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FDG-PET/CT and FLT-PET/CT for differentiating between lipid-poor benign and malignant adrenal tumours. Eur Radiol 2015; 25:3696-705. [PMID: 25925356 DOI: 10.1007/s00330-015-3787-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/31/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare F-18-fluorodeoxyglucose (FDG) and F-18-fluorothymidine (FLT) PET/CT examinations for differentiating between benign and malignant adrenal tumours. METHODS Thirty lipid-poor benign and 11 malignant tumours of 40 patients were included. FDG- and FLT-based indices including visual score, maximum standardized uptake value (SUVmax) and FDG adrenal lesion/liver SUVmax (A/L SUVmax) or FLT adrenal lesion/back muscle SUVmax (A/B SUVmax) ratio were compared between benign and malignant tumours using the Mann-Whitney's U or Wilcoxon signed-rank test, and their diagnostic performances were evaluated by means of the area under the curve (AUC) values derived from the receiver operating characteristic analysis. RESULTS All indices were significantly higher in malignant than benign tumours on both images (p < 0.05 each). On FDG-PET/CT, the sensitivity, specificity, and accuracy were 91 %, 63 % and 71 % for visual score, 91 %, 67 % and 73 % for SUVmax, and 100 %, 70 % and 78 % for A/L SUVmax ratio, respectively. On FLT-PET/CT, they were 100 %, 97 % and 98 % for visual score, SUVmax and A/B SUVmax ratio, respectively. All FLT indices were significantly higher than those of FDG in AUC (p < 0.05 each). CONCLUSION FLT-PET/CT may be superior to FDG-PET/CT in differentiating lipid-poor benign from malignant adrenal tumours because of higher specificity and accuracy. KEY POINTS • All FDG indices were significantly higher in malignant than in benign tumours. • All FLT indices were significantly higher in malignant than in benign tumours. • All FLT indices were significantly higher than those of FDG in AUC.
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Characterization of Adrenal Lesions at Chemical-Shift MRI: A Direct Intraindividual Comparison of In- and Opposed-Phase Imaging at 1.5 T and 3 T. AJR Am J Roentgenol 2015; 204:536-41. [DOI: 10.2214/ajr.14.12941] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Willatt J, Chong S, Ruma JA, Kuriakose J. Incidental Adrenal Nodules and Masses: The Imaging Approach. Int J Endocrinol 2015; 2015:410185. [PMID: 26064109 PMCID: PMC4429195 DOI: 10.1155/2015/410185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/12/2015] [Indexed: 12/21/2022] Open
Abstract
Adrenal nodules are detected with increasing frequency. The National Institute of Health (NIH), American College of Radiology (ACR), and the American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons (AACE/AAES) have produced guidelines for the management of incidental adrenal nodules. This review provides a summary of the consensus radiologic approach to these nodules.
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Affiliation(s)
- J. Willatt
- University of Michigan Health System, Ann Arbor, MI 48109, USA
- Veterans Administration Hospital, Ann Arbor, MI 48105, USA
- *J. Willatt:
| | - S. Chong
- University of Michigan Health System, Ann Arbor, MI 48109, USA
- Veterans Administration Hospital, Ann Arbor, MI 48105, USA
| | - J. A. Ruma
- University of Michigan Health System, Ann Arbor, MI 48109, USA
- Veterans Administration Hospital, Ann Arbor, MI 48105, USA
| | - J. Kuriakose
- University of Michigan Health System, Ann Arbor, MI 48109, USA
- Veterans Administration Hospital, Ann Arbor, MI 48105, USA
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Diagnostic performances of FDG-PET/CT and diffusion-weighted imaging indices for differentiating benign pheochromocytoma from other benign adrenal tumors. ACTA ACUST UNITED AC 2014; 40:1655-65. [DOI: 10.1007/s00261-014-0291-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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55
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Schieda N, Al Dandan O, Kielar A, Flood T, McInnes M, Siegelman E. Pitfalls of adrenal imaging with chemical shift MRI. Clin Radiol 2014; 69:1186-97. [DOI: 10.1016/j.crad.2014.06.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/17/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
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Woo S, Cho JY, Kim SY, Kim SH. Adrenal adenoma and metastasis from clear cell renal cell carcinoma: can they be differentiated using standard MR techniques? Acta Radiol 2014; 55:1120-8. [PMID: 24252816 DOI: 10.1177/0284185113512301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chemical-shift magnetic resonance imaging (MRI) has been known to successfully differentiate adenomas from metastases. However, there has been concern that metastasis from extra-adrenal primary malignancies which contain high lipid content such as clear cell renal cell carcinoma (RCC) could mimic adrenal adenomas. PURPOSE To evaluate the ability of MR to differentiate adrenal adenoma from metastasis using chemical-shift imaging and MR feature analysis in patients with clear cell RCC. MATERIAL AND METHODS This study was institutional review board-approved; informed consent was waived. Eleven patients with 13 metastases and 13 patients with 15 adrenal adenomas in patients with clear cell RCC for evaluation of an adrenal mass underwent MR. Signal intensity on in- and opposed-phases, signal intensity index (SII), size, T2 SI, cystic change, necrosis, and hemorrhage were evaluated. Statistical analyses included Student t-test and Fisher exact test. If available, precontrast CT attenuation of the adrenal adenomas was measured. SII was correlated with attenuation using Pearson correlation coefficient. RESULTS Mean size of adenomas was smaller than that of metastases (P < 0.002). Mean SII of adenomas (45.0% ± 24.6) was significantly greater than that of metastases (6.6% ± 4.7; P < 0.001). With a threshold of 16.5% for SII, the sensitivity, specificity, and accuracy for adenomas were 80%, 100%, and 89.2%, respectively. All six lipid-rich adenomas were diagnosed as adrenal adenoma. Three of eight (37.5%) lipid-poor adenomas were misdiagnosed as metastases. While up to 53.8% (7/13) of the metastases demonstrated cystic change, necrosis, or hemorrhage, only one (6.7%) adenoma exhibited cystic change or necrosis (P < 0.05 for all). Precontrast attenuation and SII were significantly correlated: r = -0.810 (P < 0.001). CONCLUSION In patients with clear cell RCC who underwent MR for adrenal masses, SII and MR features such as cystic change, necrosis, and hemorrhage were helpful in differentiating adenomas from metastases.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Song JH, Mayo-Smith WW. Current Status of Imaging for Adrenal Gland Tumors. Surg Oncol Clin N Am 2014; 23:847-61. [DOI: 10.1016/j.soc.2014.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Emad-Eldin S, El-Kalioubie M. Diagnostic value of combined versus individual MRI parameters in distinguishing adenomatous from non-adenomatous adrenal lesions in cancer patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Incidental adrenal neoplasms are usually nonfunctioning benign adenomas. Once hormonal production has been assessed, the nonsecreting lesions must be evaluated for the possibility of malignancy. This evaluation relies primarily on the radiographic characteristics. This article focuses on the current state of radiologic technology available to accurately assess nonfunctioning adrenal incidentalomas. As this technology advances, a lesion's malignant potential can more accurately be determined, thereby allowing physicians to make more informed treatment recommendations.
