Surg 2021; 9:2331-2342. [PMID: 33447584 DOI: 10.21037/gs-20-559] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The purpose of this pictorial essay is to review the imaging findings of adrenal lesions. Adrenal lesions could be divided into functioning or non-functioning masses, primary or metastatic, and benign or malignant. Imaging techniques have undergone significant advances in recent years. The most significant objective of adrenal imaging is represented by the detection and, when possible, characterization of adrenal lesions in order to direct patient management correctly. The detection and management of adrenal lesions is based on cross-sectional imaging obtained with non-contrast CT (tumour density), contrast-enhanced CT including delayed washout (either absolute percentage washout or relative percentage one) and finally with MR chemical shift analysis (loss of signal intensity between in-phase and out-of-phase images including both qualitative and quantitative estimates of signal loss). The small incidental adrenal nodules are benign, in most of cases; some tumors such as lipid-rich adenoma and myelolipoma have characteristic features that can be diagnosed accurately in CT. On contrary, if the presenting contrast-enhanced CT shows an adrenal mass with uncertain or malignant morphologic features, particularly in patients with a known history of malignancy, further evaluations should be considered. The most significative implications for radiologists are represented by how to assess risk of malignancy on imaging and what follow-up to indicate if an adrenal incidentaloma is not surgically removed.
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giovanna Vacca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mariapaola Belfiore
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Valerio Nardone
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy
| | - Angelo Vanzulli
- Department of Radiology, University "La Statale" of Milan, Milan, Italy
| | - Roberto Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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20
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Buryakina SA, Tarbaeva NV, Volevodz NN, Karmazanovsky GG, Kovalevich LD, Shestakova MV, Dedov II. [Adrenal incidentaloma. Part 1. Computed tomography of adrenal incidentaloma: the possibilities and difficulties of differential diagnosis]. TERAPEVT ARKH 2020; 92:185-194. [PMID: 33720593 DOI: 10.26442/00403660.2020.12.200451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022]
Abstract
The adrenal incidentaloma is a lesion of a different etiology and found incidentally in patients who underwent a diagnostic study not about the disease of this organ. Lesions can be both hormonally inactive and hormonally active, can arise from different zones of the adrenal gland or have non-specific organ affiliation, can be benign or malignant. Computed tomography characterization of these lesions, especially the differential diagnosis of benign and malignant, is extremely important for the correct diagnosis in order to provide adequate management of the patient. The article presents the key computed tomography criteria that allow radiologist to characterize the lesion most accurately and consider appropriate diagnosis.
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Affiliation(s)
- S A Buryakina
- Endocrinology Research Centre
- Vishnevsky National Medical Research Centre of Surgery
| | - N V Tarbaeva
- Endocrinology Research Centre
- Vishnevsky National Medical Research Centre of Surgery
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21
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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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Utility of the 10 Hounsfield unit threshold for identifying adrenal adenomas: Can we improve? Am J Surg 2020; 220:920-924. [PMID: 32359690 DOI: 10.1016/j.amjsurg.2020.04.021] [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] [Received: 11/21/2019] [Revised: 03/07/2020] [Accepted: 04/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Current recommendations using Hounsfield units (HU) ≤ 10 to identify adrenal adenomas on unenhanced computed tomography (CT) miss 10-40% of benign adenomas. We sought to determine if changing HU threshold and adding absolute percent contrast washout (APW) criteria would identify adrenal adenomas better than current recommendations. METHODS Imaging characteristics were compared between patients with adenomas (n = 128) and those with non-adenomas (n = 54) after unilateral adrenalectomy. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated. RESULTS Using HU ≤ 10 to identify adenomas had a sensitivity of 47.6%, specificity of 93.3% (AUC = 0.71, p < 0.001), PPV of 95.3%, and NPV of 58.1% for identifying adrenal adenomas. Applying HU ≤ 16 improved sensitivity (65.4%) without reducing specificity (93.3%) (AUC = 0.79, p < 0.001), PPV increased to 96.3%, and NPV decreased to 47.6%. Applying HU ≤ 16 as the initial criterion followed by APW > 60% for lesions exceeding 16 HU, sensitivity increased to 93.4%, specificity was 93.3% and PPV 96.6%, and NPV improved to 85.7% (AUC = 0.96, p < 0.001). CONCLUSIONS Criteria of initial threshold of HU ≤ 16 followed by APW > 60% for lesions exceeding 16 HU yielded improved sensitivity and specificity in identification of adrenal adenomas.
