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Nagayama Y, Hayashi H, Taguchi N, Yoshida R, Harai R, Kidoh M, Oda S, Nakaura T, Hirai T. Diagnostic performance of hepatic CT and chemical-shift MRI to discriminate lipid-poor adrenal adenomas from hepatocellular carcinoma metastases. Abdom Radiol (NY) 2024; 49:1626-1637. [PMID: 38456897 DOI: 10.1007/s00261-024-04228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To evaluate the diagnostic performance of multiphase hepatic CT parameters (non-contrast attenuation, absolute and relative washout ratios [APW and RPW, respectively], and relative enhancement ratio [RER]) and chemical-shift MRI (CS-MRI) for discriminating lipid-poor adrenal adenomas (with non-contrast CT attenuation > 10 HU) from metastases in patients with hepatocellular carcinoma (HCC). METHODS This retrospective study included HCC patients with lipid-poor adrenal lesions who underwent multiphase hepatic CT between January 2010 and December 2021. For each adrenal lesion, non-contrast attenuation, APW, RPW, RER, and signal-intensity index (SI-index) were measured. Each parameter was compared between adenomas and metastases. The area under the receiver operating characteristic curves (AUCs) and sensitivities to achieve 100% specificity for adenoma diagnoses were determined. RESULTS 104 HCC patients (78 men; mean age, 71.8 ± 9.6 years) with 63 adenomas and 48 metastases were identified; CS-MRI was performed in 66 patients with 49 adenomas and 21 metastases within one year of CT. Lipid-poor adenomas showed lower non-contrast attenuation (22.9 ± 7.1 vs. 37.9 ± 9.4 HU) and higher APW (40.5% ± 12.8% vs. 23.7% ± 17.4%), RPW (30.0% ± 10.2% vs. 12.4% ± 9.6%), RER (329% ± 152% vs. 111% ± 43.0%), and SI-index (43.3 ± 20.7 vs. 10.8 ± 13.4) than HCC metastases (all p < .001). AUC for non-contrast attenuation, APW, RPW, RER, and SI-index were 0.894, 0.786, 0.904, 0.969, and 0.902, respectively. The sensitivities to achieve 100% specificity were 7.9%, 25.4%, 30.2%, 63.5%, and 24.5%, respectively. Combined RER and APW achieved the highest sensitivity of 73.0%. CONCLUSION Multiphase hepatic CT allows for better discrimination between lipid-poor adrenal adenomas and metastases relative to CS-MRI, especially when combined with RER and washout parameters.
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Affiliation(s)
- Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Hidetaka Hayashi
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Narumi Taguchi
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Ryuya Yoshida
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Ryota Harai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Kocic S, Vukomanovic V, Djukic A, Saponjski J, Saponjski D, Aleksic V, Ignjatovic V, Vuleta Nedic K, Markovic V, Vojinovic R. Can MDCT Enhancement Patterns Be Helpful in Differentiating Secretory from Non-Functional Adrenal Adenoma? MEDICINA (KAUNAS, LITHUANIA) 2023; 60:72. [PMID: 38256333 PMCID: PMC10819253 DOI: 10.3390/medicina60010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Primary adrenal tumors (AT) are a heterogeneous group of neoplasms due to their functional heterogeneity, which results in the diverse clinical presentation of these tumors. The purpose of this study was to examine cross-sectional imaging characteristics using multi-detector computed tomography (MDCT) to provide insight into the lesion characterization and functional status of these tumors. The radionuclide imaging using Technetium-99m radiolabeled hydrazinonicotinylacid-d-phenylalanyl1-tyrosine3-octreotide (99mTc-HYNIC-TOC), was also used in the diagnostic evaluation of these tumors. Materials and Methods: This cross-sectional study included 50 patients with confirmed diagnoses of AT (21 hormone-secreting and 29 non-functional) at the University Clinical Center, Kragujevac, Serbia, during the 2019-2022 year period. The morphological and dynamic characteristics using MDCT were performed, using qualitative, semi-quantitative, and quantitative analysis. Absolute washout (APW) and relative washout (RPW) values were also calculated. A semi-quantitative analysis of all visual findings with 99mTc-HYNIC-TOC was performed to compare the tumor to non-tumor tracer uptake. Results: A statistically significant difference was found in the MDCT values in the native phase (p < 0.05), the venous phase (p < 0.05), and the delayed phase (p < 0.001) to detect the existence of adrenal tumors. Most of these functional adrenocortical lesions (n = 44) can be differentiated using the delayed phase (p < 0.05), absolute percentage washout (APW) (p < 0.05), and relative percentage washout (RPW) (p < 0.001). Furthermore, 99mTc-HYNIC-TOC could have a high diagnostic yield to detect adrenal tumor existence (p < 0.001). There is a positive correlation between radionuclide imaging scan and APW to detect all AT (p < 0.01) and adrenocortical adenomas as well (p < 0.01). Conclusions: The results can be very helpful in a diagnostic algorithm to quickly and precisely diagnose the expansive processes of the adrenal glands, as well as to learn about the advantages and limitations of the mentioned imaging modalities.
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Affiliation(s)
- Svetlana Kocic
- Department of Radiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia;
| | - Vladimir Vukomanovic
- Department of Nuclear Medicine, Faculty of Medical Science, University of Kragujevac, 34000 Kragujevac, Serbia; (V.I.); (K.V.N.)
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (A.D.); (V.M.); (R.V.)
| | - Aleksandar Djukic
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (A.D.); (V.M.); (R.V.)
- Department of Pathophysiology, Faculty of Medical Science, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Jovica Saponjski
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (J.S.); (D.S.)
- University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dusan Saponjski
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (J.S.); (D.S.)
- University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Vuk Aleksic
- Department of Neurosurgery, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia;
| | - Vesna Ignjatovic
- Department of Nuclear Medicine, Faculty of Medical Science, University of Kragujevac, 34000 Kragujevac, Serbia; (V.I.); (K.V.N.)
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (A.D.); (V.M.); (R.V.)
| | - Katarina Vuleta Nedic
- Department of Nuclear Medicine, Faculty of Medical Science, University of Kragujevac, 34000 Kragujevac, Serbia; (V.I.); (K.V.N.)
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (A.D.); (V.M.); (R.V.)
| | - Vladan Markovic
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (A.D.); (V.M.); (R.V.)
- Department of Radiology, Faculty of Medical Science, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Radisa Vojinovic
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (A.D.); (V.M.); (R.V.)
- Department of Radiology, Faculty of Medical Science, University of Kragujevac, 34000 Kragujevac, Serbia
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Greenish D, Evans CJ, Khine CK, Rodrigues JCL. The thymus: what's normal and what's not? Problem-solving with MRI. Clin Radiol 2023; 78:885-894. [PMID: 37709611 DOI: 10.1016/j.crad.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/16/2023]
Abstract
Anterior mediastinal masses can be difficult to characterise on computed tomography (CT) due to the wide spectrum of normal appearances of thymic tissue as well as the challenge of differentiating between benign and malignant pathologies. Additionally, attenuation of cystic mediastinal lesions can be misinterpreted on CT due to varying attenuation values. Anecdotally, non-vascular magnetic resonance imaging (MRI) of the thorax is underutilised across radiology departments in the UK, but has been shown to improve diagnostic certainty and reduce unnecessary surgical intervention. T2-weighted MRI is useful in confirming the cystic nature of lesions, whereas chemical shift techniques can be utilised to document the presence of macroscopic and intra-cellular fat and thus help distinguish between benign and malignant pathologies. In this review article, we present a practical approach to using MRI for the characterisation of anterior mediastinal lesions based on our clinical experience in a UK district general hospital.
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Affiliation(s)
- D Greenish
- Department of Radiology, Royal United Hospital, Combe Park, Bath BA13NG, UK
| | - C J Evans
- Department of Radiology, Royal United Hospital, Combe Park, Bath BA13NG, UK
| | - C K Khine
- Department of Radiology, Royal United Hospital, Combe Park, Bath BA13NG, UK
| | - J C L Rodrigues
- Department of Radiology, Royal United Hospital, Combe Park, Bath BA13NG, UK; Department of Health, University of Bath, Bath, UK.
