Adrenal adenomas: Characteristic postgadolinium capillary blush on dynamic MR imaging

Chung, Jae Joon; Semelka, Richard C.; Martín, Diego R.

doi:10.1002/1522-2586(200102)13:2<242::aid-jmri1035>3.0.co;2-#

Cited by 31 publications

(17 citation statements)

References 24 publications

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“…• Included: We identified 37 studies for inclusion in the systematic review (49,52,61,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112), with only 18 of them fulfilling the criteria for inclusion in the actual meta-analysis (61,79,80,81,82,83,84,85,86,87,88,89,90,91...…”

Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)supporting

confidence: 69%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,295

1,571

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By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected recommendations: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1 mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50 nmol/L (1.8 µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1 mg dexamethasone >138 nmol/L (>5 µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients www.eje-online.org European Journal of Endocrinology175:2 G2 Clinical Practice Guideline M Fassnacht and others ESE and ENSAT guideline on adrenal incidentalomawith an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal inciden...

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Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)supporting

confidence: 69%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,295

1,571

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“…Because of the high sensitivity of chemical shift MR imaging to minute amounts of intravoxel fat, MR imaging demonstrates signal intensity loss on opposed-phase images in the majority of adenomas, with a sensitivity of 89% for lesions with an attenuation of 10 -30 HU and 100% for lesions with an attenuation of 10 -20 HU with a maintained specificity of 100% (Fig 7) (14). In a recent study (15), dynamic postgadolinium contrast-enhanced MR imaging was suggested to provide useful complementary information to the appearance of adrenal masses on in-phase and out-of-phase images. Twenty-five of 35 adrenal adenomas showed homogeneous capillary blush on immediate postgadolinium images, and 33 of 35 adrenal adenomas demonstrated rapid washout on 45-second postgadolinium images.…”

Section: Adenomacontrasting

confidence: 97%

CT and MR Imaging of Extrahepatic Fatty Masses of the Abdomen and Pelvis: Techniques, Diagnosis, Differential Diagnosis, and Pitfalls

Pereira¹,

Sirlin

Pinto³

et al. 2005

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The differential diagnosis of extrahepatic abdominopelvic masses is wide. Demonstration of fat within a lesion at noninvasive imaging is an important clue for narrowing the differential diagnosis. Macroscopic fat is readily identified with both computed tomography (CT) and magnetic resonance (MR) imaging. Demonstration of microscopic fat is more difficult and may require special techniques. Identification of fat with CT is based on x-ray resorption and therefore on the attenuation (typically less than -20 HU). Several MR imaging techniques have been developed for fat suppression. Two of the most widely available are spectroscopic fat saturation and chemical shift (in-phase/opposed-phase) imaging. Entities with predominantly macroscopic fat include myelolipoma, angiomyolipoma, teratoma, liposarcoma, lipoma, epiploic appendagitis, omental infarction, and mesenteric panniculitis. Lesions with predominantly microscopic fat include adrenal adenoma and some teratomas. Other fat-containing entities involve the mesentery and bowel wall; these include fibrofatty mesenteric proliferation and submucosal fat deposition.

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“…Uniform blush of enhancement on arterial-phase postgadolinium images with rapid washout on portal phase images has been reported as a characteristic feature of the majority of adrenal adenomas, and the presence of irregular, patchy, inhomogeneous enhancement is characteristic of nonadenomatous malignant tumors of the adrenal glands (11). The tumor in our case demonstrated irregular, mainly peripheral enhancement, a finding that overlaps with the enhancement pattern of malignant tumors.…”

Section: Discussionmentioning

confidence: 99%

Giant adrenal myelolipoma with minimal fat content in a patient with homozygous beta‐thalassemia: Appearance on MRI

Kelekis

Alexopoulou

Brountzos

et al. 2003

Magnetic Resonance Imaging

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Giant adrenal myelolipoma is an uncommon entity. We present the atypical MR imaging findings of a giant adrenal myelolipoma in a patient with homozygous beta-thalassemia with histopathology correlation. The tumor showed a drop in signal on the opposed-phase images, with no evidence of macroscopic fat contents, and demonstrated very high signal intensity on T2-weighted images. Giant adrenal myelolipoma should be considered in the differential diagnosis of tumors with the combination of the above MR imaging characteristics.

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Adrenal adenomas: Characteristic postgadolinium capillary blush on dynamic MR imaging

Cited by 31 publications

References 24 publications

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

CT and MR Imaging of Extrahepatic Fatty Masses of the Abdomen and Pelvis: Techniques, Diagnosis, Differential Diagnosis, and Pitfalls

Giant adrenal myelolipoma with minimal fat content in a patient with homozygous beta‐thalassemia: Appearance on MRI

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