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23
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Shidlovskyi VO, Shidlovskyi OV, Tovkai OA, Sheremet MI, Maksymyuk VV, Tarabanchuk VV, Ivanovych SM, Heryak MS, Andreychyn MS, Hanberher II, Piddubna AA. Topical Diagnosis and Determination of the Primary Hyperaldosteronism Variant. J Med Life 2020; 12:322-328. [PMID: 32025248 PMCID: PMC6993286 DOI: 10.25122/jml-2019-0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Laboratory diagnosis of primary hyperaldosteronism is based on determining blood levels of aldosterone, renin on request, potassium, and sodium. The results of these studies are significantly influenced by drugs, preparation for the study and blood collection methods, age, gender, and concomitant diseases. The work analyzes the factors influencing the results of the study of aldosterone and identifies the main ways of their exclusion at each stage of the diagnosis. Their neglecting is the determining factor in obtaining false results, diagnostic errors, the selection of ill-treatment tactics, and inadequate treatment. All these diagnostic problems are covered in a variety of ways in the review, which is based on the analysis of results of individual authors' research and practical and clinical recommendations from leading world endocrinological associations. Results of laboratory diagnostics of PHA depend on the influence of many factors. Among them, it is essential to use different medication drugs, the rules for preparing for the study, and the method of conducting it. In assessing the results of research, it is necessary to take into account not only the indicators of the level of aldosterone in the blood but also the features of the clinical course of the disease, its compliance to the drug therapy, age, and gender of the patients.
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Affiliation(s)
- Viktor O Shidlovskyi
- Surgery Department, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Olexandr V Shidlovskyi
- Surgery Department, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Oleksandr A Tovkai
- Ukrainian Scientific and Practical Center of Endocrine Surgery, Endocrine and Tissue Transplantation of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Michael I Sheremet
- First Surgery Department, Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Vitaliy V Maksymyuk
- First Surgery Department, Bukovinian State Medical University, Chernivtsi, Ukraine
| | | | - Shved M Ivanovych
- Department of First Emergency Medical Aid and Emergency Medical Treatment, Ternopil, Ukraine
| | - Mykolaivna S Heryak
- Second Department of Obstetrics and Gynecology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Mykhailovych S Andreychyn
- Department of Propaedeutic of Internal Medicine and Phthisiology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Igorivna I Hanberher
- Department of Propaedeutic of Internal Medicine and Phthisiology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Antonina A Piddubna
- Department of Clinical Immunology, Allergology and Endocrinology, Bukovinian State Medical University, Chernivtsi, Ukraine
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24
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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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Shidlovskyi VO, Shidlovskyi OV, Sheremet M, Zhulkevych IV, Andreychyn SM, Hanberher II, Smachylo II, Dobrorodny VB, Futuima YM. Laboratory Diagnostics of Primary Hyperaldosteronism and its Peculiarities (Literature Review). J Med Life 2019; 12:215-220. [PMID: 31666819 PMCID: PMC6814876 DOI: 10.25122/jml-2019-0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The final stage of the diagnostic of primary hyperaldosteronism is to identify the causes of excessive secretion of aldosterone and determination of its variants. Based on the analysis of literature data, the diagnostic value, sensitivity and specificity of the methods of radiation diagnostics for primary hyperaldosteronism were assessed: ultrasound, computed tomography, magnetic resonance imaging, photon emission tomography, magnetic resonance spectroscopy, scintigraphy with iodine radiopharmaceuticals. The causes of false-positive and false-negative evaluations of changes in adrenal glands in the application of these diagnostics have been analyzed. There are many genetic and morphological studies when searching the literature data on the principles and methods of distinguishing the nosological forms of primary hyperaldosteronism based on the results of the aldosterone level estimation in the separated blood from the central veins of both adrenal glands or segmental veins of one gland with subsequent determination of the concentration gradient. It was noted that topical diagnostics and, especially, the determination of nosological forms of primary hyperaldosteronism are complex and expensive, but their results allow choosing an appropriate treatment approach for each particular case.
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Affiliation(s)
- Viktor O Shidlovskyi
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Oleander V Shidlovskyi
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Mikhail Sheremet
- 1st Surgery Department of Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Igor V Zhulkevych
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Sergyi M Andreychyn
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Inna I Hanberher
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Ivan I Smachylo
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Volodimir B Dobrorodny
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Yuryi M Futuima
- 1st Surgery Department of I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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26
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Shi B, Zhang GMY, Xu M, Jin ZY, Sun H. Distinguishing metastases from benign adrenal masses: what can CT texture analysis do? Acta Radiol 2019; 60:1553-1561. [PMID: 30799636 DOI: 10.1177/0284185119830292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Bing Shi
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, PR China
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Gu-Mu-Yang Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Min Xu
- CT Scientific Collaboration, Siemens Healthcare Limited, Shanghai, PR China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Hao Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
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Foresti M, Parmiggiani A. Adrenal Adenoma-Hemangioma Collision Tumor: Description of Two Cases. J Radiol Case Rep 2019; 13:1-12. [PMID: 31558958 DOI: 10.3941/jrcr.v13i6.3691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Adrenal collision tumors are rare clinical entities referring to separate coexisting adjacent tumors involving an adrenal gland with sharp demarcation between the two and without a substantial histologic admixture at the interface. Most of the adrenal collision tumors described are combinations of adenoma and metastasis or adenoma and myelolipoma. We report two cases of a 63-year-old male and a 76-year-old female patient with a presumable exceedingly rare adrenal hemangioma-adenoma collision tumor. To our knowledge, only two reports of a collision tumor comprising an adrenal hemangioma and an adenoma have been described in literature.