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Gabiache G, Zadro C, Rozenblum L, Vezzosi D, Mouly C, Thoulouzan M, Guimbaud R, Otal P, Dierickx L, Rousseau H, Trepanier C, Dercle L, Mokrane FZ. Image-Guided Precision Medicine in the Diagnosis and Treatment of Pheochromocytomas and Paragangliomas. Cancers (Basel) 2023; 15:4666. [PMID: 37760633 PMCID: PMC10526298 DOI: 10.3390/cancers15184666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
In this comprehensive review, we aimed to discuss the current state-of-the-art medical imaging for pheochromocytomas and paragangliomas (PPGLs) diagnosis and treatment. Despite major medical improvements, PPGLs, as with other neuroendocrine tumors (NETs), leave clinicians facing several challenges; their inherent particularities and their diagnosis and treatment pose several challenges for clinicians due to their inherent complexity, and they require management by multidisciplinary teams. The conventional concepts of medical imaging are currently undergoing a paradigm shift, thanks to developments in radiomic and metabolic imaging. However, despite active research, clinical relevance of these new parameters remains unclear, and further multicentric studies are needed in order to validate and increase widespread use and integration in clinical routine. Use of AI in PPGLs may detect changes in tumor phenotype that precede classical medical imaging biomarkers, such as shape, texture, and size. Since PPGLs are rare, slow-growing, and heterogeneous, multicentric collaboration will be necessary to have enough data in order to develop new PPGL biomarkers. In this nonsystematic review, our aim is to present an exhaustive pedagogical tool based on real-world cases, dedicated to physicians dealing with PPGLs, augmented by perspectives of artificial intelligence and big data.
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Affiliation(s)
- Gildas Gabiache
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Charline Zadro
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Laura Rozenblum
- Department of Nuclear Medicine, Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, 75013 Paris, France
| | - Delphine Vezzosi
- Department of Endocrinology, Rangueil University Hospital, 31400 Toulouse, France
| | - Céline Mouly
- Department of Endocrinology, Rangueil University Hospital, 31400 Toulouse, France
| | | | - Rosine Guimbaud
- Department of Oncology, Rangueil University Hospital, 31400 Toulouse, France
| | - Philippe Otal
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Lawrence Dierickx
- Department of Nuclear Medicine, IUCT-Oncopole, 31059 Toulouse, France;
| | - Hervé Rousseau
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Christopher Trepanier
- New York-Presbyterian Hospital/Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Laurent Dercle
- New York-Presbyterian Hospital/Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Fatima-Zohra Mokrane
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
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Araujo-Castro M, García Sanz I, Mínguez Ojeda C, Calatayud M, Hanzu FA, Mora M, Vicente Delgado A, Carrera CB, de Miguel Novoa P, Del Carmen López García M, Manjón-Miguélez L, Rodríguez de Vera Gómez P, Del Castillo Tous M, Barahona San Millán R, Recansens M, Fernández-Ladreda MT, Valdés N, Gracia Gimeno P, Robles Lazaro C, Michalopoulou T, Gómez Dos Santos V, Alvarez-Escola C, García Centeno R, Lamas C, Herrera-Martínez A. An Integrated CT and MRI Imaging Model to Differentiate between Adrenal Adenomas and Pheochromocytomas. Cancers (Basel) 2023; 15:3736. [PMID: 37509397 PMCID: PMC10378495 DOI: 10.3390/cancers15143736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/05/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE to perform an external validation of our predictive model to rule out pheochromocytoma (PHEO) based on unenhanced CT in a cohort of patients with PHEOs and adenomas who underwent adrenalectomy. METHODS The predictive model was previously developed in a retrospective cohort of 1131 patients presenting with adrenal lesions. In the present study, we performed an external validation of the model in another cohort of 214 patients with available histopathological results. RESULTS For the external validation, 115 patients with PHEOs and 99 with adenomas were included. Our previously described predictive model combining the variables of high lipid content and tumor size in unenhanced CT (AUC-ROC: 0.961) had a lower diagnostic accuracy in our current study population for the prediction of PHEO (AUC: 0.750). However, when we excluded atypical adenomas (with Hounsfield units (HU) > 10, n = 39), the diagnostic accuracy increased to 87.4%. In addition, in the whole cohort (including atypical adenomas), when MRI information was included in the model, the diagnostic accuracy increased to up to 85% when the variables tumor size, high lipid content in an unenhanced CT scan, and hyperintensity in the T2 sequence in MRI were included. The probability of PHEO was <0.3% for adrenal lesions <20 mm with >10 HU and without hyperintensity in T2. CONCLUSION Our study confirms that our predictive model combining tumor size and lipid content has high reliability for the prediction of PHEO when atypical adrenal lesions are excluded. However, for atypical adrenal lesions with >10 HU in an unenhanced CT scan, MRI information is necessary for a proper exclusion of the PHEO diagnosis.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
- Medicine Departmen, University of Alcalá, 28801 Madrid, Spain
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - César Mínguez Ojeda
- Urology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - María Calatayud
- Endocrinology & Nutrition Department, Hospital Universitario Doce de Octubre, 28041 Madrid, Spain
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, 08036 Barcelona, Spain
| | - Mireia Mora
- Endocrinology & Nutrition Department, Hospital Clinic, 08036 Barcelona, Spain
| | | | - Concepción Blanco Carrera
- Endocrinology & Nutrition Department, Hospital Universitario Príncipe de Asturias, 28805 Madrid, Spain
| | - Paz de Miguel Novoa
- Endocrinology & Nutrition Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | | | - Laura Manjón-Miguélez
- Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | | | - María Del Castillo Tous
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, 41009 Sevilla, Spain
| | | | - Mónica Recansens
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, 17001 Girona, Spain
| | | | - Nuria Valdés
- Endocrinology & Nutrition Department, Hospital Universitario de Cabueñes, 33394 Asturias, Spain
| | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanova, 50015 Zaragoza, Spain
| | - Cristina Robles Lazaro
- Endocrinology & Nutrition Department, Hospital Universitario de Salamanca, 37007 Salamanca, Spain
| | - Theodora Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, 43005 Tarragona, Spain
| | | | | | - Rogelio García Centeno
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, 28029 Madrid, Spain
| | - Cristina Lamas
- Endocrinology & Nutrition Department, Hospital Universitario de Albacete, 02008 Albacete, Spain
| | - Aura Herrera-Martínez
- Department of Endocrinology and Nutrition, Reina Sofía Hospital, 31500 Córdoba, Spain
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Chung R, Garratt J, Remer EM, Navin P, Blake MA, Taffel MT, Hackett CE, Sharbidre KG, Tu W, Low G, Bara M, Carney BW, Corwin MT, Campbell MJ, Lee JT, Lee CY, Dueber JC, Shehata MA, Caoili EM, Schieda N, Elsayes KM. Adrenal Neoplasms: Lessons from Adrenal Multidisciplinary Tumor Boards. Radiographics 2023; 43:e220191. [PMID: 37347698 DOI: 10.1148/rg.220191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
The radiologic diagnosis of adrenal disease can be challenging in settings of atypical presentations, mimics of benign and malignant adrenal masses, and rare adrenal anomalies. Misdiagnosis may lead to suboptimal management and adverse outcomes. Adrenal adenoma is the most common benign adrenal tumor that arises from the cortex, whereas adrenocortical carcinoma (ACC) is a rare malignant tumor of the cortex. Adrenal cyst and myelolipoma are other benign adrenal lesions and are characterized by their fluid and fat content, respectively. Pheochromocytoma is a rare neuroendocrine tumor of the adrenal medulla. Metastases to the adrenal glands are the most common malignant adrenal tumors. While many of these masses have classic imaging appearances, considerable overlap exists between benign and malignant lesions and can pose a diagnostic challenge. Atypical adrenal adenomas include those that are lipid poor; contain macroscopic fat, hemorrhage, and/or iron; are heterogeneous and/or large; and demonstrate growth. Heterogeneous adrenal adenomas may mimic ACC, metastasis, or pheochromocytoma, particularly when they are 4 cm or larger, whereas smaller versions of ACC, metastasis, and pheochromocytoma and those with washout greater than 60% may mimic adenoma. Because of its nonenhanced CT attenuation of less than or equal to 10 HU, a lipid-rich adrenal adenoma may be mimicked by a benign adrenal cyst, or it may be mimicked by a tumor with central cystic and/or necrotic change such as ACC, pheochromocytoma, or metastasis. Rare adrenal tumors such as hemangioma, ganglioneuroma, and oncocytoma also may mimic adrenal adenoma, ACC, metastasis, and pheochromocytoma. The authors describe cases of adrenal neoplasms that they have encountered in clinical practice and presented to adrenal multidisciplinary tumor boards. Key lessons to aid in diagnosis and further guide appropriate management are provided. © RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Ryan Chung