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Affiliation(s)
- Peter J Mazzaglia
- Department of General Surgery, The Warren Alpert School of Medicine, Brown University, 593 Eddy Street, APC 4, Providence, RI 02905, USA.
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Priola AM, Priola SM, Ciccone G, Evangelista A, Cataldi A, Gned D, Pazè F, Ducco L, Moretti F, Brundu M, Veltri A. Differentiation of rebound and lymphoid thymic hyperplasia from anterior mediastinal tumors with dual-echo chemical-shift MR imaging in adulthood: reliability of the chemical-shift ratio and signal intensity index. Radiology 2014; 274:238-49. [PMID: 25105246 DOI: 10.1148/radiol.14132665] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To prospectively evaluate (a) effectiveness and limits of dual-echo chemical-shift magnetic resonance (MR) imaging for distinguishing hyperplastic thymus from anterior mediastinal tumors in adulthood by using chemical-shift ratio ( CSR chemical-shift ratio ) and signal intensity index ( SII signal intensity index ), with proposal of optimal threshold value for each, and (b) whether age affects these indexes. MATERIALS AND METHODS Study was institutional review board approved, with informed consent obtained. Ninety-two subjects (53 men, 39 women; age range, 18-84 years) were divided into a rebound and lymphoid hyperplasia group (group A, 30 patients) and a tumor group (group B, 62 patients). MR images were assessed; interrater reliability was evaluated. Differences in CSR chemical-shift ratio and SII signal intensity index were tested with the Mann-Whitney U test and the Kruskal-Wallis test. Discrimination abilities of CSR chemical-shift ratio and SII signal intensity index were evaluated with logistic regression models, and optimal cutoff points were proposed. Quantitative parameters were correlated with age by using Pearson correlation coefficients. RESULTS Interreader agreement was excellent (intraclass correlation coefficient: CSR chemical-shift ratio , 0.893; SII signal intensity index , 0.898). Mean CSR chemical-shift ratio and SII signal intensity index ± standard deviation were 0.545 ± 0.162 and 46.29% ± 18.41 for group A and 1.045 ± 0.094 and -0.06% ± 4.89 for group B, respectively, with significant differences for both indexes between groups (P < .0001). No overlap was found for SII signal intensity index between groups; CSR chemical-shift ratio values overlapped in a few younger adults. Distinguishing hyperplastic thymus from tumors was better with SII signal intensity index than CSR chemical-shift ratio . Respective sensitivity, specificity, and cutoff points were 100%, 100%, and 8.92% for SII signal intensity index and 100%, 96.7%, and 0.849 for CSR chemical-shift ratio . Significant correlation was found for CSR chemical-shift ratio (r = -0.761) and SII signal intensity index (r = 0.821) with age in group A (P < .001). For group B, significant correlation with age was seen for CSR chemical-shift ratio (r = 0.702, P < .001) but not SII signal intensity index (r = -0.196, P = .127). All subjects but one in group A and none in group B had signal intensity decrease at chemical-shift MR imaging. CONCLUSION With dual-echo chemical-shift MR imaging, SII signal intensity index and CSR chemical-shift ratio have high accuracy to distinguish thymic hyperplasia from tumors, although overlapped CSR chemical-shift ratio values can occur in early adulthood.
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Affiliation(s)
- Adriano M Priola
- From the Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, University of Torino, Regione Gonzole 10, 10043, Orbassano (Torino), Italy (A.M.P., S.M.P., A.C., D.G., F.P., L.D., F.M., M.B., A.V.); and Unit of Clinical Epidemiology, Città della Salute e della Scienza and CPO Piemonte, Torino, Italy (G.C., A.E.)