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Affiliation(s)
- Michele Foresti
- Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Parmiggiani
- Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Alshahrani MA, Bin Saeedan M, Alkhunaizan T, Aljohani IM, Azzumeea FM. Bilateral adrenal abnormalities: imaging review of different entities. Abdom Radiol (NY) 2019; 44:154-179. [PMID: 29938331 DOI: 10.1007/s00261-018-1670-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Bilateral adrenal abnormalities are not infrequently encountered during routine daily radiology practice. The differential diagnoses of bilateral adrenal abnormalities include neoplastic and non-neoplastic entities. The bilateral adrenal tumors include metastasis, lymphoma, neuroblastoma, pheochromocytoma, adenoma, and myelolipoma. Non-neoplastic bilateral adrenal masses include infectious processes and haematomas. There are different diffuse bilateral adrenal changes such as adrenal atrophy, adrenal enlargement, adrenal calcifications, and altered adrenal enhancement. In this pictorial review article, we will discuss the imaging features of these entities with emphasis on their clinical implications.
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Affiliation(s)
- Meshal Ali Alshahrani
- Department of Radiology, King Faisal Specialist Hospital and Research Center, MBC-28, P.O. Box 3354, Riyadh, 11211, Saudi Arabia
| | - Mnahi Bin Saeedan
- Department of Radiology, King Faisal Specialist Hospital and Research Center, MBC-28, P.O. Box 3354, Riyadh, 11211, Saudi Arabia.
| | - Tariq Alkhunaizan
- Department of Radiology, King Faisal Specialist Hospital and Research Center, MBC-28, P.O. Box 3354, Riyadh, 11211, Saudi Arabia
| | - Ibtisam Musallam Aljohani
- Department of Radiology, King Faisal Specialist Hospital and Research Center, MBC-28, P.O. Box 3354, Riyadh, 11211, Saudi Arabia
| | - Fahad Mohammed Azzumeea
- National Guard Health Affairs, King Abdulaziz Medical City, Medical Imaging Department, Riyadh, Saudi Arabia
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Liu T, Sun H, Zhang H, Duan J, Hu Y, Xie S. Distinguishing adrenal adenomas from non-adenomas with multidetector CT: evaluation of percentage washout values at a short time delay triphasic enhanced CT. Br J Radiol 2018; 92:20180429. [PMID: 30433826 DOI: 10.1259/bjr.20180429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE: To retrospectively evaluate the diagnostic values of absolute percentage washout ratio (APW) and relative percentage washout ratio (RPW) obtained from a short time delay triphasic enhanced CT in distinguishing adenomas from non-adenomas. METHODS: The study population consisted of 116 patients (58 males and 58 females; mean age, 52 years; age range, 23-89 years) with 116 adrenal masses from 2010 to 2016. Absolute attenuation values in each phase of CT were measured, and then the APW and RPW were calculated. The APW and RPW receiver operating characteristic (ROC) analysis was performed to evaluate the strength of the tests. Sensitivity, specificity, and accuracy were calculated for APW and RPW. RESULTS: Significant differences were observed in APW and RPW values between the adenoma and non-adenoma groups (p < 0.001). Areas under the ROC curve were 0.822 (95% confidence interval: 0.730, 0.914) and 0.913 (95% confidence interval: 0.851, 0.975) for the APW and RPW tests, respectively. The RPW (≥30%) criterion showed the best accuracy (86%), with 85% sensitivity and 90% specificity, followed by the APW (≥32%) criterion, with 81% accuracy, 85% sensitivity, and 69% specificity. CONCLUSION: The APW and RPW values from a short time delay triphasic enhanced CT were efficient and helpful in differentiating adenomas from non-adenomas, and could provide comparable diagnostic results to the previous reported longer delayed dedicated adrenal CT protocols. ADVANCES IN KNOWLEDGE: The washout ratio from a short time delay triphasic enhanced CT could help in differentiating adenomas from non-adenomas without the dedicated adrenal CT.