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Joanie Garratt
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Erick M Remer
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Patrick Navin
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Michael A Blake
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Myles T Taffel
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Caitlin E Hackett
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Kedar G Sharbidre
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Wendy Tu
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Gavin Low
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Meredith Bara
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Benjamin W Carney
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Michael T Corwin
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Michael J Campbell
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - James T Lee
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Cortney Y Lee
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Julie C Dueber
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Mostafa A Shehata
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Elaine M Caoili
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Nicola Schieda
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Khaled M Elsayes
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
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Dual Energy-Derived Metrics for Differentiating Adrenal Adenomas From Nonadenomas on Single-Phase Contrast-Enhanced CT. AJR Am J Roentgenol 2023; 220:693-704. [PMID: 36416399 DOI: 10.2214/ajr.22.28323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND. Adrenal masses are often indeterminate on single-phase postcontrast CT. Dual-energy CT (DECT) with three-material decomposition algorithms may aid characterization. OBJECTIVE. The purpose of this study was to compare the diagnostic performance of metrics derived from portal venous phase DECT, including virtual noncontrast (VNC) attenuation, fat fraction, iodine density, and relative enhancement ratio, for characterizing adrenal masses. METHODS. This retrospective study included 128 patients (82 women, 46 men; mean age, 64.6 ± 12.7 [SD] years) who between January 2016 and December 2019 underwent portal venous phase abdominopelvic DECT that showed a total of 139 adrenal lesions with an available reference standard based on all imaging, clinical, and pathologic records (87 adenomas, 52 nonadenomas [48 metastases, two adrenal cortical carcinomas, one ganglioneuroma, one hematoma]). Two radiologists placed ROIs to determine the following characteristics of the masses: VNC attenuation, fat fraction, iodine density normalized to portal vein, and for masses with VNC greater than 10 HU, relative enhancement ratio (ratio of portal venous phase attenuation to VNC attenuation). Readers' mean measurements were used for ROC analyses, and clinically optimal thresholds were derived as thresholds yielding the highest sensitivity at 100% specificity. RESULTS. Adenomas and nonadenomas were significantly different (all p < .001) in VNC attenuation (mean ± SD, 18.5 ± 12.9 vs 34.1 ± 8.9 HU), fat fraction (mean ± SD, 24.3% ± 8.2% vs 14.2% ± 5.6%), normalized iodine density (mean ± SD, 0.34 ± 0.15 vs 0.17 ± 0.17), and relative enhancement ratio (mean ± SD, 186% ± 96% vs 58% ± 59%). AUCs for all metrics ranged from 0.81 through 0.91. The metric with highest sensitivity for adenoma at the clinically optimal threshold (i.e., 100% specificity) was fat fraction (threshold, ≥ 23.8%; sensitivity, 59% [95% CI, 48-69%]) followed by VNC attenuation (≤ 15.2 HU; sensitivity, 39% [95% CI, 29-50%]), relative enhancement ratio (≥ 214%; sensitivity, 37% [95% CI, 25-50%]), and normalized iodine density (≥ 0.90; sensitivity, 1% (95% CI, 0-60%]). VNC attenuation at the traditional true noncontrast attenuation threshold of 10 HU or lower had sensitivity of 28% (95% CI, 19-38%) and 100% specificity. Presence of fat fraction 23.8% or greater or relative enhancement ratio 214% or greater yielded sensitivity of 68% (95% CI, 57-77%) with 100% specificity. CONCLUSION. For adrenal lesions evaluated with single-phase DECT, fat fraction had higher sensitivity than VNC attenuation at both the clinically optimal threshold and the traditional threshold of 10 HU or lower. CLINICAL IMPACT. By helping to definitively diagnose adenomas, DECT-derived metrics can help avoid downstream imaging for incidental adrenal lesions.
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Roseland ME, Zhang M, Caoili EM. Imaging of pregnant and lactating patients with suspected adrenal disorders. Rev Endocr Metab Disord 2023; 24:97-106. [PMID: 35624403 DOI: 10.1007/s11154-022-09733-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 02/01/2023]
Abstract
A high level of clinical suspicion is essential in the diagnosis and management of a suspected adrenal mass during pregnancy and the peripartum period. Timely recognition is important in order to improve fetal and maternal outcomes. Imaging is often performed to confirm a suspected adrenal lesion; however, increasing usage of diagnostic imaging during pregnancy and lactation has also increased awareness, concerns and confusion regarding the safety risks regarding fetal and maternal exposure to radiation and imaging intravenous contrast agents. This may lead to anxiety and avoidance of imaging examinations which can delay diagnosis and appropriate treatment. This article briefly reviews evidence-based recommended imaging modalities during pregnancy and the lactation period for the assessment of a suspected adrenal mass while recognizing that no examination should be withheld when the exam is necessary to confirm an important clinical suspicion. The imaging characteristics of the more common adrenal pathologies that may affect pregnant women are also discussed.
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Affiliation(s)
- Molly E Roseland
- Department of Radiology, Michigan Medicine, 1500. E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Man Zhang
- Department of Radiology, Michigan Medicine, 1500. E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Elaine M Caoili
- Department of Radiology, Michigan Medicine, 1500. E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
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9
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Prevalence of Malignancy in Adrenal Nodules With Heterogeneous Microscopic Fat on Chemical-Shift MRI: A Multiinstitutional Study. AJR Am J Roentgenol 2023; 220:86-94. [PMID: 35920707 DOI: 10.2214/ajr.22.27976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND. Homogeneous microscopic fat within adrenal nodules on chemical-shift MRI (CS-MRI) is diagnostic of benign adrenal adenoma, but the clinical relevance of heterogeneous microscopic fat is not well established. OBJECTIVE. This study sought to determine the prevalence of malignancy in adrenal nodules with heterogeneous microscopic fat on dual-echo T1-weighted CS-MRI. METHODS. We performed a retrospective study of adult patients with adrenal nodules detected on MRI performed between August 2007 and November 2020 at seven institutions. Eligible nodules had a short-axis diameter of 10 mm or larger with heterogeneous microscopic fat (defined by an area of signal loss of < 80% on opposed-phase CS-MRI). Two radiologists from each center, blinded to reference standard results, determined the signal loss pattern (diffuse, two distinct parts, speckling pattern, central loss, or peripheral loss) within the nodules. The reference standard used was available for 283 nodules (pathology for 21 nodules, ≥ 1 year of imaging follow-up for 245, and ≥ 5 years of clinical follow-up for 17) in 282 patients (171 women and 111 men; mean age, 60 ± 12 [SD] years); 30% (86/282) patients had prior malignancy. RESULTS. The mean long-axis diameter was 18.7 ± 7.9 mm (range, 10-80 mm). No malignant nodules were found in patients without prior cancer (0/197; 95% CI, 0-1.5%). Four of the 86 patients with prior malignancy (hepatocellular carcinoma [HCC], renal cell carcinoma [RCC], lung cancer, or both colon cancer and RCC) (4.7%; 95% CI, 1.3-11.5%) had metastatic nodules. Detected patterns were diffuse heterogeneous signal loss (40% [114/283]), speckling (28% [80/283]), two distinct parts (18% [51/283]), central loss (9% [26/283]), and peripheral loss (4% [12/283]). Two metastases from HCC and RCC showed diffuse heterogeneous signal loss. Lung cancer metastasis manifested as two distinct parts, and the metastasis in the patient with both colon cancer and RCC showed peripheral signal loss. CONCLUSION. Presence of heterogeneous microscopic fat in adrenal nodules on CS-MRI indicates a high likelihood of benignancy, particularly in patients without prior cancer. This finding is also commonly benign in patients with cancer; however, caution is warranted when primary malignancies may contain fat or if the morphologic pattern of signal loss may indicate a collision tumor. CLINICAL IMPACT. In the absence of prior cancer, adrenal nodules with heterogeneous microscopic fat do not require additional imaging evaluation.