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Low yield of chemical shift MRI for characterization of adrenal lesions with high attenuation density on unenhanced CT. ACTA ACUST UNITED AC 2014; 40:318-26. [DOI: 10.1007/s00261-014-0208-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Combined Chemical Shift Imaging With Early Dynamic Serial Gadolinium-Enhanced MRI in the Characterization of Adrenal Lesions. AJR Am J Roentgenol 2014; 203:99-106. [DOI: 10.2214/ajr.13.11731] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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63
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64
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Characterization of Lipid-Poor Adrenal Adenoma: Chemical-Shift MRI and Washout CT. AJR Am J Roentgenol 2014; 202:1043-50. [DOI: 10.2214/ajr.13.11389] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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65
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Koo HJ, Choi HJ, Kim HJ, Kim SO, Cho KS. The value of 15-minute delayed contrast-enhanced CT to differentiate hyperattenuating adrenal masses compared with chemical shift MR imaging. Eur Radiol 2014; 24:1410-20. [DOI: 10.1007/s00330-013-3084-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/12/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
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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: 0.9] [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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Shiue K, Song A, Teh BS, Ellis RJ, Yao M, Mayr NA, Huang Z, Sohn J, Machtay M, Lo SS. Stereotactic body radiation therapy for metastasis to the adrenal glands. Expert Rev Anticancer Ther 2014; 12:1613-20. [DOI: 10.1586/era.12.125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Stone WZ, Wymer DC, Canales BK. Fluorodeoxyglucose-positron-emission tomography/computed tomography imaging for adrenal masses in patients with lung cancer: review and diagnostic algorithm. J Endourol 2014; 28:104-11. [PMID: 23927734 PMCID: PMC3880901 DOI: 10.1089/end.2013.0380] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Positron-emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) is used as first-line staging for patients with newly diagnosed non-small cell lung cancer (NSCLC). Our purpose was to review the accuracy of FDG-PET/CT to predict adrenal gland metastasis, explain the causes for false-positive PET, and provide a diagnostic algorithm. PATIENTS AND METHODS Two patients with incidentally discovered lung masses were found to have hypermetabolic adrenal activity by FDG-PET/CT with maximal standard uptake value (SUV) of 4.5 and 6.5. A MEDLINE search was performed on the topic of FDG-PET/CT, adrenal gland metastasis, and NSCLC. Literature was reviewed with regard to diagnosis, accuracy, outcomes, and alternative imaging or diagnostic strategies. RESULTS Both patients underwent transabdominal laparoscopic adrenalectomy and were found to have nodular hyperplasia without evidence of adrenal tumor. A total of seven articles containing 343 patients were identified as having pertinent oncologic information for NSCLC patients with adrenal lesions. Sensitivity and specificity of PET/CT for distant metastasis was 94% and 85%, respectively, but only 13% (44/343) of these patients had histologically confirmed adrenal diagnoses. Based on this, a diagnostic algorithm was created to aid in decision making. CONCLUSIONS Although PET/CT has high sensitivity and specificity for adrenal metastasis in the setting of NSCLC, adrenal biopsy or other secondary imaging should be considered to confirm the finding. Adrenalectomy in lieu of biopsy may have both diagnostic and therapeutic benefit in cases where the adrenal mass is ≥10 mm with high PET maximum SUV (≥3.1) and SUV ratios (>2.5), where washout CT or chemical shift MRI is positive, or where percutaneous biopsy is deemed too difficult or unsafe.
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Affiliation(s)
- W. Zachary Stone
- Department of Urology, University of Florida, Gainesville, Florida
| | - David C. Wymer
- Department of Radiology, University of Florida, Gainesville, Florida
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Guerrisi A, Marin D, Baski M, Guerrisi P, Capozza F, Catalano C. Adrenal lesions: spectrum of imaging findings with emphasis on multi-detector computed tomography and magnetic resonance imaging. J Clin Imaging Sci 2013; 3:61. [PMID: 24605256 PMCID: PMC3935261 DOI: 10.4103/2156-7514.124088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 10/28/2013] [Indexed: 11/04/2022] Open
Abstract
The adrenal gland is a common site of a large spectrum of abnormalities like primary tumors, hemorrhage, metastases, and enlargement of the gland from external hormonal stimulation. Most of these lesions represent nonfunctioning adrenal adenomas and thus warrant a conservative management. Multi-detector computed tomography (CT) and magnetic resonance (MR) imaging are still considered highly specific and complementary techniques for the detection and characterization of adrenal abnormalities. Radiologist can establish a definitive diagnosis for most adrenal masses (i.e., carcinoma, hemorrhage) based on imaging alone. Imaging therefore can differentiate malignant lesions from those benign and avoid unnecessary aggressive management of benign lesions. The article gives an overview of the adrenal lesions and their imaging characteristics seen on CT and MR imaging.