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Affiliation(s)
- Tongxi Liu
- 1 Department of Radiology, China-Japan Friendship Hospital , Beijing , China
| | - Hongliang Sun
- 1 Department of Radiology, China-Japan Friendship Hospital , Beijing , China
| | - Haibo Zhang
- 1 Department of Radiology, China-Japan Friendship Hospital , Beijing , China
| | - Jianghui Duan
- 1 Department of Radiology, China-Japan Friendship Hospital , Beijing , China
| | - Yingying Hu
- 1 Department of Radiology, China-Japan Friendship Hospital , Beijing , China
| | - Sheng Xie
- 1 Department of Radiology, China-Japan Friendship Hospital , Beijing , China
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Can Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT? AJR Am J Roentgenol 2018; 211:1044-1050. [DOI: 10.2214/ajr.17.19276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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31
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Dickson PV, Kim L, Yen TWF, Yang A, Grubbs EG, Patel D, Solórzano CC. Evaluation, Staging, and Surgical Management for Adrenocortical Carcinoma: An Update from the SSO Endocrine and Head and Neck Disease Site Working Group. Ann Surg Oncol 2018; 25:3460-3468. [DOI: 10.1245/s10434-018-6749-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Indexed: 08/30/2023]
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Thomas AJ, Habra MA, Bhosale PR, Qayyum AA, Ahmed K, Vicens R, Elsayes KM. Interobserver agreement in distinguishing large adrenal adenomas and adrenocortical carcinomas on computed tomography. Abdom Radiol (NY) 2018; 43:3101-3108. [PMID: 29671009 DOI: 10.1007/s00261-018-1603-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Large adrenal masses pose a diagnostic dilemma. The purpose of this study was twofold: first, to assess the degree of interobserver agreement in evaluating the morphology of pathologically proven adrenal adenomas and adrenocortical carcinomas larger than 4 cm in diameter; and second, to identify morphologic characteristics that correlated with the pathologic diagnosis. MATERIALS AND METHODS For this blinded, retrospective study, we collected cases of 25 adrenal adenomas and 33 adrenocortical carcinomas measuring larger than 4 cm. Two radiologists evaluated morphologic characteristics of the lesions on CT. Interobserver agreement was evaluated using kappa statistics, and the correlation of imaging characteristics with the diagnosis was evaluated using a logistic regression model. RESULTS We found the highest interobserver agreement in the assessment of precontrast attenuation (Κ = 0.81) as well as substantial agreement in determining the shape and the presence of calcifications (Κ = 0.69 and 0.74, respectively). Readers agreed less often regarding the presence of fat (Κ = 0.48), as well as regarding the presence of necrosis, heterogeneity, and the overall impression (Κ = 0.15, 0.24, and 0.26, respectively). CT characteristics correlated with benignity included round shape (p = 0.02), an overall radiologic impression of a benign lesion (p < 0.0001), the presence of fat (p = 0.01), and a precontrast attenuation of less than 10 Hounsfield units (p < 0.0001). The latter two of these characteristics were highly specific for benign pathology (93% and 100%, respectively). CONCLUSION Our study suggests that CT has the ability to consistently identify characteristics significantly correlated with benign vs. malignant adrenal tumors.
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Affiliation(s)
- Aaron J Thomas
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Mouhammed A Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aliya A Qayyum
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kareem Ahmed
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rafael Vicens
- Department of Radiology, Hospital Auxilio Mutuo, San Juan, PR, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Johnson PT, Bello JA, Chatfield MB, Flug JA, Pandharipande PV, Rohatgi S, Fishman EK, Megibow AJ. New ACR Choosing Wisely Recommendations: Judicious Use of Multiphase Abdominal CT Protocols. J Am Coll Radiol 2018; 16:56-60. [PMID: 30219345 DOI: 10.1016/j.jacr.2018.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Pamela T Johnson
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland.
| | - Jacqueline A Bello
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | | | | | | | - Saurabh Rohatgi
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
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Abstract
Various pathologies can affect the adrenal gland. Noninvasive cross-sectional imaging is used for evaluating adrenal masses. Accurate diagnosis of adrenal lesions is critical, especially in cancer patients; the presence of adrenal metastasis changes prognosis and treatment. Characterization of adrenal lesions predominantly relies on morphologic and physiologic features to enable correct diagnosis and management. Key diagnostic features to differentiate benign and malignant adrenal lesions include presence/absence of intracytoplasmic lipid, fat cells, hemorrhage, calcification, or necrosis and locoregional and distant disease; enhancement pattern and washout values; and lesion size and stability. This article reviews a spectrum of adrenal pathologies.
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Affiliation(s)
- Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA.
| | - Sally Emad-Eldin
- Department of Diagnostic and Intervention Radiology, Cairo University, Kasr Al-Ainy Street, Cairo 11652, Egypt
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA
| | - Corey T Jensen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA
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35
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Pheochromocytomas Versus Adenoma: Role of Venous Phase CT Enhancement. AJR Am J Roentgenol 2018; 210:1073-1078. [DOI: 10.2214/ajr.17.18472] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sung CT, Shetty A, Menias CO, Houshyar R, Chatterjee S, Lee TK, Tung P, Helmy M, Lall C. Collision and composite tumors; radiologic and pathologic correlation. Abdom Radiol (NY) 2017. [PMID: 28623377 DOI: 10.1007/s00261-017-1200-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The terms composite and collision tumors have been used interchangeably throughout radiological literature. Both composite and collision tumors involve two morphologically and immunohistochemically distinct neoplasms coexisting within a single organ. However, collision tumors lack the histological cellular intermingling seen in composite tumors. Composite tumors often arise from a common driver mutation that induces a divergent histology from a common neoplastic source while collision tumors may arise from coincidental neoplastic change. The purpose of this review is to provide an overview of abdominal composite and collision tumors by discussing hallmark radiographic and pathological presentations of rare hepatic, renal, and adrenal case studies. A better understanding of the presentation of each lesion is imperative for proper recognition, diagnosis, and management of these unique tumor presentations.