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10
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Bracci B, De Santis D, Del Gaudio A, Faugno MC, Romano A, Tarallo M, Zerunian M, Guido G, Polici M, Polidori T, Pucciarelli F, Matarazzo I, Laghi A, Caruso D. Adrenal Lesions: A Review of Imaging. Diagnostics (Basel) 2022; 12:diagnostics12092171. [PMID: 36140572 PMCID: PMC9498052 DOI: 10.3390/diagnostics12092171] [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: 08/15/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Adrenal lesions are frequently incidentally diagnosed during investigations for other clinical conditions. Despite being usually benign, nonfunctioning, and silent, they can occasionally cause discomfort or be responsible for various clinical conditions due to hormonal dysregulation; therefore, their characterization is of paramount importance for establishing the best therapeutic strategy. Imaging techniques such as ultrasound, computed tomography, magnetic resonance, and PET-TC, providing anatomical and functional information, play a central role in the diagnostic workup, allowing clinicians and surgeons to choose the optimal lesion management. This review aims at providing an overview of the most encountered adrenal lesions, both benign and malignant, including describing their imaging characteristics.
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Affiliation(s)
- Benedetta Bracci
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Domenico De Santis
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Antonella Del Gaudio
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Maria Carla Faugno
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Allegra Romano
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Mariarita Tarallo
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, 00185 Rome, Italy
| | - Marta Zerunian
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Gisella Guido
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Michela Polici
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Tiziano Polidori
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Francesco Pucciarelli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Iolanda Matarazzo
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza—University of Rome, Radiology Unit—Sant’Andrea University Hospital, 00189 Rome, Italy
- Correspondence:
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11
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Canu L, Perigli G, Badii B, Santi R, Nesi G, Pradella S, Maggi M, Peri A. Case Report: Adrenocortical Oncocytoma in a Patient with a Previous Contralateral Adrenalectomy for a Cortisol-Secreting Adenoma. Front Surg 2022; 9:897967. [PMID: 35662823 PMCID: PMC9160572 DOI: 10.3389/fsurg.2022.897967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Oncocytomas are uncommon benign tumors that arise in various organs and are predominantly composed of oncocytes. Adrenocortical oncocytomas are extremely rare and are generally non-functioning. Methods We report the case of a 40-year-old patient with a progressively enlarging left adrenal mass. At the age of 19 he had undergone right adrenalectomy for a cortisol-secreting adenoma. Radiologic features were not typical of an adenoma and positive uptake was detected at 18F-FDG-PET. Because of the uncertain nature of the growing lesion, it was decided to proceed to surgical resection. Results The surgeon managed to remove the left adrenal mass, sparing the normal adrenal gland, and histology was consistent with adrenocortical oncocytoma. Corticosteroid supplementation was prescribed, but at reassessment, adrenal function was found to be preserved and treatment withdrawn. Conclusions Adrenal oncocytoma is a rare diagnosis, but should be considered in the presence of a growing mass with non-specific radiologic appearance.
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Affiliation(s)
- Letizia Canu
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
| | - Giuliano Perigli
- Endocrine Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Benedetta Badii
- Endocrine Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Raffaella Santi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriella Nesi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Silvia Pradella
- Department of Emergency Radiology, University Hospital Careggi, Florence, Italy
| | - Mario Maggi
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
| | - Alessandro Peri
- Endocrinology, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
- Pituitary Diseases and Sodium Alterations Unit, University Hospital Careggi, Florence, Italy
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12
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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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13
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Rusakov VF, Shcherbakov IE, Chinchuk IK, Savelyeva TV, Rebrova DV, Loginova OI, Pridvizhkina TS, Chernikov RA, Krasnov LM, Fedotov JN, Fedorov EA, Sablin IV, Sleptsov IV, Shihmagomedov SS, Zgoda EA. [Diagnostic value of ct in examination of patients with adrenal cancer]. PROBLEMY ENDOKRINOLOGII 2022; 68:13-29. [PMID: 36104962 DOI: 10.14341/probl12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/17/2022] [Accepted: 04/25/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND In most cases adrenal tumours are detected by accident while performing medical imaging tests for other diseases. These findings are treated as adrenal incidentaloma. Prevalence of incidentalomas detected on CT scans is up to 4%. According to different authors, 4-12% of all adrenal tumours are adrenocortical carcinomas. As for today, the most significant medical imaging technique is CT scan with bolus IV injection of contrast agent and assessment of tumour's density. The analysis of the results of CT imaging in 67 patients with ACC was carried out according to a single protocol. The main signs characteristic of this disease are described. It is very important to evaluate typical signs of ACC on CT scans for risk assessment of ACC before surgical treatment. If malignant tumour is suspected during preoperative examination, it is extremely important to choose the right surgical treatment strategy. AIM To evaluate the significance of CT as the main method of preoperative diagnosis in patients with malignant tumors of the adrenal cortex. Studying CT semiotics of adrenocortical cancer in a large group of patients using a single standard imaging protocol. Find the main radiological symptoms characteristic of adrenocortical cancerMATERIALS AND METHODS: Here are the results of retrospective study of CT scans performed on 67 patients with adrenocortical carcinoma who received treatment in the Department of Endocrine Surgery of Saint-Petersburg State University N.I. Pirogov Clinic of High Medical Technologies during 2012-2020. The diagnostic significance of CT in patients with ACC was assessed. RESULTS The most common features of ACC: tumour heterogeneity (84.3%), tumour's size 3-9 cm (75%), signs of invasion into surrounding structures (10%), pre-contrast density above +30 HU (75%), absolute contrast washout less than 60% (68.8%), relative contrast washout less than 40% (64.6%)CONCLUSION: CT scan with IV contrast was not able to show any definitive pathognomonic signs of ACC. Nevertheless, CT scan should be performed in all patients with suspected (or confirmed using other medical imaging technique) adrenal tumour according to standard protocol. Bolus injection of contrast agent should be performed in all patients with tumour's pre-contrast density above +5 HU.
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Affiliation(s)
- V F Rusakov
- N.I. Pirogov Clinic of High Medical Technologies
| | | | - I K Chinchuk
- N.I. Pirogov Clinic of High Medical Technologies
| | | | - D V Rebrova
- N.I. Pirogov Clinic of High Medical Technologies
| | - O I Loginova
- N.I. Pirogov Clinic of High Medical Technologies
| | | | | | - L M Krasnov
- N.I. Pirogov Clinic of High Medical Technologies
| | - J N Fedotov
- N.I. Pirogov Clinic of High Medical Technologies
| | - E A Fedorov
- N.I. Pirogov Clinic of High Medical Technologies
| | - I V Sablin
- N.I. Pirogov Clinic of High Medical Technologies
| | - I V Sleptsov
- N.I. Pirogov Clinic of High Medical Technologies
| | | | - E A Zgoda
- N.I. Pirogov Clinic of High Medical Technologies
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14
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Araujo-Castro M, García Centeno R, Robles Lázaro C, Parra Ramírez P, Gracia Gimeno P, Rojas-Marcos PM, Fernández-Ladreda MT, Percovich Hualpa JC, Sampedro Núñez M, López-García MC, Lamas C, Álvarez Escolá C, Calatayud Gutiérrez M, Blanco Carrera C, de Miguel Novoa P, Valdés Gallego N, Hanzu F, Marazuela M, Mora Porta M, Mínguez Ojeda C, García Gómez Muriel I, Escobar-Morreale HF, Valderrabano P. Predictive model of pheochromocytoma based on the imaging features of the adrenal tumours. Sci Rep 2022; 12:2671. [PMID: 35177692 PMCID: PMC8854552 DOI: 10.1038/s41598-022-06655-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/03/2022] [Indexed: 12/18/2022] Open
Abstract
The purpose of our study was to develop a predictive model to rule out pheochromocytoma among adrenal tumours, based on unenhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) features. We performed a retrospective multicentre study of 1131 patients presenting with adrenal lesions including 163 subjects with histological confirmation of pheochromocytoma (PHEO), and 968 patients showing no clinical suspicion of pheochromocytoma in whom plasma and/or urinary metanephrines and/or catecholamines were within reference ranges (non-PHEO). We found that tumour size was significantly larger in PHEO than non-PHEO lesions (44.3 ± 33.2 versus 20.6 ± 9.2 mm respectively; P < 0.001). Mean unenhanced CT attenuation was higher in PHEO (52.4 ± 43.1 versus 4.7 ± 17.9HU; P < 0.001). High lipid content in CT was more frequent among non-PHEO (83.6% versus 3.8% respectively; P < 0.001); and this feature alone had 83.6% sensitivity and 96.2% specificity to rule out pheochromocytoma with an area under the receiver operating characteristics curve (AUC-ROC) of 0.899. The combination of high lipid content and tumour size improved the diagnostic accuracy (AUC-ROC 0.961, sensitivity 88.1% and specificity 92.3%). The probability of having a pheochromocytoma was 0.1% for adrenal lesions smaller than 20 mm showing high lipid content in CT. Ninety percent of non-PHEO presented loss of signal in the “out of phase” MRI sequence compared to 39.0% of PHEO (P < 0.001), but the specificity of this feature for the diagnosis of non-PHEO lesions low. In conclusion, our study suggests that sparing biochemical screening for pheochromocytoma might be reasonable in patients with adrenal lesions smaller than 20 mm showing high lipid content in the CT scan, if there are no typical signs and symptoms of pheochromocytoma.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain.