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Affiliation(s)
- Antonino Guerrisi
- Department of Radiological Sciences, University of Rome "La Sapienza", Viale Regina Elena 324, Rome, 00161, Italy
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Duke North-Room 1417, Erwin Road, Durham, NC 27710, USA
| | - Mahbubeh Baski
- Department of Radiological Sciences, University of Rome "La Sapienza", Viale Regina Elena 324, Rome, 00161, Italy
| | - Pietro Guerrisi
- Department of Radiological Sciences, University of Rome "La Sapienza", Viale Regina Elena 324, Rome, 00161, Italy
| | - Federica Capozza
- Department of Radiological Sciences, University of Rome "La Sapienza", Viale Regina Elena 324, Rome, 00161, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, University of Rome "La Sapienza", Viale Regina Elena 324, Rome, 00161, Italy
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Morphologic Features of 211 Adrenal Masses at Initial Contrast-Enhanced CT: Can We Differentiate Benign From Malignant Lesions Using Imaging Features Alone? AJR Am J Roentgenol 2013; 201:1248-53. [DOI: 10.2214/ajr.12.10302] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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71
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Yanik B, Keyik B, Conkbayir I. Fatty degeneration of multifidus muscle in patients with chronic low back pain and in asymptomatic volunteers: quantification with chemical shift magnetic resonance imaging. Skeletal Radiol 2013; 42:771-8. [PMID: 23263412 DOI: 10.1007/s00256-012-1545-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/02/2012] [Accepted: 11/04/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate and compare the fatty degeneration of multifidus muscles by chemical shift magnetic resonance imaging (MRI) in patients with chronic low back pain and in asymptomatic volunteers. MATERIALS AND METHODS Sixty-five patients with lumbar disc pathology were selected prospectively for this study. The control group consisted of 25 asymptomatic volunteers. The patients were grouped according to the fatty degeneration of multifidus muscles by a semiquantitative method (grade 0-4) on axial T2 weighted imaging. Chemical shift MRI was performed in the axial plane using a double-echo fast low-angle shot (FLASH) sequence. Fatty degeneration was calculated through signal intensity suppression rate (SISR) and signal intensity index (SII). RESULTS The semiquantitative grading of fatty degeneration of the multifidus muscle was 0 in 25 of 65 patients (patient group 0), 1 in 20 patients (patient group 1), 2 in 20 patients (patient group 2). Neither grade 3 nor grade 4 were detected in patient groups. For the control group, patient group 0, patient group 1, and patient group 2, median SISR values were 5.00, -9.00, -17.50, and -22.50 %, respectively. SII median values were -4.20 % for the control group, 7.00 % for patient group 0, 12.50 % for patient group 1, and 19.50 % for patient group 2. SISR values in the multifidus muscle calculated for the patient groups were significantly lower than those calculated for the control group. SII values in patients groups were significantly higher than in the control group. CONCLUSIONS Chemical shift MRI may be a useful method to quantitatively evaluate the fatty degeneration in multifidus muscle in patients with low back pain.
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Affiliation(s)
- Bahar Yanik
- Department of Radiology, Balikesir University, School of Medicine, Balikesir, Turkey.
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Korivi BR, Elsayes KM. Cross-sectional imaging work-up of adrenal masses. World J Radiol 2013; 5:88-97. [PMID: 23671745 PMCID: PMC3650209 DOI: 10.4329/wjr.v5.i3.88] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/12/2012] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
Advances in medical imaging with current cross-section modalities enable non-invasive characterization of adrenal lesions. Computed tomography (CT) provides characterization with its non-contrast and wash-out features. Magnetic resonance imaging (MRI) is helpful in further characterization using chemical shift imaging (CSI) and MR spectroscopy. For differentiating between benign and malignant masses, positron emission tomography (PET) imaging is useful with its qualitative analysis, as well as its ability to detect the presence of extra-adrenal metastases in cancer patients. The work-up for an indeterminate adrenal mass includes evaluation with a non-contrast CT. If a lesion is less than 10 Hounsfield Units on a non-contrast CT, it is a benign lipid-rich adenoma and no further work-up is required. For the indeterminate adrenal masses, a lipid-poor adenoma can be differentiated from a metastasis utilizing CT wash-out features. Also, MRI is beneficial with CSI and MR spectroscopy. If a mass remains indeterminate, PET imaging may be of use, in which benign lesions demonstrate low or no fluorodeoxyglucose activity. In the few cases in which adrenal lesions remain indeterminate, surgical sampling such as percutaneous biopsy can be performed.
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MR imaging of renal cortical tumours: qualitative and quantitative chemical shift imaging parameters. Eur Radiol 2013; 23:1738-44. [PMID: 23300041 DOI: 10.1007/s00330-012-2758-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/31/2012] [Accepted: 12/01/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess qualitative and quantitative chemical shift MRI parameters of renal cortical tumours. METHODS A total of 251 consecutive patients underwent 1.5-T MRI before nephrectomy. Two readers (R1, R2) independently evaluated all tumours visually for a decrease in signal intensity (SI) on opposed- compared with in-phase chemical shift images. In addition, SI was measured on in- and opposed-phase images (SI(IP), SI(OP)) and the chemical shift index was calculated as a measure of percentage SI change. Histopathology served as the standard of reference. RESULTS A visual decrease in SI was identified significantly more often in clear cell renal cell carcinoma (RCCs) (R1, 73 %; R2, 64 %) and angiomyolipomas (both, 80 %) than in oncocytomas (29 %, 12 %), papillary (29 %, 17 %) and chromophobe RCCs (13 %, 9 %; all, P < 0.05). Median chemical shift index was significantly greater in clear cell RCC and angiomyolipoma than in the other histological subtypes (both, P < 0.001). Interobserver agreement was fair for visual (kappa, 0.4) and excellent for quantitative analysis (concordance correlation coefficient, 0.80). CONCLUSIONS A decrease in SI on opposed-phase chemical shift images is not an identifying feature of clear cell RCCs or angiomyolipomas, but can also be observed in oncocytomas, papillary and chromophobe RCCs. After excluding angiomyolipomas, a decrease in SI of more than 25 % was diagnostic for clear cell RCCs. KEY POINTS • Chemical shift MRI offers new information about fat within renal tumours. • Opposed-phase signal decrease can be observed in all renal cortical tumours. • A greater than 25 % decrease in signal appears to be diagnostic for clear cell RCCs.
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Chemical-shift MRI of pulmonary hamartomas: initial experience using a modified technique to assess nodule fat. AJR Am J Roentgenol 2012; 199:W331-4. [PMID: 22915423 DOI: 10.2214/ajr.11.8056] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to show the usefulness of chemical-shift MRI in the diagnosis of intranodular fat in seven patients with pulmonary hamartomas and indeterminate CT findings. CONCLUSION In the setting of chemical-shift MRI, the average nodule signal intensity index of pulmonary hamartomas was 45.3% (SD = 25.5%). The correlation between average nodule signal intensity and CT attenuation in Hounsfield units was -0.94. Chemical-shift MRI could be an important tool for the detection of fat in pulmonary hamartomas with inconclusive CT findings.
