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Navin PJ, Moynagh MR. Optimal and novel imaging of the adrenal glands. Curr Opin Endocrinol Diabetes Obes 2022; 29:253-262. [PMID: 35621177 DOI: 10.1097/med.0000000000000730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Adrenal imaging forms an important role in the workup of adrenal masses. The purpose of this review is to briefly review the traditional role of imaging in adrenal diseases and highlight the most recent research and new applications aimed to improve diagnostic accuracy. RECENT FINDINGS The current review will focus on new applications of computed tomography (CT), MRI and PET/CT imaging, addressing the implications of artificial intelligence and radiomics in progressing diagnostic accuracy. SUMMARY The new applications of adrenal imaging are improving diagnostic accuracy and expanding the role of imaging, particularly with novel PET radiotracers and the use of artificial intelligence.
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Affiliation(s)
- Patrick J Navin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Martins VG, Torres CVS, Mermejo LM, Tucci Jr. S, Molina CAF, Elias Jr. J, Muglia VF. Frequency of lipid-poor adrenal adenomas in magnetic resonance imaging examinations of the abdomen. Radiol Bras 2022; 55:145-150. [PMID: 35795608 PMCID: PMC9254705 DOI: 10.1590/0100-3984.2021.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To estimate the frequency of lipid-poor adenomas (LPAs) in magnetic resonance
imaging (MRI) examinations. Materials and Methods We retrospectively investigated adrenal lesions on MRI examinations performed
in a total of 2,014 patients between January 2016 and December 2017. After
exclusions, the sample comprised 69 patients with 74 proven adenomas. Two
readers (reader 1 and reader 2) evaluated lesion size, laterality,
homogeneity, signal drop on out-of-phase (OP) images, and the signal
intensity index (SII). An LPA was defined as a lesion with no signal drop on
OP images and an SII < 16.5%. For 68 lesions, computed tomography (CT)
scans (obtained within one year of the MRI) were also reviewed. Results Of the 69 patients evaluated, 42 (60.8%) were women and 27 (39.2%) were men.
The mean age was 59.2 ± 14.1 years. Among the 74 confirmed adrenal
adenomas evaluated, the mean lesion size was 18.5 ± 7.7 mm (range,
7.0-56.0 mm) for reader 1 and 21.0 ± 8.3 mm (range, 7.0-55.0 mm) for
reader 2 (p = 0.055). On the basis of the signal drop in OP
MRI sequences, both readers identified five (6.8%) of the 74 lesions as
being LPAs. When determined on the basis of the SII, that frequency was
three (4.0%) for reader 1 and four (5.4%) for reader 2. On CT, 21 (30.8%) of
the 68 lesions evaluated were classified as LPAs. Conclusion The prevalence of LPA was significantly lower on MRI than on CT. That
prevalence tends to be even lower when the definition of LPA relies on a
quantitative analysis rather than on a qualitative (visual) analysis.
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Stanzione A, Verde F, Galatola R, Romeo V, Liuzzi R, Mainenti PP, Aprea G, Klain M, Guadagno E, Del Basso De Caro M, Maurea S. Qualitative Heterogeneous Signal Drop on Chemical Shift (CS) MR Imaging: Correlative Quantitative Analysis between CS Signal Intensity Index and Contrast Washout Parameters Using T1-Weighted Sequences. Tomography 2021; 7:961-971. [PMID: 34941651 PMCID: PMC8709007 DOI: 10.3390/tomography7040079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to calculate MRI quantitative parameters extracted from chemical-shift (CS) and dynamic contrast-enhanced (DCE) T1-weighted (T1-WS) images of adrenal lesions (AL) with qualitative heterogeneous signal drop on CS T1-WS and compare them to those of AL with homogeneous or no signal drop on CS T1-WS. On 3 T MRI, 65 patients with a total of 72 AL were studied. CS images were qualitatively assessed for grouping AL as showing homogeneous (Group 1, n = 19), heterogeneous (Group 2, n = 23), and no (Group 3, n = 30) signal drop. Histopathology or follow-up data served as reference standard to classify AL. ROIs were drawn both on CS and DCE images to obtain adrenal CS signal intensity index (ASII), absolute (AWO), and relative washout (RWO) values. Quantitative parameters (QP) were compared with ANOVA analysis and post hoc Dunn’s test. The performance of QP to classify AL was assessed with receiver operating characteristic analysis. CS ASII values were significantly different among the three groups (p < 0.001) with median values of 71%, 53%, and 3%, respectively. AWO/RWO values were similar in Groups 1 (adenomas) and 2 (benign AL) but significantly (p < 0.001) lower in Group 3 (20 benign AL and 10 malignant AL). With cut-offs, respectively, of 60% (Group 1 vs. 2), 20% (Group 2 vs. 3), and 37% (Group 1 vs. 3), CS ASII showed areas under the curve of 0.85, 0.96, and 0.93 for the classification of AL, overall higher than AWO/RWO. In conclusion, AL with qualitative heterogeneous signal drop at CS represent benign AL with QP by DCE sequence similar to those of AL with homogeneous signal drop at CS, but different to those of AL with no signal drop at CS; ASII seems to be the only quantitative parameter able to differentiate AL among the three different groups.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (F.V.); (V.R.); (M.K.); (E.G.); (M.D.B.D.C.); (S.M.)