| | - Rogelio García Centeno
- Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Robles Lázaro
- Department of Endocrinology & Nutrition, Hospital Universitario Virgen de La Concha, Zamora, Spain
| | - Paola Parra Ramírez
- Department of Endocrinology & Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Paola Gracia Gimeno
- Department of Endocrinology & Nutrition, Hospital Universitario Rollo Villanova, Zaragoza, Spain
| | | | | | | | - Miguel Sampedro Núñez
- Department of Endocrinology & Nutrition, Hospital Universitario La Princesa, Madrid, Spain
| | - María-Carmen López-García
- Department of Endocrinology & Nutrition, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Cristina Lamas
- Department of Endocrinology & Nutrition, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | - Paz de Miguel Novoa
- Department of Endocrinology & Nutrition, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Nuria Valdés Gallego
- Department of Endocrinology & Nutrition, Hospital Universitario de Cabueñes, Asturias, Spain
| | - Felicia Hanzu
- Department of Endocrinology & Nutrition, Hospital Clinic, Barcelona, Spain
| | - Mónica Marazuela
- Department of Endocrinology & Nutrition, Hospital Universitario La Princesa, Madrid, Spain
| | - Mireia Mora Porta
- Department of Endocrinology & Nutrition, Hospital Clinic, Barcelona, Spain
| | | | | | - Héctor F Escobar-Morreale
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Pablo Valderrabano
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain.
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15
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Abstract
Schwannoma is a common mesenchymal neoplasm; however, adrenal schwannoma is rare, and it is frequently misdiagnosed as adrenal cortical adenoma. We herein report a 91-year-old Japanese man with right adrenal schwannoma that was pathologically diagnosed after adrenalectomy. To our knowledge, this is the first case of adrenal schwannoma in the oldest patient and with the longest follow-up period reported, including radiological images from 10 years earlier.
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Affiliation(s)
- Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Japan
| | - Takushi Naroda
- Department of Urology, Japanese Red Cross Kochi Hospital, Japan
| | - Masato Tamura
- Department of Urology, Japanese Red Cross Kochi Hospital, Japan
| | - Satoshi Ito
- Department of Radiology, Japanese Red Cross Kochi Hospital, Japan
| | - Kimiko Nakatani
- Department of Radiology, Japanese Red Cross Kochi Hospital, Japan
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16
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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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Quantitative 3-tesla multiparametric MRI in differentiation between renal cell carcinoma subtypes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00405-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
MRI provides several distinct quantitative parameters that may better differentiate renal cell carcinoma (RCC) subtypes. The purpose of the study is to evaluate the diagnostic accuracy of apparent diffusion coefficient (ADC), chemical shift signal intensity index (SII), and contrast enhancement in differentiation between different subtypes of renal cell carcinoma.
Results
There were 63 RCC as regard surgical histopathological analysis: 43 clear cell (ccRCC), 12 papillary (pRCC), and 8 chromophobe (cbRCC). The mean ADC ratio for ccRCC (0.75 ± 0.13) was significantly higher than that of pRCC (0.46 ± 0.12, P < 0.001) and cbRCC (0.41 ± 0.15, P < 0.001). The mean ADC value for ccRCC (1.56 ± 0.27 × 10−3 mm2/s) was significantly higher than that of pRCC (0.96 ± 0.25 × 10−3 mm2/s, P < 0.001) and cbRCC (0.89 ± 0.29 × 10−3 mm2/s, P < 0.001). The mean SII of pRCC (1.49 ± 0.04) was significantly higher than that of ccRCC (0.93 ± 0.01, P < 0.001) and cbRCC (1.01 ± 0.16, P < 0.001). The ccRCC absolute corticomedullary enhancement (196.7 ± 81.6) was significantly greater than that of cbRCC (177.8 ± 77.7, P < 0.001) and pRCC (164.3 ± 84.6, P < 0.001).
Conclusion
Our study demonstrated that multiparametric MRI is able to afford some quantitative features such as ADC ratio, SII, and absolute corticomedullary enhancement which can be used to accurately distinguish different subtypes of renal cell carcinoma.
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18
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Nawar MMA, Hanna SAAZ, El-Sawy SS, Shokralla SY. Adrenal incidentalomas: imaging challenges—role of MDCT scan versus MRI in evaluating adrenal incidentalomas. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00437-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The term adrenal incidentaloma (AI), by definition, is an adrenal mass that is unexpectedly detected through an imaging procedure performed for reasons unrelated to adrenal dysfunction or suspected dysfunction. Despite their frequent appearance, the challenge remains in recognizing and treating the small percentage of AI that poses a significant risk, either because of their hormonal activity or because of their malignant histology. The aim of this study is to study the role of MRI, specifically chemical shift imaging (CSI), against various MDCT scans (non-enhanced, enhanced, and delayed) in the characterization of incidentally discovered adrenal masses to offer a way for the patients to avoid unnecessary time and money-wasting imaging modalities used to reach a diagnosis of their incidentally discovered adrenal lesions. We examined a total number of 20 patients with total of 22 adrenal lesions. The mean age was 51.1 ± 15.27.
Results
In our study, we found that among CT parameters, APW and RPW showed the highest sensitivity and specificity for detection of lipid-rich adenomas. CSI has also proven to be the best MR technique. However, there is no statistically significant difference in the diagnostic capability of CSI versus the CT washout technique. Both modalities could be conducted, according to specific patient preferences and/or limitations, with comparable highly accurate outcomes.
Conclusion
This study demonstrates that a similar diagnostic outcome is obtained from contrast-enhanced CT (CECT) and MRI with CSI of adrenal lesions.
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Adam SZ, Rabinowich A, Kessner R, Blachar A. Spectral CT of the abdomen: Where are we now? Insights Imaging 2021; 12:138. [PMID: 34580788 PMCID: PMC8476679 DOI: 10.1186/s13244-021-01082-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
Spectral CT adds a new dimension to radiological evaluation, beyond assessment of anatomical abnormalities. Spectral data allows for detection of specific materials, improves image quality while at the same time reducing radiation doses and contrast media doses, and decreases the need for follow up evaluation of indeterminate lesions. We review the different acquisition techniques of spectral images, mainly dual-source, rapid kV switching and dual-layer detector, and discuss the main spectral results available. We also discuss the use of spectral imaging in abdominal pathologies, emphasizing the strengths and pitfalls of the technique and its main applications in general and in specific organs.
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Affiliation(s)
- Sharon Z Adam
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviad Rabinowich
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Kessner
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arye Blachar
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nandra G, Duxbury O, Patel P, Patel JH, Patel N, Vlahos I. Technical and Interpretive Pitfalls in Adrenal Imaging. Radiographics 2021; 40:1041-1060. [PMID: 32609593 DOI: 10.1148/rg.2020190080] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The adrenal gland may exhibit a wide variety of pathologic conditions. A number of imaging techniques can be used to characterize these, although it is not always possible to attain a definitive diagnosis radiologically. Incorrect diagnoses may be made if radiologists are not attentive to technical parameters and interpretive factors associated with adrenal gland imaging. Hence, an appreciation of the intricacies of adrenal imaging strategies and characterization is required; this can be aided by understanding the pitfalls of adrenal imaging. Technical pitfalls at CT may relate to the imaging parameters, including region of interest characteristics, tube voltage selection, and the timing of contrast material-enhanced imaging. With MRI, imaging acquisition technique and evaluation of the reference tissues used in chemical shift MRI are important considerations that can directly influence image interpretation. Interpretive errors may occur when evaluating adrenal washout at CT without considering other radiologic features, including the size of adrenal nodules, the presence of fat or calcification, the attenuation of nodules, and atypical imaging features. The characterization of an incidental adrenal lesion as benign or malignant does not end the role of the radiologist; consideration as to whether an adrenal lesion is associated with endocrine dysfunction is required. While imaging may not be optimal for establishing endocrine activity, there are imaging features from which radiologists may infer function. In cases of known endocrine activity, imaging can guide clinical management, including further investigations such as venous sampling. ©RSNA, 2020.