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37
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Computed Tomography in the Management of Adrenal Tumors: Does Size Still Matter? J Comput Assist Tomogr 2017; 41:628-632. [PMID: 28107213 DOI: 10.1097/rct.0000000000000578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to evaluate computed tomography (CT) imaging as a predictor of adrenal tumor pathology. METHODS A retrospective review was conducted of patients who underwent unilateral adrenalectomy for an adrenal mass between January 2005 and July 2015. Tumors were classified as benign, indeterminate, or malignant based on preoperative CT findings. RESULTS Of 697 patients who underwent unilateral adrenalectomy, 216 met the inclusion criteria. Pathology was benign in 88.4%, indeterminate in 2.3%, and malignant in 9.3%, with a median tumor diameter of 2.7 cm (interquartile range, 1.7-4.1 cm) and 9.5 cm (interquartile range, 7.1-12 cm) in the benign and malignant groups, respectively (P < 0.001). Of the tumors with benign features on CT, 100% (143/143) had benign final pathology. CONCLUSIONS Imaging characteristics of adrenal tumors on CT scan predict benign pathology 100% of the time. Regardless of size, when interpreted as benign on CT scan, laparoscopic adrenalectomy, if technically feasible, should be the technique used when surgery is offered, or close surveillance may be a safe alternative.
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Abstract
Various pathologies can affect the adrenal gland. Noninvasive cross-sectional imaging is used for evaluating adrenal masses. Accurate diagnosis of adrenal lesions is critical, especially in cancer patients; the presence of adrenal metastasis changes prognosis and treatment. Characterization of adrenal lesions predominantly relies on morphologic and physiologic features to enable correct diagnosis and management. Key diagnostic features to differentiate benign and malignant adrenal lesions include presence/absence of intracytoplasmic lipid, fat cells, hemorrhage, calcification, or necrosis and locoregional and distant disease; enhancement pattern and washout values; and lesion size and stability. This article reviews a spectrum of adrenal pathologies.
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Affiliation(s)
- Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA.
| | - Sally Emad-Eldin
- Department of Diagnostic and Intervention Radiology, Cairo University, Kasr Al-Ainy Street, Cairo 11652, Egypt
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA
| | - Corey T Jensen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA
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Mendichovszky IA, Powlson AS, Manavaki R, Aigbirhio FI, Cheow H, Buscombe JR, Gurnell M, Gilbert FJ. Targeted Molecular Imaging in Adrenal Disease-An Emerging Role for Metomidate PET-CT. Diagnostics (Basel) 2016; 6:diagnostics6040042. [PMID: 27869719 PMCID: PMC5192517 DOI: 10.3390/diagnostics6040042] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/17/2022] Open
Abstract
Adrenal lesions present a significant diagnostic burden for both radiologists and endocrinologists, especially with the increasing number of adrenal ‘incidentalomas’ detected on modern computed tomography (CT) or magnetic resonance imaging (MRI). A key objective is the reliable distinction of benign disease from either primary adrenal malignancy (e.g., adrenocortical carcinoma or malignant forms of pheochromocytoma/paraganglioma (PPGL)) or metastases (e.g., bronchial, renal). Benign lesions may still be associated with adverse sequelae through autonomous hormone hypersecretion (e.g., primary aldosteronism, Cushing’s syndrome, phaeochromocytoma). Here, identifying a causative lesion, or lateralising the disease to a single adrenal gland, is key to effective management, as unilateral adrenalectomy may offer the potential for curing conditions that are typically associated with significant excess morbidity and mortality. This review considers the evolving role of positron emission tomography (PET) imaging in addressing the limitations of traditional cross-sectional imaging and adjunctive techniques, such as venous sampling, in the management of adrenal disorders. We review the development of targeted molecular imaging to the adrenocortical enzymes CYP11B1 and CYP11B2 with different radiolabeled metomidate compounds. Particular consideration is given to iodo-metomidate PET tracers for the diagnosis and management of adrenocortical carcinoma, and the increasingly recognized utility of 11C-metomidate PET-CT in primary aldosteronism.
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Affiliation(s)
- Iosif A Mendichovszky
- Department of Radiology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Andrew S Powlson
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Roido Manavaki
- Department of Radiology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Franklin I Aigbirhio
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 1TN, UK.
| | - Heok Cheow
- Department of Radiology, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - John R Buscombe
- Department of Nuclear Medicine, Cambridge University Hospitals, Cambridge CB2 0QQ, UK.