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Siegelman ES. Adrenal MRI: Techniques and clinical applications. J Magn Reson Imaging 2012; 36:272-85. [DOI: 10.1002/jmri.23601] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Taffel M, Haji-Momenian S, Nikolaidis P, Miller FH. Adrenal imaging: a comprehensive review. Radiol Clin North Am 2012; 50:219-43, v. [PMID: 22498440 DOI: 10.1016/j.rcl.2012.02.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The discovery of an incidental adrenal mass (adrenal incidentaloma) continues to rise with the increasing use of cross-sectional imaging. Although most adrenal lesions are benign and asymptomatic, radiologists should guide evaluation of these lesions, whether benign or malignant. This article reviews the various imaging techniques used to evaluate adrenal masses and their relative strengths and weaknesses. It focuses on the most prevalent adrenal pathologies and their typical imaging characteristics, and concludes with a brief discussion of developing techniques, including diffusion-weighted imaging and dual-energy CT.
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Affiliation(s)
- Myles Taffel
- Department of Radiology, George Washington University Medical Center, Washington, DC, USA.
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McDermott S, O'Connor OJ, Cronin CG, Blake MA. Radiological evaluation of adrenal incidentalomas: current methods and future prospects. Best Pract Res Clin Endocrinol Metab 2012; 26:21-33. [PMID: 22305450 DOI: 10.1016/j.beem.2011.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Incidental adrenal lesions are very common. Computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) all have a role to play in characterizing adrenal lesions. The purpose of this review is to discuss the rationale behind both established and emerging imaging techniques. We also discuss how to follow up incidentally found lesions.
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Affiliation(s)
- S McDermott
- Department of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
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Halefoglu AM, Altun I, Disli C, Ulusay SM, Ozel BD, Basak M. A Prospective Study on the Utility of Diffusion-Weighted and Quantitative Chemical-Shift Magnetic Resonance Imaging in the Distinction of Adrenal Adenomas and Metastases. J Comput Assist Tomogr 2012; 36:367-74. [DOI: 10.1097/rct.0b013e3182597613] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Oliveira Caiafa R, Salvador Izquierdo R, Buñesch Villalba L, Sebastià Cerqueda M, Nicolau Molina C. Diagnosis and management of adrenal incidentaloma. RADIOLOGIA 2011. [DOI: 10.1016/j.rxeng.2011.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Farshchian N, Tamari S, Farshchian N, Madani H, Rezaie M, Mohammadi-Motlagh HR. Diagnostic value of chemical shift artifact in distinguishing benign lymphadenopathy. Eur J Radiol 2011; 80:594-7. [DOI: 10.1016/j.ejrad.2010.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 10/01/2010] [Accepted: 10/08/2010] [Indexed: 01/12/2023]
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Nakamura S, Namimoto T, Morita K, Utsunomiya D, Oda S, Nakaura T, Hirai T, Yamashita Y. Characterization of adrenal lesions using chemical shift MRI: Comparison between 1.5 tesla and two echo time pair selection at 3.0 tesla MRI. J Magn Reson Imaging 2011; 35:95-102. [DOI: 10.1002/jmri.22728] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 06/30/2011] [Indexed: 11/10/2022] Open
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Characterization of adrenal lesions with 1.5-T MRI: preliminary observations on comparison of three in-phase and out-of-phase gradient-echo techniques. AJR Am J Roentgenol 2011; 197:415-23. [PMID: 21785088 DOI: 10.2214/ajr.10.5848] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this study was to use previously described quantitative evaluation methods to compare the performance of 3D gradient-recalled echo (GRE) and magnetization-prepared (MP) GRE in-phase and out-of phase sequences with standard 2D GRE technique in the characterization of adrenal lesions. MATERIALS AND METHODS The study sample consisted of 44 consecutively registered patients (22 men, 22 women; mean age, 59.1 ± 11.6 years) with 50 adrenal lesions who underwent standard abdominal MRI that included in-phase and out-of-phase 2D GRE (n = 41), 3D GRE (n = 35), MP GRE (n = 36), or a combination of these techniques. The adrenal signal intensity (SI) index and adrenal-to-spleen, adrenal-to-liver, and adrenal-to-muscle SI ratios of each lesion were calculated and compared for the three techniques by independent samples Student t test. The area under the receiver operating characteristic (ROC) curve (AUC) for each evaluation method was determined, and comparisons of independent ROC curves were performed for all sequences. RESULTS For all sequences, the mean adrenal SI index and SI ratios of adenomas and nonadenomas differed significantly (p < 0.001). For the 3D GRE and MP GRE techniques, adrenal SI index and modified adrenal-to-spleen ratio, respectively, had the larger AUCs, but the difference was not statistically significant. Different thresholds for the three techniques were recommended for discriminating adenoma from nonadenoma. CONCLUSION The results of characterization of adrenal lesions with MP GRE and 3D GRE in-phase and out-of-phase MRI techniques are comparable to those obtained with the reference standard 2D GRE technique. Different thresholds should be selected according to the in-phase and out-of-phase techniques used and for the various evaluation methods.