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Affiliation(s)
- Gurinder Nandra
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
| | - Oliver Duxbury
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
| | - Pawan Patel
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
| | - Jaymin H Patel
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
| | - Nirav Patel
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
| | - Ioannis Vlahos
- From the Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, England
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21
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Abstract
Incidentally detected adrenal nodules are common, and prevalence increases with patient age. Although most are benign, it is important for the radiologist to be able to accurately determine which nodules require further testing and which are safely left alone. The American College of Radiology incidental adrenal White Paper provides a structured algorithm based on expert consensus for management of incidental adrenal nodules. If further diagnostic testing is indicated, adrenal computed tomography is the most appropriate test in patients for nodules less than 4 cm. In addition to imaging, biochemical testing and endocrinology referral is warranted to exclude a functioning mass.
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Affiliation(s)
- Daniel I Glazer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Michael T Corwin
- Department of Radiology, University of California, Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - William W Mayo-Smith
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Hajjo R, Sabbah DA, Bardaweel SK, Tropsha A. Identification of Tumor-Specific MRI Biomarkers Using Machine Learning (ML). Diagnostics (Basel) 2021; 11:742. [PMID: 33919342 PMCID: PMC8143297 DOI: 10.3390/diagnostics11050742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
The identification of reliable and non-invasive oncology biomarkers remains a main priority in healthcare. There are only a few biomarkers that have been approved as diagnostic for cancer. The most frequently used cancer biomarkers are derived from either biological materials or imaging data. Most cancer biomarkers suffer from a lack of high specificity. However, the latest advancements in machine learning (ML) and artificial intelligence (AI) have enabled the identification of highly predictive, disease-specific biomarkers. Such biomarkers can be used to diagnose cancer patients, to predict cancer prognosis, or even to predict treatment efficacy. Herein, we provide a summary of the current status of developing and applying Magnetic resonance imaging (MRI) biomarkers in cancer care. We focus on all aspects of MRI biomarkers, starting from MRI data collection, preprocessing and machine learning methods, and ending with summarizing the types of existing biomarkers and their clinical applications in different cancer types.
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Affiliation(s)
- Rima Hajjo
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman 11733, Jordan;
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, The University of North Carlina at Chapel Hill, Chapel Hill, NC 27599, USA;
- National Center for Epidemics and Communicable Disease Control, Amman 11118, Jordan
| | - Dima A. Sabbah
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman 11733, Jordan;
| | - Sanaa K. Bardaweel
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Jordan, Amman 11942, Jordan;
| | - Alexander Tropsha
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, The University of North Carlina at Chapel Hill, Chapel Hill, NC 27599, USA;
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Handcrafted MRI radiomics and machine learning: Classification of indeterminate solid adrenal lesions. Magn Reson Imaging 2021; 79:52-58. [PMID: 33727148 DOI: 10.1016/j.mri.2021.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/16/2020] [Accepted: 03/11/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess a radiomic machine learning (ML) model in classifying solid adrenal lesions (ALs) without fat signal drop on chemical shift (CS) as benign or malignant. METHOD 55 indeterminate ALs (21 lipid poor adenomas, 15 benign pheocromocytomas, 1 oncocytoma, 12 metastases, 6 primary tumors) showing no fat signal drop on CS were retrospectively included. Manual 3D segmentation on T2-weighted and CS images was performed for subsequent radiomic feature extraction. After feature stability testing and an 80-20% train-test split, the train set was balanced via oversampling. Following a multi-step feature selection, an Extra Trees model was tuned with 5-fold stratified cross-validation in the train set and then tested on the hold-out test set. RESULTS A total of 3396 features were extracted from each AL, of which 133 resulted unstable while none had low variance (< 0.01). Highly correlated (r > 0.8) features were also excluded, leaving 440 parameters. Among these, Support Vector Machine 5-fold stratified cross-validated recursive feature elimination selected a subset of 6 features. ML obtained a cross-validation accuracy of 0.94 on the train and 0.91 on the test sets. Precision, recall and F1 score were respectively 0.92, 0.91 and 0.91. CONCLUSIONS Our MRI handcrafted radiomics and ML pipeline proved useful to characterize benign and malignant solid indeterminate adrenal lesions.
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Tu W, Abreu-Gomez J, Udare A, Alrashed A, Schieda N. Utility of T2-weighted MRI to Differentiate Adrenal Metastases from Lipid-Poor Adrenal Adenomas. Radiol Imaging Cancer 2020; 2:e200011. [PMID: 33778748 DOI: 10.1148/rycan.2020200011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022]
Abstract
Purpose To evaluate T2-weighted MRI features to differentiate adrenal metastases from lipid-poor adenomas. Materials and Methods With institutional review board approval, this study retrospectively compared 40 consecutive patients (mean age, 66 years ± 10 [standard deviation]) with metastases to 23 patients (mean age, 60 years ± 15) with lipid-poor adenomas at 1.5- and 3-T MRI between June 2016 and March 2019. A blinded radiologist measured T2-weighted signal intensity (SI) ratio (SInodule/SIpsoas muscle), T2-weighted histogram features, and chemical shift SI index. Two blinded radiologists (radiologist 1 and radiologist 2) assessed T2-weighted SI and T2-weighted heterogeneity using five-point Likert scales. Results Subjectively, T2-weighted SI (P < .001 for radiologist 1 and radiologist 2) and T2-weighted heterogeneity (P < .001, for radiologist 1 and radiologist 2) were higher in metastases compared with adenomas when assessed by both radiologists. Agreement between the radiologists was substantial for T2-weighted SI (Cohen κ = 0.67) and T2-weighted heterogeneity (κ = 0.62). Metastases had higher T2-weighted SI ratio than adenomas (3.6 ± 1.7 [95% confidence interval {CI}: 0.2, 8.2] vs 2.2 ± 1.0 [95% CI: 0.6, 4.3], P < .001) and higher T2-weighted entropy (6.6 ± 0.6 [95% CI: 4.9, 7.5] vs 5.0 ± 0.8 [95% CI: 3.5, 6.6], P < .001). At multivariate analysis, T2-weighted entropy was the best differentiating feature (P < .001). Chemical shift SI index did not differ between metastases and adenomas (P = .748). Area under the receiver operating characteristic curve (AUC) for T2-weighted SI ratio and T2-weighted entropy were 0.76 (95% CI: 0.64, 0.88) and 0.94 (95% CI: 0.88, 0.99). The logistic regression model combining T2-weighted SI ratio with T2-weighted entropy yielded AUC of 0.95 (95% CI: 0.91, 0.99) and did not differ compared with T2-weighted entropy alone (P = .268). There was no difference in logistic regression model accuracy comparing the data by either field strength, 1.5- or 3-T MRI (P > .05). Conclusion Logistic regression models combining T2-weighted SI and T2-weighted heterogeneity can differentiate metastases from lipid-poor adenomas. Validation of these preliminary results is required.Keywords: Adrenal, MR-Imaging, UrinarySupplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Wendy Tu
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.)
| | - Jorge Abreu-Gomez
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.)
| | - Amar Udare
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.)
| | - Abdulmohsen Alrashed
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.)
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.)