| | - Francesco Verde
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (F.V.); (V.R.); (M.K.); (E.G.); (M.D.B.D.C.); (S.M.)
| | - Roberta Galatola
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (F.V.); (V.R.); (M.K.); (E.G.); (M.D.B.D.C.); (S.M.)
- Correspondence: ; Tel.: +39-0817463560; Fax: +39-0815457081
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (F.V.); (V.R.); (M.K.); (E.G.); (M.D.B.D.C.); (S.M.)
| | - Raffaele Liuzzi
- Institute of Biostructures and Bioimaging, The National Research Council (CNR), 80131 Naples, Italy; (R.L.); (P.P.M.)
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging, The National Research Council (CNR), 80131 Naples, Italy; (R.L.); (P.P.M.)
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (F.V.); (V.R.); (M.K.); (E.G.); (M.D.B.D.C.); (S.M.)
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (F.V.); (V.R.); (M.K.); (E.G.); (M.D.B.D.C.); (S.M.)
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (F.V.); (V.R.); (M.K.); (E.G.); (M.D.B.D.C.); (S.M.)
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (A.S.); (F.V.); (V.R.); (M.K.); (E.G.); (M.D.B.D.C.); (S.M.)
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Mody RN, Remer EM, Nikolaidis P, Khatri G, Dogra VS, Ganeshan D, Gore JL, Gupta RT, Heilbrun ME, Lyshchik A, Mayo-Smith WW, Purysko AS, Savage SJ, Smith AD, Wang ZJ, Wolfman DJ, Wong-You-Cheong JJ, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Adrenal Mass Evaluation: 2021 Update. J Am Coll Radiol 2021; 18:S251-S267. [PMID: 34794587 DOI: 10.1016/j.jacr.2021.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/24/2022]
Abstract
The appropriate evaluation of adrenal masses is strongly dependent on the clinical circumstances in which it is discovered. Adrenal incidentalomas are masses that are discovered on imaging studies that have been obtained for purposes other than adrenal disease. Although the vast majority of adrenal incidentalomas are benign, further radiological and biochemical evaluation of these lesions is important to arrive at a specific diagnosis. Patients with a history of malignancy or symptoms of excess hormone require different imaging evaluations than patients with incidentalomas. This document reviews imaging approaches to adrenal masses and the various modalities utilized in evaluation of adrenal lesions. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Rekha N Mody
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio.