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Oliveira Caiafa R, Salvador Izquierdo R, Buñesch Villalba L, Sebastià Cerqueda MC, Nicolau Molina C. [Diagnosis and management of adrenal incidentaloma]. RADIOLOGIA 2011; 53:516-30. [PMID: 21944711 DOI: 10.1016/j.rx.2011.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 06/01/2011] [Accepted: 06/15/2011] [Indexed: 12/17/2022]
Abstract
The growing demand for imaging tests and the progressive aging of the population have led to a progressive increase in the detection of indeterminate adrenal lesions. Once an adrenal incidentaloma is detected, clinical and hormone tests together with a battery of imaging techniques (CT, MRI, PET/CT…) make it possible to determine the cause in most cases. In this article, we discuss the advantages and limitations of each technique. We show the imaging characteristics of the most common adrenal lesions and propose a diagnostic algorithm to enable their diagnosis.
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Affiliation(s)
- R Oliveira Caiafa
- Centro de Diagnóstico por la Imagen, Hospital Clínic, Barcelona, España.
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84
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Effectiveness of a three-dimensional dual gradient echo two-point Dixon technique for the characterization of adrenal lesions at 3 Tesla. Eur Radiol 2011; 22:259-68. [DOI: 10.1007/s00330-011-2244-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/28/2011] [Accepted: 08/05/2011] [Indexed: 02/02/2023]
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85
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Wasnik AP, Mazza MB, Lalchandani UR, Liu PS. Normal and Variant Abdominal Anatomy on Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2011; 19:521-45; viii. [DOI: 10.1016/j.mric.2011.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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86
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Muth A, Hammarstedt L, Hellström M, Sigurjónsdóttir HÁ, Almqvist E, Wängberg B. Cohort study of patients with adrenal lesions discovered incidentally. Br J Surg 2011; 98:1383-91. [DOI: 10.1002/bjs.7566] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2011] [Indexed: 02/03/2023]
Abstract
Abstract
Background
This prospective cohort study investigated the incidence, clinical features and natural history of incidentally discovered adrenal mass lesions (adrenal incidentaloma, AI) in an unselected population undergoing radiological examination.
Methods
During an 18-month period, all patients with AI were reported prospectively from all 19 radiology departments in western Sweden. Inclusion criteria were: incidentally discovered adrenal enlargement or mass lesion in patients without extra-adrenal malignancy on detection. Clinical and biochemical evaluation was performed on inclusion and after 24 months. Computed tomography (CT) of the adrenals was scheduled at 4, 12 and 24 months. Magnetic resonance imaging was performed for lesions larger than 20 mm. The indications for surgical excision were: hormone activity, lesion diameter more than 30 mm, lesion growth or other radiological features suspicious of malignancy.
Results
Of 534 patients assessed for eligibility, 226 (mean age 67 years, 62·4 per cent women; mean lesion diameter 23·9 mm, 22·6 per cent bilateral) fulfilled the inclusion criteria. Mean follow-up was 19·0 months. After baseline evaluation, 14 patients had surgery owing to primary hyperaldosteronism (3), catecholamine-producing tumour (1), tumour size (6), size and indication of subclinical hypercortisolism (3) and metastasis (1). No hypersecreting lesions were confirmed during follow-up; one patient underwent adrenalectomy for a suspected phaeochromocytoma (adrenocortical adenoma at histopathology). No primary adrenal malignancy was found.
Conclusion
In this prospective cohort study 6·6 per cent of patients with an AI had surgery and benign hormone-producing tumours were verified in 3·1 per cent. Repeat CT and hormone evaluation after 2 years did not increase the sensitivity for diagnosis of malignant or hormone-producing tumours.
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Affiliation(s)
- A Muth
- Department of Surgery, Department of Endocrinology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - L Hammarstedt
- Department of Radiology, Department of Endocrinology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - M Hellström
- Department of Radiology, Department of Endocrinology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - H Á Sigurjónsdóttir
- Department of Endocrinology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - E Almqvist
- Department of Medicine, Skövde Hospital, Skövde, Sweden
| | - B Wängberg
- Department of Surgery, Department of Endocrinology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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89
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Evaluation of vertebral bone marrow fat content by chemical-shift MRI in osteoporosis. Skeletal Radiol 2011; 40:577-85. [PMID: 21069523 DOI: 10.1007/s00256-010-1048-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 08/09/2010] [Accepted: 09/29/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantitatively evaluate vertebral bone marrow fat content and investigate its association with osteoporosis with chemical-shift magnetic resonance imaging (CS-MRI). MATERIALS AND METHODS Fifty-six female patients (age range 50-65 years) with varying bone mineral densities as documented with dual x-ray absorptiometry (DXA) were prospectively included in the study. According to the DXA results, the patients were grouped as normal bone density, osteopenic, or osteoporotic. In order to calculate fat content, the lumbar region was visualized in the sagittal plane by CS-MRI sequence. "Region of interest" (ROI)s were placed within L3 vertebral bodies and air (our reference point) at different time points by different radiologists. Fat content was calculated through "signal intensity (SI) suppression rate" and "SI Index". The quantitative values were compared statistically with those obtained from DXA examinations. Kruskal-Wallis, and Mann-Whitney U tests were used for comparisons between groups. The reliability of the measurements performed by two radiologists was evaluated with the "intraclass correlation coefficient". This study was approved by an institutional review board and all participants provided informed consent to participate in the study. RESULTS Eighteen subjects with normal bone density (mean T score, 0.39 ± 1.3 [standard deviation]), 20 subjects with osteopenia (mean T score, -1.79 ± 0.38), and 18 subjects with osteoporosis (mean T score, -3 ± 0.5) were determined according to DXA results. The median age was 55.9 (age range 50-64 years) in the normal group, 55.5 (age range 50-64 years) in the osteopenic group, and 55.1 (age range 50-65 years) in the osteoporotic group (p = 0.872). In the CS-MRI examination, the values of "SI suppression ratio" and "SI Index" (median [min:max]) were calculated by the first and second reader, independently. There was no statistically significant difference between the groups with regard to vertebral bone marrow fat content (p > 0.05). According to the "intraclass correlation coefficient", the measurements were reliable (0.55 and 0.60). CONCLUSIONS Vertebral bone marrow fat content calculated with CS-MRI is not a reliable parameter for predicting bone mineral density in female patients aged between 50 and 65 years.