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25
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Elbanan MG, Javadi S, Ganeshan D, Habra MA, Rao Korivi B, Faria SC, Elsayes KM. Adrenal cortical adenoma: current update, imaging features, atypical findings, and mimics. Abdom Radiol (NY) 2020; 45:905-916. [PMID: 31529204 DOI: 10.1007/s00261-019-02215-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Adrenal adenoma is the most common adrenal lesion. Due to its wide prevalence, adrenal adenomas may demonstrate various imaging features. Thus, it is important to identify typical and atypical imaging features of adrenal adenomas and to be able to differentiate atypical adrenal adenomas from potentially malignant lesions. In this article, we will discuss the diagnostic approach, typical and atypical imaging features of adrenal adenomas, as well as other lesions that mimic adrenal adenomas.
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Affiliation(s)
- Mohamed G Elbanan
- Department of Diagnostic Radiology, Yale New Haven Health System, Bridgeport Hospital, Bridgeport, CT, USA
| | - Sanaz Javadi
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Dhakshinamoorthy Ganeshan
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Brinda Rao Korivi
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Silvana C Faria
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Departments of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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26
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Ahmed AA, Thomas AJ, Ganeshan DM, Blair KJ, Lall C, Lee JT, Morshid AI, Habra MA, Elsayes KM. Adrenal cortical carcinoma: pathology, genomics, prognosis, imaging features, and mimics with impact on management. Abdom Radiol (NY) 2020; 45:945-963. [PMID: 31894378 DOI: 10.1007/s00261-019-02371-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare tumor with a poor prognosis. Most tumors are either metastatic or locally invasive at the time of diagnosis. Differentiation between ACC and other adrenal masses depends on clinical, biochemical, and imaging factors. This review will discuss the genetics, pathological, and imaging feature of ACC.
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Affiliation(s)
- Ayahallah A Ahmed
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Aaron J Thomas
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Dhakshina Moorthy Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Katherine J Blair
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - James T Lee
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Ali I Morshid
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mouhammed A Habra
- Departments of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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Abstract
OBJECTIVE To review the current evidence and guidelines for diagnosis and management of incidental adrenal masses with a focus on the recent changes made by the American College of Radiology (ACR) Incidental Findings Committee. CONCLUSION Incidentally detected adrenal nodules are a commonly encountered finding estimated to occur in 5-7% of the adult population. By following current recommendations, radiologists can improve patient care by efficiently determining which masses require further diagnostic testing and which masses can be considered benign and not require further follow-up.
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Affiliation(s)
- Daniel I Glazer
- Division of Abdominal Imaging and Intervention, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - William W Mayo-Smith
- Division of Abdominal Imaging and Intervention, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA
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28
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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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29
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van Vucht N, Santiago R, Lottmann B, Pressney I, Harder D, Sheikh A, Saifuddin A. The Dixon technique for MRI of the bone marrow. Skeletal Radiol 2019; 48:1861-1874. [PMID: 31309243 DOI: 10.1007/s00256-019-03271-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 02/02/2023]
Abstract
Dixon sequences are established as a reliable MRI technique that can be used for problem-solving in the assessment of bone marrow lesions. Unlike other fat suppression methods, Dixon techniques rely on the difference in resonance frequency between fat and water and in a single acquisition, fat only, water only, in-phase and out-of-phase images are acquired. This gives Dixon techniques the unique ability to quantify the amount of fat within a bone lesion, allowing discrimination between marrow-infiltrating and non-marrow-infiltrating lesions such as focal nodular marrow hyperplasia. Dixon can be used with gradient echo and spin echo techniques, both two-dimensional and three-dimensional imaging. Another advantage is its rapid acquisition time, especially when using traditional two-point Dixon gradient echo sequences. Overall, Dixon is a robust fat suppression method that can also be used with intravenous contrast agents. After reviewing the available literature, we would like to advocate the implementation of additional Dixon sequences as a problem-solving tool during the assessment of bone marrow pathology.
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Affiliation(s)
- Niels van Vucht
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Rodney Santiago
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Bianca Lottmann
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ian Pressney
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Dorothee Harder
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Adnan Sheikh
- Department of Medical Imaging, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - Asif Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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Kunz WG, Auernhammer CJ, Nölting S, Pfluger T, Ricke J, Cyran CC. [Pheochromocytoma and paraganglioma : Importance of diagnostic imaging]. Radiologe 2019; 59:975-981. [PMID: 31338528 DOI: 10.1007/s00117-019-0569-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
CLINICAL BACKGROUND If pheochromocytoma (PC) or paraganglioma (PGL) is diagnosed based on serologic studies, imaging is required to locate the adrenal mass for further management. Besides pathognomonic hormonal findings, PC/PGL can exhibit typical imaging features. However, PC/PGL can also show morphological overlap with other pathologies. STANDARD RADIOLOGICAL METHODS The modality of choice for evaluation of PC is CT. In case of extra-adrenal location, MRI is superior to CT. Imaging with PET-CT provides complementary information in the differentiation of PC/PGL and is recommended as the imaging modality of choice for malignant PC/PGL. 68Ga-DOTATATE (or 68Ga-DOTATOC/ 68Ga-DOTANOC) PET-CT has high sensitivity for SDHx-mutated PC/PGL and serves for planning of radioreceptor therapy with somatostatin analogues. In contrast, 123I-metaiodobenzylguanidine (MIBG) scintigraphy is important in assessing the potential efficacy of radioreceptor therapy with MIBG. METHODICAL DETAILS The CT protocol for PC evaluation should include non-enhanced, arterial, portal-venous and late phases; the latter for the evaluation of wash-out. Recent studies indicate non-enhanced CT alone may be sufficient to rule out PC. For MRI, in- and opposed-phase sequences should be additionally acquired. PRACTICAL RECOMMENDATIONS A relevant proportion of PC is diagnosed incidentally. Therefore, imaging of PC will gain further importance. Recent studies show better response rates of PC/PGL after radioreceptor therapy with somatostatin analogues (177Lu-DOTATATE) than with MIBG. Therefore, 68Ga-DOTATATE PET-CT gains further importance-for diagnostic imaging and therapy planning.
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Affiliation(s)
- W G Kunz
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - C J Auernhammer
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Deutschland
| | - S Nölting
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Deutschland
| | - T Pfluger
- Klinik und Poliklinik für Nuklearmedizin, Klinikum der Universität München, München, Deutschland
| | - J Ricke
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - C C Cyran
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
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31
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Wang X, Colgan TJ, Hinshaw LA, Roberts NT, Bancroft LCH, Hamilton G, Hernando D, Reeder SB. T 1 -corrected quantitative chemical shift-encoded MRI. Magn Reson Med 2019; 83:2051-2063. [PMID: 31724776 DOI: 10.1002/mrm.28062] [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] [Received: 07/29/2019] [Revised: 09/27/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022]
Abstract
PURPOSE To develop and validate a T1 -corrected chemical-shift encoded MRI (CSE-MRI) method to improve noise performance and reduce bias for quantification of tissue proton density fat-fraction (PDFF). METHODS A variable flip angle (VFA)-CSE-MRI method using joint-fit reconstruction was developed and implemented. In computer simulations and phantom experiments, sources of bias measured using VFA-CSE-MRI were investigated. The effect of tissue T1 on bias using low flip angle (LFA)-CSE-MRI was also evaluated. The noise performance of VFA-CSE-MRI was compared to LFA-CSE-MRI for liver fat quantification. Finally, a prospective pilot study in patients undergoing gadoxetic acid-enhanced MRI of the liver to evaluate the ability of the proposed method to quantify liver PDFF before and after contrast. RESULTS VFA-CSE-MRI was accurate and insensitive to transmit B1 inhomogeneities in phantom experiments and computer simulations. With high flip angles, phase errors because of RF spoiling required modification of the CSE signal model. For relaxation parameters commonly observed in liver, the joint-fit reconstruction improved the noise performance marginally, compared to LFA-CSE-MRI, but eliminated T1 -related bias. A total of 25 patients were successfully recruited and analyzed for the pilot study. Strong correlation and good agreement between PDFF measured with VFA-CSE-MRI and LFA-CSE-MRI (pre-contrast) was observed before (R2 = 0.97; slope = 0.88, 0.81-0.94 95% confidence interval [CI]; intercept = 1.34, -0.77-1.92 95% CI) and after (R2 = 0.93; slope = 0.88, 0.78-0.98 95% CI; intercept = 1.90, 1.01-2.79 95% CI) contrast. CONCLUSION Joint-fit VFA-CSE-MRI is feasible for T1 -corrected PDFF quantification in liver, is insensitive to B1 inhomogeneities, and can eliminate T1 bias, but with only marginal SNR advantage for T1 values observed in the liver.