| | - Erick M Remer
- Cleveland Clinic, Cleveland, Ohio; Chair, Gaps And Harmonization Committee, ACR Appropriateness Criteria; Portfolio Director, Society of Abdominal Radiology; Chair, Section Urinary Imaging, Scientific Program Committee, American Roentgen Ray Society
| | - Paul Nikolaidis
- Panel Chair, Northwestern University, Chicago, Illinois; Vice-Chair, Operations - Diagnostic Imaging, Northwestern University
| | - Gaurav Khatri
- Panel Vice-Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York; and Chair, Penile Performance Consensus Statement
| | | | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina; and Chair, ACR Meetings Sub-committee, Commission on Publications and Lifelong Learning
| | - Marta E Heilbrun
- Vice-Chair for Quality, Emory Radiology Department, Emory University School of Medicine, Atlanta, Georgia; and RSNA Structured Reporting Subcommittee Chair
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Board Member, ICUS
| | | | | | - Stephen J Savage
- Medical University of South Carolina, Charleston, South Carolina; American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California
| | - Darcy J Wolfman
- Clinical Director, Ultrasound Hopkins NCR; and Committee Chair, ACR US Accreditation Johns Hopkins University School of Medicine, Washington, District of Columbia
| | - Jade J Wong-You-Cheong
- University of Maryland School of Medicine, Baltimore, Maryland; and Vice-Chair Quality and Safety, Diagnostic Radiology, University of Maryland Medical Center
| | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mark E Lockhart
- Speciatly Chair, University of Alabama at Birmingham, Birmingham, Alabama; Chair, Radiology Departmental Appointments, Promotions, and Tenure Committee, and Departmental Chief, Genitourinary Imaging, University of Alabama at Birmingham, Birmingham, Alabama; Chair, ACR Appropriateness Committee; Chair, Society of Radiologists in Ultrasound, Annual Meeting Program Committee; and Chair, Research Committee of AIUM Future Fund
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5
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Zheng Y, Liu X, Zhong Y, Lv F, Yang H. A Preliminary Study for Distinguish Hormone-Secreting Functional Adrenocortical Adenoma Subtypes Using Multiparametric CT Radiomics-Based Machine Learning Model and Nomogram. Front Oncol 2020; 10:570502. [PMID: 33117700 PMCID: PMC7552922 DOI: 10.3389/fonc.2020.570502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose: To explore the application value of multiparametric computed tomography (CT) radiomics in non-invasive differentiation between aldosterone-producing and cortisol-producing functional adrenocortical adenomas. Methods: This retrospective review analyzed 83 patients including 41 patients with aldosterone-producing adenoma and 42 patients with cortisol-producing adenoma. The quantitative radiomics features were extracted from the complete unenhanced, arterial, and venous phase CT images. A comparative study of several frequently used machine learning models (linear discriminant analysis, logistic regression, random forest, and support vector machine) combined with different feature selection methods was implemented in order to determine which was most advantageous for differential diagnosis using radiomics features. Then, the integrated model using the combination of radiomic signature and clinic-radiological features was built, and the associated calibration curve was also presented. The diagnostic performance of these models was estimated and compared using the area under the receiver operating characteristic (ROC) curve (AUC). Result: In the radiomics-based machine learning model, logistic regression model with LASSO (least absolute shrinkage and selection operator) outperformed the other models, which yielded a sensitivity of 0.935, a specificity of 0.823, and an accuracy of 0.887 [AUC = 0.882, 95% confidence interval (CI) = 0.819-0.945]. Moreover, the nomogram representing the integrated model achieved good discrimination performances, which yielded a sensitivity of 0.915, a specificity of 0.928, and an accuracy of 0.922 (AUC = 0.902, 95% CI = 0.822-0.982), and it was better than that of the radiomics model alone. Conclusion: This study found that the combination of multiparametric radiomics signature and clinic-radiological features can non-invasively differentiate the subtypes of hormone-secreting functional adrenocortical adenomas, which may have good potential for facilitating the diagnosis and treatment in clinical practice.
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Affiliation(s)
- Yineng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Zhong
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haitao Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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6
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Preresection Radiologic Assessment and Imaging Features of 156 Pathologically Proven Adrenal Adenomas. J Comput Assist Tomogr 2020; 44:419-425. [PMID: 32345808 DOI: 10.1097/rct.0000000000001018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of the study were to assess the typical and atypical radiologic features of pathologically proven adrenal adenomas and to determine the relationship between the radiologic and histopathologic classification. METHODS We retrospectively studied 156 pathologically proven adrenal adenomas in 154 patients from our institutional databases who have computed tomography (CT) and/or magnetic resonance imaging (MRI) examinations before intervention. We determined the histopathologic diagnosis (typical or atypical) using Weiss scoring and classified the adenomas radiologically into typical, atypical, or indeterminate based on lesion size, precontrast CT attenuation, absolute percentage washout, calcification, and necrosis. The κ statistic was used to assess the agreement between radiologists. The Fisher exact test was used to compare the radiologic and pathological classifications. RESULTS In consensus, there were 83 typical, 42 atypical, and 31 indeterminate adrenal lesions. Logistic regression model showed that radiologically atypical adenoma was significantly associated with larger size, lobulated shape, higher unenhanced CT attenuation, heterogeneous appearance, nonfunctioning status, absolute percentage washout of less than 60%, and a signal intensity index of less than 16.5%.Pathologically, 147 adenomas were pathologically typical (Weiss 0), and 9 adenomas were pathologically atypical (Weiss 1-2). Radiologically, there was substantial agreement between both readers, with Cohen κ at 0.71. Approximately 98% of radiologically typical adenomas were pathologically typical. Only 17% of radiologically atypical adenomas were pathologically atypical. All radiologically indeterminate adenomas were pathologically typical. However, some of the radiologically indeterminate and typical adenomas still had an atypical component on pathologic analysis, such as necrosis, nuclear atypia, or oncocytic features. CONCLUSIONS Radiologically atypical lesion was significantly associated with larger size and higher unenhanced CT attenuation. Approximately 27% of the cases demonstrated atypical features on imaging. Most radiologically atypical adrenal adenomas are pathologically typical.
