Adrenal masses: characterization with delayed contrast-enhanced CT.

Abstract

Adrenal masses detected with contrast-enhanced CT can be characterized as benign or malignant on early delayed scans of the adrenal glands.

Adrenalectomy: Defining Its Role in the Surgical Treatment of Renal Cell Carcinoma

“…Patients with such a history are precisely the population in whom characterization of an incidentally detected adrenal mass is essential. However, recent work suggests that adrenal masses detected with contrast-enhanced CT can be characterized on early delayed scans of the adrenal glands selecting an attenuation threshold value of 24 HU [25]. Kletscher et al [26] carried out a prospective study on 100 patients with RCC aiming to evaluate CT in predicting adrenal involvement preoperatively.…”

Contralateral adrenal suppression on adrenocortical scintigraphy provides good evidence showing subclinical cortisol overproduction from unilateral adenomas

“…The inclusion criteria were: 1) adrenal masses discovered serendipitously by radiological evaluation in the absence of clinical features suggestive of adrenal diseases, 2) unilateral adrenal mass more than 10 mm in diameter on abdominal computed tomography (CT), 3) abdominal CT and/or magnetic resonance imaging features suggesting benign adrenocortical adenoma; round-or oval-shaped hypodense mass (density on unenhanced CT scan of less than 10 Hounsfield units) with a homogenous pattern and well-defined margin [6], and 4) normal morning serum cortisol levels in repeated testing. Patients with suspected or confirmed adrenomedullary tumors, cysts, and metastatic lesions, and those with primary aldosteronism based on endocrine testing, imaging studies, or histopathological examination of resected tumors were excluded.…”

Genitourinary System

“…Adrenal washout CT should be performed after a standard contrast-enhanced 60 s portal venous phase (PVP) delay and 15 min post-contrast delay, with or without NECT. Calculation of HU ratios can be relative (enhanced -delayed/ enhanced × 100 %) or absolute (enhanceddelayed/enhanced -unenhanced × 100 %) with values >60 % or >40 % diagnostic of adenoma, respectively (Boland et al 1997 ;Korobkin et al 1998 ;Caoili et al 2000 ). Ten-minute delays have also been studied to decrease imaging time but have decreased diagnostic accuracy when compared to 15 min delays (Blake et al 2006 ;Taffel et al 2012 ).…”