Adrenal Imaging with MDCT: Nonneoplastic Disease

Johnson, Pamela T.; Horton, Karen M.; Fishman, Elliot K.

doi:10.2214/ajr.09.2551

Cited by 33 publications

(11 citation statements)

References 20 publications

(48 reference statements)

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“…Furthermore, their detection is likely to increase with advances in imaging technology, and approach the rates seen in large autopsy series (up to 10% of the population) [5]. Frequently, such nodules are detected on ‘non-adrenal’ imaging protocols, and further investigation (e.g., dedicated adrenal MRI or contrast ‘washout’ CT) is required to determine whether the lesion can be confidently declared as benign, or requires further assessment to exclude/confirm malignancy [1,6,7,8,9,10,11,12,13]. Adrenal adenomas are the most commonly encountered benign lesion and are readily characterized in about 70% of cases by detecting significant amounts of intracellular lipid on unenhanced CT or chemical-shift MRI [1,9].…”

Section: Introductionmentioning

confidence: 99%

Targeted Molecular Imaging in Adrenal Disease—An Emerging Role for Metomidate PET-CT

et al. 2016

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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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Section: Introductionmentioning

confidence: 99%

Targeted Molecular Imaging in Adrenal Disease—An Emerging Role for Metomidate PET-CT

et al. 2016

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“…Another useful differentiating CT feature is the thickness of the cyst's wall. The presence of calcifications also suggests a benign nature of the depicted cystic lesion [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of a Giant Adrenal Pseudocyst: A Case Report and Review of the Literature in the Last Decade

Paramythiotis

Bangeas

Karakatsanis

et al. 2018

Case Reports in Surgery

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Adrenal pseudocysts are rare entities and occurred in the 5th and the 6th decades of life. They are discovered accidentally, while appearing with nonspecific clinical and imaging findings. We report a case of a 28-year-old woman presented in our Emergency Department complaining about upper abdomen pain. Computed tomography revealed a hypodense cystic lesion containing hyperdense material. The size of a mass was 11. 7 × 9.3 × 6.6 cm in diameter close to the pancreas, but the origin was from the left adrenal gland. The mass was excised with surgical laparotomy. Giant adrenal pseudocysts are rare entities. Final diagnosis usually confirmed with the pathology examination. Management of such adrenal lesions depends on the unique characteristics, the surgeon's experience, and local resources.

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“…53 ). If the cyst wall exhibits nodular enhancement on imaging studies, the differential diagnosis must take into consideration a cystic adrenal tumour, in particular phaeochromocytoma and carcinoma 53 .…”

Section: Cystsmentioning

confidence: 99%

“…9b) (ref. 53 ). An incidentally found old adrenal haematoma that can be partially or completely calcified is more typically encountered in adulthood.…”

Section: Bleeding/haematomamentioning

confidence: 99%

Adrenal disease: a clinical update and overview of imaging. A review

Čtvrtlík¹,

Koranda²,

Tichý³

2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. The aim of this article is to provide an overview of the most frequent clinically significant adrenal diseases and to describe the latest trends in their diagnostics, particularly by means of imaging techniques. Methods. The authors reviewed standard textbooks and subsequently conducted a search using the PubMed (Public/ Publisher MEDLINE) electronic database by the year 2013 with the following search terms: adrenal masses, adrenal adenoma, phaeochromocytoma, adrenocortical carcinoma, metastases, incidentalomas, hypercortisolism, hyperaldosteronism. Results. If adrenal disease is clinically suspected, hormone tests are performed to detect adrenal hyperfunction and imaging studies are used to assess the nature of adrenal lesion. The most frequent syndromes include hypercortisolism, primary hyperaldosteronism, and phaeochromocytoma. The clinically most significant pathologies of the adrenal glands are adenomas and adrenal hyperplasia, adrenocortical carcinomas, phaeochromocytomas, and metastases. Given the availability and improved quality of imaging techniques, adrenal incidentalomas are detected increasingly often. In these cases, it is necessary to rule out hormonal activity and malignancy. Incidentalomas can be associated with clinical syndromes of adrenal hormone overproduction. In most cases, they are clinically silent. In some cases, the definitive diagnosis can be determined as early as during the initial examination with an imaging technique (most frequently, a CT scan). If the finding is inconsistent, other imaging techniques can be used: CT contrast washout analysis, MRI, SPECT or PET/CT. Conclusion. In the case of adrenal gland disorders, correct interpretation of the results of laboratory tests and imaging studies is essential for further management of these patients.

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Adrenal Imaging with MDCT: Nonneoplastic Disease

Abstract: Proper characterization is essential to ensure that life-threatening sequelae from Addisonian crisis are averted in infection and hemorrhage, or to identify "leave-alone" lesions such as pseudocyst and chronic calcification.

Cited by 33 publications

References 20 publications

Targeted Molecular Imaging in Adrenal Disease—An Emerging Role for Metomidate PET-CT

Targeted Molecular Imaging in Adrenal Disease—An Emerging Role for Metomidate PET-CT

Surgical Management of a Giant Adrenal Pseudocyst: A Case Report and Review of the Literature in the Last Decade

Adrenal disease: a clinical update and overview of imaging. A review

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