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Abstract
Due to the widespread use of imaging, incidental adrenal masses are commonly encountered. A number of pitfalls can result in misdiagnosis of these lesions, including inappropriate choice of imaging technique, presence of pseudolesions, and overlap of imaging features of different adrenal lesions. This article explores the potential pitfalls in imaging of the adrenal glands, on computed tomography and magnetic resonance imaging, that can lead to misinterpretation. Clues to correct diagnoses are provided to evade potential misinterpretation.
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d'Amuri FV, Maestroni U, Pagnini F, Russo U, Melani E, Ziglioli F, Negrini G, Cella S, Cappabianca S, Reginelli A, Barile A, De Filippo M. Magnetic resonance imaging of adrenal gland: state of the art. Gland Surg 2019; 8:S223-S232. [PMID: 31559189 DOI: 10.21037/gs.2019.06.02] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Detection of adrenal lesions, because of the widespread use of imaging and especially high-resolution imaging procedures, is increased. Because of the importance to characterize those findings, magnetic resonance imaging (MRI), in particular chemical shift imaging (CSI), is useful to distinguish whether a lesion is benignant or malignant and to avoid further diagnostic or surgical procedures. It represents the first choice of imaging in patient like children or pregnant women, and a valid complement to other imaging techniques like CT or PET/CT. In this review we analyze the role and characteristic of MRI and the imaging features of most common benignant (adenoma, hyperplasia, pheochromocytoma, hemorrhage, cyst, myelolipoma, teratoma, ganglioneuroma, cystic lymphangioma, hemangioma) and malignant [neuroblastoma, adrenocortical carcinoma (ACC), metastases, lymphoma] adrenal lesions.
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Affiliation(s)
- Fabiano Vito d'Amuri
- Department of Medicine and Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Parma, Italy
| | - Umberto Maestroni
- Department of Medicine and Surgery, Unit of Urology, Maggiore Hospital, Parma, Italy
| | - Francesco Pagnini
- Department of Medicine and Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Parma, Italy
| | - Umberto Russo
- Department of Medicine and Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Parma, Italy
| | - Elisa Melani
- Department of Medicine and Surgery, Unit of Urology, Maggiore Hospital, Parma, Italy
| | - Francesco Ziglioli
- Department of Medicine and Surgery, Unit of Urology, Maggiore Hospital, Parma, Italy
| | - Giulio Negrini
- Department of Medicine and Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Parma, Italy
| | - Simone Cella
- Department of Medicine and Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Parma, Italy
| | - Salvatore Cappabianca
- Department of Radiology and Radiotherapy, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Alfonso Reginelli
- Department of Radiology and Radiotherapy, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Ospedale San Salvatore, L'Aquila, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Parma, Italy
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Update on Gadolinium-Based Contrast Agent-Enhanced Imaging in the Genitourinary System. AJR Am J Roentgenol 2019; 212:1223-1233. [PMID: 30973785 DOI: 10.2214/ajr.19.21137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE. The purpose of this article is to review gadolinium-based contrast agent (GBCA)-enhanced MRI applications in the genitourinary system. CONCLUSION. Nephrogenic systemic fibrosis is rare or nonexistent with standard dosing of group II GBCAs. Gadolinium retention, cost, and examination times are emerging considerations affecting GBCA use. GBCA is unnecessary to diagnose adrenal adenomas, simple cysts, and some Bosniak category II cysts; however, it is required to determine solid or septal renal mass enhancement. Biparametric prostate MRI requires high-quality and reproducible DWI; therefore, dynamic contrast-enhanced MRI remains valuable in selected prostate MRI examinations.