| | - Mark Gurnell
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
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Abstract
PURPOSE To retrospectively evaluate CT sensitivity for characterizing adrenal adenoma according to lesion size. MATERIALS AND METHODS Between January 2004 and November 2012, 140 patients with 140 histologically proven adenomas underwent preoperative adrenal CT protocols consisting of unenhanced CT, early enhanced CT, and delayed enhanced CT. Adenomas were divided into three size groups: small adenoma (n = 60), ≥ 1 to <2 cm; medium adenoma (n = 47), ≥ 2 to <3 cm; and large adenoma (n = 33), ≥ 3 cm. Adenoma was diagnosed when a lesion met one of the following criteria: (a) unenhanced CT attenuation value ≤ 10 HU, (b) absolute percentage washout ≥ 60%, or (c) relative percentage washout ≥ 40%. The standard reference was pathologic examination of an adrenalectomy specimen. Adenoma size, lesion attenuation value, or percentage washout was correlated with the Spearman's rank correlation. CT sensitivities were compared between size groups of adenomas with the Fisher's exact test. RESULTS As adenoma size increased, the lesion attenuation value (ρ = 0.324; P = 0.001) increased on unenhanced CT, and the absolute (ρ = -0.186; P = 0.028) or relative (ρ = -0.374; P < 0.001) percentage washout decreased on early and delayed enhanced CT. CT sensitivities were 100% (60/60) for small adenomas, 97.9% (46/47) for medium adenomas, and 66.7% (22/33) for large adenomas (P < 0.001). CONCLUSIONS Adrenal CT protocols misdiagnose a substantial number of large adenomas as non-adenomas because CT sensitivity for adenoma markedly decreases, when the lesion size is 3 cm or larger.
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41
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Adrenal Incidentalomas: Clinical Controversies and Modified Recommendations. AJR Am J Roentgenol 2016; 206:1170-8. [DOI: 10.2214/ajr.15.15475] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Romano RFT, Salvadori PS, Torres LR, Bretas EAS, Bekhor D, Caldana RP, Medeiros RB, D'Ippolito G. Readjustment of abdominal computed tomography protocols in a university hospital: impact on radiation dose. Radiol Bras 2015; 48:292-7. [PMID: 26543280 PMCID: PMC4633073 DOI: 10.1590/0100-3984.2014.0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To assess the reduction of estimated radiation dose in abdominal computed
tomography following the implementation of new scan protocols on the basis of
clinical suspicion and of adjusted images acquisition parameters. Materials and Methods Retrospective and prospective review of reports on radiation dose from abdominal
CT scans performed three months before (group A – 551 studies) and three months
after (group B – 788 studies) implementation of new scan protocols proposed as a
function of clinical indications. Also, the images acquisition parameters were
adjusted to reduce the radiation dose at each scan phase. The groups were compared
for mean number of acquisition phases, mean CTDIvol per phase, mean DLP
per phase, and mean DLP per scan. Results A significant reduction was observed for group B as regards all the analyzed
aspects, as follows: 33.9%, 25.0%, 27.0% and 52.5%, respectively for number of
acquisition phases, CTDIvol per phase, DLP per phase and DLP per scan
(p < 0.001). Conclusion The rational use of abdominal computed tomography scan phases based on the
clinical suspicion in conjunction with the adjusted images acquisition parameters
allows for a 50% reduction in the radiation dose from abdominal computed
tomography scans.
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Affiliation(s)
- Ricardo Francisco Tavares Romano
- Collaborating Physicians, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Priscila Silveira Salvadori
- Collaborating Physicians, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Lucas Rios Torres
- Masters, Physicians Assistants, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Elisa Almeida Sathler Bretas
- MD, Fellow, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Daniel Bekhor
- Masters, Physicians Assistants, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Regina Bitelli Medeiros
- Affiliate Professor, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Giuseppe D'Ippolito
- Private Docent, Associate Professor, Department of Imaging Diagnosis at Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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MDCT Linear and Volumetric Analysis of Adrenal Glands: Normative Data and Multiparametric Assessment. Eur Radiol 2015; 26:2494-501. [PMID: 26515550 DOI: 10.1007/s00330-015-4063-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 10/05/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To study linear and volumetric adrenal measurements, their reproducibility, and correlations between total adrenal volume (TAV) and adrenal micronodularity, age, gender, body mass index (BMI), visceral (VAAT) and subcutaneous adipose tissue volume (SAAT), presence of diabetes, chronic alcoholic abuse and chronic inflammatory disease (CID). METHODS We included 154 patients (M/F, 65/89; mean age, 57 years) undergoing abdominal multidetector row computed tomography (MDCT). Two radiologists prospectively independently performed adrenal linear and volumetric measurements with semi-automatic software. Inter-observer reliability was studied using inter-observer correlation coefficient (ICC). Relationships between TAV and associated factors were studied using bivariate and multivariable analysis. RESULTS Mean TAV was 8.4 ± 2.7 cm(3) (3.3-18.7 cm(3)). ICC was excellent for TAV (0.97; 95 % CI: 0.96-0.98) and moderate to good for linear measurements. TAV was significantly greater in men (p < 0.0001), alcoholics (p = 0.04), diabetics (p = 0.0003) and those with micronodular glands (p = 0.001). TAV was lower in CID patients (p = 0.0001). TAV correlated positively with VAAT (r = 0.53, p < 0.0001), BMI (r = 0.42, p < 0.0001), SAAT (r = 0.29, p = 0.0003) and age (r = 0.23, p = 0.005). Multivariable analysis revealed gender, micronodularity, diabetes, age and BMI as independent factors influencing TAV. CONCLUSIONS Adrenal gland MDCT-based volumetric measurements are more reproducible than linear measurements. Gender, micronodularity, age, BMI and diabetes independently influence TAV. KEY POINTS • Volumetric measurements are more reproducible than linear measurements for adrenal glands. • Inter-observer reproducibility of adrenal gland volume is excellent using semiautomatic software. • Gender, age, BMI, and diabetes independently influence total adrenal gland volume. • Adrenal micronodularity is associated with increased total adrenal gland volume.