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Mclean K, Lilienfeld H, Caracciolo JT, Hoffe S, Tourtelot JB, Carter WB. Management of Isolated Adrenal Lesions in Cancer Patients. Cancer Control 2011; 18:113-26. [DOI: 10.1177/107327481101800206] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Kelly Mclean
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Howard Lilienfeld
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Sarah Hoffe
- Radiation Oncology Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - John B. Tourtelot
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - W. Bradford Carter
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Abstract
Adrenal masses are common incidental findings on cross-sectional imaging. Most of these masses are benign, and adenomas are the most common entity. Several imaging studies allow accurate diagnosis of these masses, separating inconsequential benign masses from the lesions that require treatment. This article discusses contemporary adrenal imaging and the optimal algorithm for the workup of incidentally detected adrenal masses.
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Affiliation(s)
- Julie H Song
- Department of Diagnostic Imaging, Rhode Island Hospital-Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA.
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93
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Using chemical-shift MR imaging to quantify fatty degeneration within supraspinatus muscle due to supraspinatus tendon injuries. Skeletal Radiol 2010; 39:1211-7. [PMID: 20428862 DOI: 10.1007/s00256-010-0927-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/25/2010] [Accepted: 03/29/2010] [Indexed: 02/02/2023]
Abstract
The objective of this study was to prospectively quantify the fatty degeneration of supraspinatus (SSP) muscle due to SSP tendon injuries by using chemical-shift magnetic resonance imaging (CS-MRI). Forty-one patients with suspected rotator cuff tear or impingement examined with MR arthrography were included in the study. The following images were obtained after injection of diluted gadolinium chelate into glenohumeral joint: fat-saturated T1-weighted spin echo in the coronal, axial, and sagittal-oblique plane; fat-saturated T2-weighted and intermediate-weighted fast spin-echo in the coronal-oblique plane; and T1-weighted spin echo in the sagittal-oblique plane. CS-MRI was performed in the coronal plane using a double-echo fast low-angle shot (FLASH) sequence. SSP tendon changes were classified as normal, tendinosis, and partial and complete tear according to MR arthrography findings. Fatty degeneration was quantified after measurement of signal intensity values within the region of interest (ROI) placed over SSP muscle. Signal intensity (SI) suppression ratio and SI index were calculated with the values obtained. Degrees of fatty degeneration depicted in normal subjects and subjects with rotator cuff injuries were compared. Median (min:max) was used as descriptive values. SI suppression ratio was -3.5% (-15.5:3.03) in normal subjects, whereas it was -13.5% (-28.55:-6.60), -30.7% (-41.5:-20.35), and -43.75% (-62:-24.90) in tendinosis, partial and complete tears, respectively. SI index was 0.75% (-6:11.5) in normal subjects. It was 10% (4.50:27), 26.5% (19.15:35.5), and 41% (23.9:57) in tendinosis, partial and complete tears, respectively. The increase in degree of fatty degeneration parallels the seriousness of tendon pathology. CS-MRI is a useful method for grading fat accumulation within SSP muscle.
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Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD, Francis IR, Herts BR, Israel GM, Krinsky G, Platt JF, Shuman WP, Taylor AJ. Managing Incidental Findings on Abdominal CT: White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2010; 7:754-73. [DOI: 10.1016/j.jacr.2010.06.013] [Citation(s) in RCA: 512] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 06/07/2010] [Indexed: 02/06/2023]
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Magnetic resonance characterization of pheochromocytomas in the abdomen and pelvis: imaging findings in 18 surgically proven cases. J Comput Assist Tomogr 2010; 34:548-53. [PMID: 20657223 DOI: 10.1097/rct.0b013e3181d529f2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the magnetic resonance imaging characteristics of adrenal and extra-adrenal pheochromocytomas in the abdomen and pelvis. METHODS We retrospectively reviewed 18 cases of pathologically proven cases of pheochromocytomas in the abdomen and pelvis. These patients have undergone magnetic resonance imaging evaluation before surgery. The study population included 10 men and 7 women (age range, 19-68 years; mean, 38 years). A consensus review of the magnetic resonance images was performed by 2 blinded expert observers. A qualitative evaluation was completed, and the tumors were classified by anatomical location, shape, T2 signal, contrast enhancement, and signal dropout on chemical shift pulse sequences. RESULTS On T2-weighted images, most lesions demonstrated mild to moderate increased signal intensity (SI) (n = 12), 5 lesions demonstrated a markedly increased SI, and only 1 lesion demonstrated an isointense SI on T2-weighted images.Five lesions demonstrated marked postcontrast enhancement. Three lesions demonstrated moderate enhancement, and 5 lesions demonstrated mild postcontrast enhancement.The pattern of enhancement was variable: 4 salt and pepper, 4 homogeneous, 3 heterogeneous, and 2 target with central necrosis and hemorrhage. None of the lesions contained significant amount of intracellular lipid, as no lesions demonstrated greater than 16.5% signal dropout on out-of-phase compared with in-phase pulse sequences.