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The role of dynamic post-contrast T1-w MRI sequence to characterize lipid-rich and lipid-poor adrenal adenomas in comparison to non-adenoma lesions: preliminary results. Abdom Radiol (NY) 2018; 43:2119-2129. [PMID: 29214448 DOI: 10.1007/s00261-017-1429-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of the article is to compare the features of wash-out (WO) parameters between lipid-rich and lipid-poor adrenal adenomas as well as with a group of non-adenoma adrenal lesions. METHODS 46 patients (36 F and 10 M, median age 58 years) with unilateral adrenal lesions (35 adenomas, 7 pheochromocytomas, 1 carcinoma, and 3 metastases) were prospectively evaluated; adrenal lesions were divided into adenomas (Group 1) and non-adenomas (Group 2). MR imaging was performed with a 3-Tesla scanner using pre- and post-contrast dedicated sequences. On the basis of the evaluation of qualitative chemical-shift (CS) signal intensity (SI) loss, adrenal adenomas were, respectively, divided in Group 1A (n = 25) as lipid-rich and Group 1B (n = 10) as lipid-poor; non-adenoma adrenal lesions were grouped in Group 2 (n = 11). The following parameters were evaluated: size (mm), CS SI index (%), early (5 min), and delayed (10 min) Relative (R) and Absolute (A) WO values (%). RESULTS The comparison of AWO and RWO showed significant (p ≤ 0.05) differences between Group 1A and Groups 1B and 2, both using 5- and 10-min images for calculation; conversely, no differences in these dynamic parameters were found between Group 1B and 2; AWO and RWO values were significantly lower in adrenal lesions of Groups 1B and 2 compared to Group 1A, both using 5- and 10-min images for calculation. CONCLUSIONS The quantitative evaluation of WO parameters could not be used to characterize lipid-poor adrenal adenomas for which alternative imaging modalities are required.
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Scialpi M, D'Andrea A, Rondoni V, Orlandi E, Bernardini S, Napoletano M, Pusiol T. Lipid-poor adrenal adenoma versus metastasis in lung cancer: Diagnosis by "comparative enhancement" at multiphasic MR imaging. Lung India 2018; 35:364-366. [PMID: 29970786 PMCID: PMC6034370 DOI: 10.4103/lungindia.lungindia_6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Michele Scialpi
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, S.M. Della Misericordia Hospital, Perugia, Italy
| | - Alfredo D'Andrea
- Department of Sperimental Medicine, Magrassi Lanzara, Luigi Vanvitelli, Second University of Naples, Naples, Italy
| | - Valeria Rondoni
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, S.M. Della Misericordia Hospital, Perugia, Italy
| | - Emanuele Orlandi
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, S.M. Della Misericordia Hospital, Perugia, Italy
| | - Serena Bernardini
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, S.M. Della Misericordia Hospital, Perugia, Italy
| | - Maria Napoletano
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, S.M. Della Misericordia Hospital, Perugia, Italy
| | - Teresa Pusiol
- Provincial Health Care, Institute of Anatomic Pathology, Rovereto Hospital, Rovereto, Italy
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12
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Canellas R, Lo G, Bhowmik S, Ferrone C, Sahani D. Pancreatic neuroendocrine tumor: Correlations between MRI features, tumor biology, and clinical outcome after surgery. J Magn Reson Imaging 2017; 47:425-432. [PMID: 28480609 DOI: 10.1002/jmri.25756] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/19/2017] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To assess which magnetic resonance imaging (MRI) features are associated with pNETs (pancreatic neuroendocrine tumors) grade based on the WHO classification, as well as identify MRI features related to disease progression after surgery. MATERIALS AND METHODS In this Institutional Review Board (IRB)-approved study, 1.5T and 3.0T MRI scans of 80 patients with surgically verified pNETs were assessed. The images were evaluated for tumor location; size; pattern; predominant signal intensity on precontrast T1 - and T2 -weighted images, as well as on postcontrast arterial and portal venous phase T1 -weighted sequences; presence of pancreatic duct dilatation; pancreatic atrophy; restricted diffusion; vascular involvement by the tumor; extrapancreatic tumor spread; and synchronous liver metastases. Tumors were graded based on the WHO classification and patients were followed-up with computed tomography (CT) or MRI after surgical resection. Data were analyzed with Student's t and chi-square tests, logistic regression, and Kaplan-Meier curves. RESULTS The MRI features that were associated with aggressive tumors were: size >2.0 cm (odds ratio [OR] = 4.8, P = 0.002), "T2 nonbright lesions" on T2 -weighted images (OR = 4.6, P = 0.008), presence of pancreatic ductal dilatation (OR = 4.9, P = 0.024), and restricted diffusion within the lesion (OR = 4.9, P = 0.013). Differences in progression-free survival distribution were found for patients whose pNETs were associated with the following MRI features: size >2.0 cm (χ2 (1) = 6.0, P = 0.014), "nonbright lesions" on T2 -weighted images (χ2 (1) = 6.8, P = 0.009), and presence of pancreatic duct dilatation (χ2 (1) = 10.9, P = 0.001). CONCLUSION MRI features can be used to assess pNETs aggressiveness and identify patients at risk for early disease progression after surgical resection. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:425-432.