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Chambre C, McMurray E, Baudry C, Lataud M, Guignat L, Gaujoux S, Lahlou N, Guibourdenche J, Tissier F, Sibony M, Dousset B, Bertagna X, Bertherat J, Legmann P, Groussin L. The 10 Hounsfield units unenhanced computed tomography attenuation threshold does not apply to cortisol secreting adrenocortical adenomas. Eur J Endocrinol 2015; 173:325-32. [PMID: 26243637 DOI: 10.1530/eje-15-0036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
CONTEXT Computed tomography (CT) unenhanced attenuation value of <10 Hounsfield units (HU) has an excellent specificity (98%) to diagnose lipid-rich adrenocortical adenomas (ACAs) with a weaker sensitivity (71%). OBJECTIVE To determine from a routine clinical perspective if unenhanced attenuation value is influenced by cortisol secretion in ACAs. DESIGN This was a retrospective study of cases collected between 2009 and 2012. SETTING This study was conducted in a tertiary-care university hospital. PATIENTS Seventy-two patients operated on for an ACA (Weiss score ≤ 2) were analysed. Thirty-four patients had an ACA oversecreting cortisol (Cush-ACA). Thirty-eight patients had an ACA without cortisol oversecretion (Non Hyper-ACA). MAIN OUTCOME MEASURE CT unenhanced attenuation value was correlated with the functional status. The Weiss score items were analysed. RESULTS Among the 34 patients with a Cush-ACA a minority (n = 7) had an unenhanced attenuation value under 10 HU. Among the high precontrast density (> 10 HU) Cush-ACAs, washout analysis after contrast administration was consistent with the benign nature of the tumor in ∼ 60% of the cases. Less than 25% clear cells (lipid-rich cells), a Weiss score item, was present in 50% of the Cush-ACAs in favour of a lipid-poor content. CONCLUSIONS Unenhanced attenuation value has a poor sensitivity to diagnose an ACA in case of cortisol oversecretion due to poor lipid content. Nevertheless, the accuracy of washout analysis was preserved in the group of Cush-ACAs.
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Affiliation(s)
- Claire Chambre
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Emily McMurray
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Camille Baudry
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Marine Lataud
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Laurence Guignat
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France
| | - Sébastien Gaujoux
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Najiba Lahlou
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Jean Guibourdenche
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Frédérique Tissier
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Mathilde Sibony
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Bertrand Dousset
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Xavier Bertagna
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Jérôme Bertherat
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Paul Legmann
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
| | - Lionel Groussin
- Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
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Burrello J, Monticone S, Buffolo F, Tetti M, Giraudo G, Schiavone D, Veglio F, Mulatero P. Issues in the Diagnosis and Treatment of Primary Aldosteronism. High Blood Press Cardiovasc Prev 2015; 23:73-82. [PMID: 25854140 DOI: 10.1007/s40292-015-0084-5] [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: 02/17/2015] [Accepted: 03/16/2015] [Indexed: 11/26/2022] Open
Abstract
Primary aldosteronism (PA) is associated with a high rate of cardio- and cerebrovascular complications and metabolic alterations. PA is also recognized as the most frequent, although often unrecognized, secondary form of hypertension. Guidelines have been released to assist clinicians in the diagnostic work-up and subtype differentiation of PA. In this review we discuss and compare the available guidelines in the context of our professional experience and evaluate diagnostic and therapeutic aspects that are still a matter of debate.
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Affiliation(s)
- Jacopo Burrello
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy.
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Fabrizio Buffolo
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Martina Tetti
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | | | - Domenica Schiavone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy.