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Abstract
OBJECTIVE Adrenal nodules are frequently encountered on current high-resolution imaging, and accurate characterization of such lesions is critical for appropriate patient care. Our article highlights how imaging techniques such as CT densitometry, CT washout characteristics, chemical shift MRI, PET, and PET/CT help characterize most adrenal lesions. We focus on these techniques as well as specifically, because of space constraints, the varied imaging appearances of adrenocortical carcinoma, pheochromocytoma, and lymphoma on these techniques. CONCLUSION The imaging characterization of adrenal lesions has continued to advance over the past decade as new technologies have evolved. CT, MRI, PET, and PET/CT are now established clinical techniques capable of differentiating benign from malignant adrenal lesions.
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97
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Marin D, Husarik DB, Boll DT, Merkle EM. Abdominal magnetic resonance imaging at 3 T: oncological applications. Top Magn Reson Imaging 2010; 21:149-156. [PMID: 21847034 DOI: 10.1097/rmr.0b013e3181e8fb7a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The gain in signal-to-noise ratio at 3 T magnetic resonance (MR) imaging produces many benefits for abdominal imaging applications, including the capability to reduce acquisition times and/or improve spatial resolution for a variety of pulse sequences, the potential for broader application of parallel imaging techniques, and an increased sensitivity to gadolinium-based contrast media. These advances have the potential of improving the accuracy of MR imaging in the detection, staging, treatment planning, and follow-up of patients with abdominal tumors. At the same time, because certain high-field-strength-related drawbacks could not be compensated for, abdominal 3 T MR imaging should be clinically implemented with caution in some patients (eg, patients with massive ascites).
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Affiliation(s)
- Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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Utility of diffusion-weighted MRI in characterization of adrenal lesions. AJR Am J Roentgenol 2010; 194:W179-85. [PMID: 20093571 DOI: 10.2214/ajr.09.2891] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the utility of apparent diffusion coefficient (ADC) values for characterizing adrenal lesions and determine if diffusion-weighted imaging (DWI) can distinguish lipid-rich from lipid-poor adenomas. MATERIALS AND METHODS We retrospectively evaluated 160 adrenal lesions in 156 patients (96 women and 60 men; mean age, 63 years). ADCs and signal intensity (SI) decrease on chemical shift imaging were measured in adrenal lesions with a wide variety of pathologies. Lipid-rich and lipid-poor adenomas were identified by unenhanced CT. The overall predictive power of ADC, SI decrease, and lesion size were determined by receiver operating characteristic (ROC) analysis. Areas under the ROC curve (AUC) were compared for equivalence using nonparametric methods. Sensitivity, specificity, and positive and negative predictive values were calculated. Correlation coefficients were used to assess ADCs versus percentage SI decrease and ADCs versus CT attenuation. RESULTS ADCs of adrenal malignancies (median, 1.67 x 10(-3) mm(2)/s; interquartile range, 1.41-1.84 x 10(-3) mm(2)/s) were not different compared with those of benign lesions (1.61 x 10(-3) mm(2)/s; 1.27-1.96 x 10(-3) mm(2)/s; p > 0.05). Cysts (2.93 x 10(-3) mm(2)/s; 2.70-3.09 x 10(-3) mm(2)/s) showed higher ADCs than the remaining adrenal lesions (p < 0.05). The median ADCs of lipid-rich adenomas did not differ from those of lipid-poor ones (p > 0.05). The CT attenuation had no negative or positive correlation with the ADCs of adrenal adenomas (r = -0.05, p = 0.97). CONCLUSION Unlike lesion size and percentage decrease in SI, the ADCs were not useful in distinguishing benign from malignant adrenal lesions. Lipid-poor adenomas could not be distinguished from lipid-rich adenomas and all other nonfatty lesions of the adrenal gland with DWI.
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100
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Marin D, Soher BJ, Dale BM, Boll DT, Youngblood RS, Merkle EM. Characterization of adrenal lesions: comparison of 2D and 3D dual gradient-echo MR imaging at 3 T--preliminary results. Radiology 2010; 254:179-87. [PMID: 20032151 DOI: 10.1148/radiol.09090486] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To retrospectively compare a two-dimensional (2D) and a three-dimensional (3D) technique for in-phase (IP) and opposed-phase (OP) single-breath-hold 3-T magnetic resonance (MR) imaging in the characterization of adrenal lesions, with histopathologic confirmation, computed tomographic findings, or imaging follow-up for a minimum of 6 months used as the reference standard. MATERIALS AND METHODS This retrospective HIPAA-compliant study was approved by institutional review board, and a waiver of informed consent was obtained. Thirty-four patients (mean age, 57 years) with 37 adrenal lesions underwent 3-T adrenal MR imaging with both 2D and 3D single-breath-hold dual gradient-echo (GRE) MR sequences. Signal intensity (SI) index and adrenal-to-spleen, adrenal-to-liver, and adrenal-to-muscle SI ratios for each lesion were compared between the two techniques by using repeated-measures analysis of variance. The area under the receiver operating characteristic curve (AUC) for each evaluation method was determined, with retrospective selection of suggested thresholds. RESULTS For the 2D and 3D techniques, the mean SI index and SI ratios were significantly different between adenomas and nonadenomas (P < .05), except for the adrenal-to-liver SI ratio with the 2D technique and the adrenal-to-muscle SI ratio with both techniques. For all evaluation methods, the AUCs were higher, although not statistically significant, for the 3D technique. The two techniques exploited different suggested thresholds for discriminating adenomas from nonadenomas. CONCLUSION Adrenal adenomas can be readily differentiated from nonadenomas at 3-T MR imaging with either a 2D or 3D single-breath-hold dual GRE MR technique. Depending on the acquisition technique, different suggested thresholds need to be selected for various evaluation methods.
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Affiliation(s)
- Daniele Marin
- Department of Radiology, Duke University Medical Center, Duke North-Room 1417, Erwin Rd, Durham, NC 27710, USA
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