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Affiliation(s)
- Rodrigo Canellas
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Grace Lo
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sreejita Bhowmik
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cristina Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dushyant Sahani
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA
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13
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Abstract
OBJECTIVE The objective of this article is to review the current role of CT and MRI for the characterization of adrenal nodules. CONCLUSION Unenhanced CT and chemical-shift MRI have high specificity for lipid-rich adenomas. Dual-energy CT provides comparable to slightly lower sensitivity for the diagnosis of lipid-rich adenomas but may improve characterization of lipid-poor adenomas. Nonadenomas containing intracellular lipid pose an imaging challenge; however, nonadenomas that contain lipid may be potentially diagnosed using other imaging features. Multiphase adrenal washout CT can be used to differentiate lipid-poor adenomas from metastases but is limited for the diagnosis of hypervascular malignancies and pheochromocytoma.
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Wang X, Li K, Sun H, Zhao J, Zheng L, Zhang Z, Bai R, Zhang G. Differentiation between adrenal adenomas and nonadenomas using dynamic contrast-enhanced computed tomography. Onco Targets Ther 2016; 9:6809-6817. [PMID: 27843331 PMCID: PMC5098566 DOI: 10.2147/ott.s112003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study was performed to evaluate the findings including the time density curve (TD curve), the relative percentage of enhancement washout (Washr) and the absolute percentage of enhancement washout (Washa) at dynamic contrast-enhanced computed tomography (DCE-CT) in 70 patients with 79 adrenal masses (including 44 adenomas and 35 nonadenomas) confirmed histopathologically and/or clinically. The results demonstrated that the TD curves of adrenal masses were classified into 5 types, and the type distribution of the TD curves was significantly different between adenomas and nonadenomas. Types A and C were characteristic of adenomas, whereas types B, D and E were features of nonadenomas. The sensitivity, specificity and accuracy for the diagnosis of adenoma based on the TD curves were 93%, 80% and 87%, respectively. Furthermore, when myelolipomas were excluded, the specificity and accuracy for adenoma were 90% and 92%, respectively. The Washr and the Washa values for the adenomas were higher than those for the nonadenomas. The diagnostic efficiency for adenoma was highest at 7-min delay time at DCE-CT; Washr was more efficient than Washa. Washr ≥34% and Washa ≥43% were both suggestive of adenomas and, on the contrary, suspicious of nonadenomas. The sensitivity, specificity and accuracy for the diagnosis of adenoma were 84%, 77% and 81%, respectively. When myelolipomas were precluded, the diagnostic specificity and accuracy were 87% and 85%, respectively. Therefore, DCE-CT aids in characterization of adrenal tumors, especially for lipid-poor adenomas which can be correctly categorized on the basis of TD curve combined with the percentage of enhancement washout.
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Affiliation(s)
- Xifu Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai
| | - Kangan Li
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai
| | - Haoran Sun
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Jinglong Zhao
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai
| | - Linfeng Zheng
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Renju Bai
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Guixiang Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai
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Grajo JR, Paspulati RM, Sahani DV, Kambadakone A. Multiple Endocrine Neoplasia Syndromes: A Comprehensive Imaging Review. Radiol Clin North Am 2016; 54:441-51. [PMID: 27153782 DOI: 10.1016/j.rcl.2015.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
MEN1, MEN2, and MEN4 comprise a series of familial disorders involving the simultaneous occurrence of tumors in more than one endocrine organ, collectively known as multiple endocrine neoplasia. Patients with this family of disorders develop tumors of the parathyroid gland, pancreas, pituitary gland, adrenal gland, and thyroid gland, along with miscellaneous neuroendocrine tumors of the respiratory and gastrointestinal tracts. Although some patients undergo early prophylactic surgical management, particularly in the setting of familial medullary thyroid carcinoma, many develop tumors later in life. These tumors are often discovered at imaging for screening purposes. Recognition of the imaging features of the known tumors is important for appropriate patient management.
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Affiliation(s)
- Joseph R Grajo
- Division of Abdominal Imaging, Department of Radiology, Shands Medical Center, University of Florida College of Medicine, PO Box 100374, Gainesville, FL 32610, USA.
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Dushyant V Sahani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114, USA
| | - Avinash Kambadakone
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114, USA
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