Adrenocortical Carcinoma: The Range of Appearances on CT and MRI

Bharwani, Nishat; Rockall, Andrea; Sahdev, Anju; Gueorguiev, Maria; Drake, William; Grossman, Ashley; Reznek, Rodney H.

doi:10.2214/ajr.10.5540

Cited by 167 publications

(131 citation statements)

References 70 publications

(105 reference statements)

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“…By selecting appropriate sequencing parameters, separate images can be generated with water and fat protons oscillating in phase or out of phase to each other. Adrenal adenomas with a high content of intracellular lipid usually lose signal intensity on out-of-phase images compared with in-phase images, whereas malignant lesions and pheochromocytomas (but also lipid-poor adrenal adenomas) that all lack intracellular lipid remain unchanged (58,65,66). Simple visual assessment of signal intensity loss is diagnostic in most cases, but quantitative methods may be useful in less clear-cut cases.…”

Section: Short Overview On Adrenal Imagingmentioning

confidence: 99%

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

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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: Short Overview On Adrenal Imagingmentioning

confidence: 99%

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

Self Cite

1,254

1,571

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“…On contrast CT, ACC often demonstrates inhomogenous enhancement, a thin enhancing peripheral rim, atenuation value >10 HU, and an absolute contrast washout <60% after 15 minutes of contrast administration [10]. ACC tend to be locally invasive, especially in vascular structures such as the adrenal and renal veins, and inferior vena cava.…”

Section: Computed Tomographymentioning

confidence: 99%

Current Management of Adrenal Incidentalomas

Michailidou¹,

Guerrero²

2017

Clinical Management of Adrenal Tumors

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Adrenal "incidentalomas" refer to a group of adrenal masses initially discovered during cross-sectional imaging obtained for other clinical reasons. The majority of incidentalomas are benign nonfunctional adrenal adenomas and can be safely managed expectantly. A subset of adrenal incidentalomas, however, are functional and/or malignant, and these lesions most often require adrenalectomy. The following chapter outlines the diferential diagnosis, the diferent imaging modalities and features, as well as biochemical evaluation of adrenal incidentalomas.

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“…Lokalno je invazivan, a česta je i vaskularna invazija 52,53 . Heterogena postkontrastna opacifikacija, sa sporim ispiranjem je karakterističan prikaz na kompjutoriziranoj tomografiji 48,54 .…”

Section: Adrenokortikalni Karcinomunclassified

Computed tomography and magnetic resonance imaging of adrenal lesions

et al. 2017

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Sažetak.Od ranije je poznato kako učestalost ekspanzivnih lezija nadbubrežnih žlijezda na obdukcijama značajno nadilazi broj klinički potvrđenih adrenalnih lezija. Zbog sve učestalijeg korištenja slojevnih tehnika snimanja posljednjih godina otkriva se značajno veći broj suprarenalnih tvorbi koje zahtijevaju karakterizaciju i endokrinološku obradu. Većina tih lezija su nefunkcionalni (silentni) adenomi, tzv. incidentalomi, no potrebna je slikovna karakterizacija lezija kako bi se isključio maligni tumor i odredili daljnji terapijski postupci. U radu prikazujemo pregled literature o slikovnoj dijagnostici najčešćih benignih i malignih lezija nadbubrežnih žlijezda, s fokusom na kompjutoriziranu tomografiju i magnetsku rezonanciju s prikazom primjera iz vlastite kliničke prakse. U nastavku prikazujemo algoritam temeljen na preporukama ACR-a (American College of Radiology) i algoritmu koji je sastavio Incidental Findings Committee o optimalnom odabiru slikovne metode i daljnjim postupcima s novootkrivenim lezijama nadbubrežnih žlijezda.Ključne riječi: adenom; incidentalom; nadbubrežne žlijezde; slikovne metode Abstract. The incidence of adrenal lesions on autopsy significantly overcomes the number of clinically diagnosed adrenal lesions. Due to increasing use of cross-sectional imaging in the past few years, a significantly higher number of adrenal lesions is detected, which require characterisation and endocrinological workup. Although a majority of these lesions are nonfunctional (silent) adenomas, imaging characterisation is required to exclude malignant process and determine further management. In this article we present the review of current litterature on imaging of benign and malignant adrenal lessions, with emphassis on computed tomography (CT) and magnetic resonance imaging (MRI) characteristics, presenting images from our clinical practice. Furthermore, we present the algorithm based on the recommendations of American College of Radiology Incidental Findings Committee on how to select optimal imaging method and further management of adrenal lesions.

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Adrenocortical Carcinoma: The Range of Appearances on CT and MRI

Cited by 167 publications

References 70 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

Current Management of Adrenal Incidentalomas

Computed tomography and magnetic resonance imaging of adrenal lesions

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