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Lattin GE, Sturgill ED, Tujo CA, Marko J, Sanchez-Maldonado KW, Craig WD, Lack EE. From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics 2015; 34:805-29. [PMID: 24819798 DOI: 10.1148/rg.343130127] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Advanced imaging often reveals adrenal tumors and tumor-like conditions in both symptomatic and asymptomatic patients. When adrenal disease is clinically suspected, cross-sectional imaging can be helpful in evaluating the etiology of the patient's symptoms. When adrenal disease is incidentally identified, what the clinician and patient really want to know is whether the findings are benign or malignant, as this ultimately will affect their next step in management. Using radiologic-pathologic correlation, we broadly classify common, uncommon, and rare tumors and tumor-like conditions that can occur in the adrenal as benign or malignant. This classification follows predominant trends in observed biologic behavior while acknowledging those tumors that may behave in the minority in an unpredictable manner. We review the clinical background and presentation of functional adrenal tumors including Conn syndrome, Cushing syndrome, and catecholamine-secreting tumors, as well as their relationship with adrenal anatomy. We discuss a variety of benign tumors, including adrenal cortical adenoma (including oncocytoma) and pheochromocytoma, as well as uncommonly and rarely encountered tumors such as myelolipoma, hemangioma, lymphangioma, schwannoma, ganglioneuroma, and adenomatoid tumor. A variety of tumefactive but nonneoplastic lesions are addressed, including adrenal cortical hyperplasia, adrenal hemorrhage, adrenal cysts, and infections. Malignant tumors discussed include adrenal cortical carcinoma, the rare malignant pheochromocytoma, lymphoma, metastases, and sarcomas. For each tumor and tumor-like lesion, the clinical presentation, epidemiology, key imaging findings, diagnostic differential considerations, and management options are briefly addressed. Finally, an approach to the workup of suspected or incidentally discovered tumors is presented based on a selected literature survey and our clinical experience. Radiologists play an important role in identification and diagnosis of adrenal tumors and tumor-like conditions in both symptomatic and asymptomatic patients.
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Affiliation(s)
- Grant E Lattin
- From the Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (G.E.L., C.A.T., J.M., W.D.C.); American Institute for Radiologic Pathology, Silver Spring, Md (G.E.L., E.D.S., W.D.C.); Department of Radiology, Naval Medical Center Portsmouth, Portsmouth, Va (E.D.S.); Department of Radiology, David Grant USAF Medical Center, Travis AFB, Calif (C.A.T.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (J.M.); School of Medicine, Georgetown University, Washington, DC (K.W.S.); Department of Radiology, Suburban Hospital, Bethesda, Md (W.D.C.); and Department of Endocrine Pathology, The Joint Pathology Center, Silver Spring, Md (E.E.L.)
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Lee HJ, Lee J. Differential diagnosis of adrenal mass using imaging modality: special emphasis on f-18 fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography. Endocrinol Metab (Seoul) 2014; 29:5-11. [PMID: 24741448 PMCID: PMC3970283 DOI: 10.3803/enm.2014.29.1.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Adrenal incidentalomas are adrenal masses serendipitously detected during an imaging study performed for reasons unrelated to suspicion of adrenal disease. The incidence of adrenal incidentalomas has increased because of the widespread use of various imaging modalities. In oncology patients with adrenal incidentalomas, the characterization of the adrenal masses is challenging because nearly 50% of incidental adrenal masses are metastatic lesions that need special medical attention. Although unenhanced computed tomography (CT) densitometry, chemical shift magnetic resonance imaging (MRI), delayed contrast-enhanced CT and CT histogram analysis have been used as sensitive and specific modalities for differentiating benign from malignant adrenal masses, F-18 fluoro-2-deoxy-D-glucose positron emission tomography (F-18 FDG PET)/CT is a highly accurate imaging modality compared to CT or MRI, especially when these two imaging modalities are combined. In addition, a semiquantitative analysis using standardized uptake value ratio further improves the diagnostic accuracy of F-18 FDG PET/CT in differentiating benign from malignant adrenal masses. Thus, F-18 FDG PET/CT is very helpful for determining the best therapeutic management, especially for assessing the need for surgery.
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Affiliation(s)
- Hong Je Lee
- Department of Nuclear Medicine, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | - Jaetae Lee
- Department of Nuclear Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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Katabathina VS, Flaherty E, Kaza R, Ojili V, Chintapalli KN, Prasad SR. Adrenal collision tumors and their mimics: multimodality imaging findings. Cancer Imaging 2013; 13:602-10. [PMID: 24434021 PMCID: PMC3893905 DOI: 10.1102/1470-7330.2013.0053] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Adrenal collision tumors (ACTs) refer to coexistence of two adjacent, but histologically distinct neoplasms involving the adrenal gland without histologic admixture at interface. ACTs include adenoma with myelolipoma, adenoma with metastases, hemangioma with adenoma, and adrenocortical carcinoma with myelolipoma. In addition, hemorrhage into a pre-existing adrenal mass can mimic an ACT, and it is important to differentiate these two pathologies. Accurate characterization of ACTs is difficult, but critical, for correct staging of patients with malignancies and to guide percutaneous biopsy. Magnetic resonance imaging (MRI) and multidetector computed tomography imaging techniques may depict different tumor components separately; however, biopsy may be required in selected patients for confirmation. [18F]Fluorodeoxyglucose-positron emission tomography (PET) shows increased uptake in the malignant component of ACTs, and guides percutaneous biopsy. Even in patients requiring percutaneous biopsy for a definite diagnosis, imaging findings can help in guiding the appropriate component to be biopsied. Knowledge of imaging findings of different ACTs and their mimics on MRI, computed tomography, and PET help in optimal patient management.
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Affiliation(s)
- Venkata S Katabathina
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Erin Flaherty
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ravi Kaza
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kedar N Chintapalli
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Srinivasa R Prasad
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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