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Affiliation(s)
- Xiaoke Wang
- Department of Radiology, University of Wisconsin, Madison, Wisconsin.,Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin
| | - Timothy J Colgan
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Louis A Hinshaw
- Department of Radiology, University of Wisconsin, Madison, Wisconsin.,Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin
| | - Nathan T Roberts
- Department of Radiology, University of Wisconsin, Madison, Wisconsin.,Department of Electrical and Computer Engineering, University of Wisconsin, Madison, Wisconsin
| | | | - Gavin Hamilton
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California
| | - Diego Hernando
- Department of Radiology, University of Wisconsin, Madison, Wisconsin.,Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, Wisconsin.,Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin.,Department of Medical Physics, University of Wisconsin, Madison, Wisconsin.,Department of Medicine, University of Wisconsin, Madison, Wisconsin.,Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
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Hekimsoy İ, Güler E, Harman M, Elmas N. Characterization of adrenal lesions on chemical shift MRI: comparison of 1.5 T and 3 T MRI. Abdom Radiol (NY) 2019; 44:3359-3369. [PMID: 31129784 DOI: 10.1007/s00261-019-02067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare three chemical shift MRI techniques [two-dimensional (2D) dual gradient echo (dGRE), 3D VIBE, and 3D VIBE-Dixon] at 3 T and 2D dGRE technique at 1.5 T to assess their ability of detecting microscopic fat in adrenal adenomas and differentiating between adenomas and non-adenomas. METHODS Seventy-eight patients with 97 lesions (78 adenomas, 19 non-adenomas) underwent both 1.5 T and 3 T chemical shift MRI. The Wilcoxon signed-ranked test was used to determine if there was significant difference between the signal intensity index (SII) values of each technique to assess their ability to detect microscopic fat in adrenal adenomas. ROC analysis was performed for the SII values of each technique, the adrenal-to-spleen SI ratio of 2D dGRE technique at 3 T, and the fat fraction values of the 3D VIBE-Dixon technique to identify the optimal threshold for differentiation of adrenal adenomas from non-adenomas. RESULTS For detection of microscopic fat, the mean SII value of 2D dGRE technique at 1.5 T was significantly higher than that of the chemical shift imaging techniques at 3 T (p = 0.001). For discrimination of adenomas from non-adenomas, the area under the curve (AUC) and 95% confidence interval values of 2D dGRE technique at 1.5 T and 2D dGRE, 3D VIBE, 3D VIBE-Dixon techniques at 3 T were calculated as 1.00 (1.00-1.00), 0.991 (0.978-1.00), 0.999 (0.995-1.00), 0.993 (0.979-1.00), respectively, for the SII. CONCLUSION Chemical shift MRI at 1.5 T using the 2D dGRE technique provided the most accurate differentiation between adenomas and non-adenomas. However, there was no statistically significant difference between chemical shift imaging techniques at 1.5 T and 3 T.
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Affiliation(s)
- İlhan Hekimsoy
- Department of Radiology, Ege University School of Medicine, 35100, Izmir, Turkey.
| | - Ezgi Güler
- Department of Radiology, Ege University School of Medicine, 35100, Izmir, Turkey
| | - Mustafa Harman
- Department of Radiology, Ege University School of Medicine, 35100, Izmir, Turkey
| | - Nevra Elmas
- Department of Radiology, Ege University School of Medicine, 35100, Izmir, Turkey
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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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deSouza NM, Achten E, Alberich-Bayarri A, Bamberg F, Boellaard R, Clément O, Fournier L, Gallagher F, Golay X, Heussel CP, Jackson EF, Manniesing R, Mayerhofer ME, Neri E, O'Connor J, Oguz KK, Persson A, Smits M, van Beek EJR, Zech CJ. Validated imaging biomarkers as decision-making tools in clinical trials and routine practice: current status and recommendations from the EIBALL* subcommittee of the European Society of Radiology (ESR). Insights Imaging 2019; 10:87. [PMID: 31468205 PMCID: PMC6715762 DOI: 10.1186/s13244-019-0764-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
Observer-driven pattern recognition is the standard for interpretation of medical images. To achieve global parity in interpretation, semi-quantitative scoring systems have been developed based on observer assessments; these are widely used in scoring coronary artery disease, the arthritides and neurological conditions and for indicating the likelihood of malignancy. However, in an era of machine learning and artificial intelligence, it is increasingly desirable that we extract quantitative biomarkers from medical images that inform on disease detection, characterisation, monitoring and assessment of response to treatment. Quantitation has the potential to provide objective decision-support tools in the management pathway of patients. Despite this, the quantitative potential of imaging remains under-exploited because of variability of the measurement, lack of harmonised systems for data acquisition and analysis, and crucially, a paucity of evidence on how such quantitation potentially affects clinical decision-making and patient outcome. This article reviews the current evidence for the use of semi-quantitative and quantitative biomarkers in clinical settings at various stages of the disease pathway including diagnosis, staging and prognosis, as well as predicting and detecting treatment response. It critically appraises current practice and sets out recommendations for using imaging objectively to drive patient management decisions.
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Affiliation(s)
- Nandita M deSouza
- Cancer Research UK Imaging Centre, The Institute of Cancer Research and The Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | | | | | - Fabian Bamberg
- Department of Radiology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | | | | | | | - Claus Peter Heussel
- Universitätsklinik Heidelberg, Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Edward F Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rashindra Manniesing
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | | | - Emanuele Neri
- Department of Translational Research, University of Pisa, Pisa, Italy
| | - James O'Connor
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | | | | | - Marion Smits
- Department of Radiology and Nuclear Medicine (Ne-515), Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh Bioquarter, 47 Little France Crescent, Edinburgh, UK
| | - Christoph J Zech
- University Hospital Basel, Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
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Neuroimaging and Stereotactic Body Radiation Therapy (SBRT) for Spine Metastasis. Top Magn Reson Imaging 2019; 28:85-96. [PMID: 31022051 DOI: 10.1097/rmr.0000000000000199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Historically, management options for spinal metastases include surgery for stabilization and decompression and/or external beam radiation therapy (EBRT). EBRT is palliative in nature, as it lacks accurate targeting such that the prescribed radiation doses must be limited in order to maintain safety. Modern advancement in imaging and radiotherapy technology have facilitated the development of stereotactic body radiation therapy (SBRT), which provides increased targeted precision for radiation delivery to tumors resulting in lower overall toxicity, particularly to regional structures such as the spinal cord and esophagus, while delivering higher, more effective, and radically ablative radiation doses.Over the past decade, SBRT has been increasingly utilized as a method of treating spinal metastases either as the primary modality or following surgical intervention in both de novo and reirradiation setting. Numerous studies suggest that SBRT is associated with an 80% to 90% rate of 1-year local control across clinical scenarios. For example, studies of SBRT as the primary treatment modality suggest long-term local control rate of 80% to 95% for spinal metastases. Similarly, SBRT in the adjuvant setting following surgery is associated with local control rates ranging from 70% to 100%. Furthermore, because SBRT allows for lower dose to the spinal cord, it has also been used in patients who have had prior radiation therapy, with studies showing 66% to 93% local control in this scenario.
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Schieda N, Davenport MS, Pedrosa I, Shinagare A, Chandarana H, Curci N, Doshi A, Israel G, Remer E, Wang J, Silverman SG. Renal and adrenal masses containing fat at MRI: Proposed nomenclature by the society of abdominal radiology disease-focused panel on renal cell carcinoma. J Magn Reson Imaging 2019; 49:917-926. [PMID: 30693607 DOI: 10.1002/jmri.26542] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022] Open
Abstract
This article proposes a consensus nomenclature for fat-containing renal and adrenal masses at MRI to reduce variability, improve understanding, and enhance communication when describing imaging findings. The MRI appearance of "macroscopic fat" occurs due to a sufficient number of aggregated adipocytes and results in one or more of: 1) intratumoral signal intensity (SI) loss using fat-suppression techniques, or 2) chemical shift artifact of the second kind causing linear or curvilinear India-ink (etching) artifact within or at the periphery of a mass at macroscopic fat-water interfaces. "Macroscopic fat" is most commonly observed in adrenal myelolipoma and renal angiomyolipoma (AML) and only rarely encountered in other adrenal cortical tumors and renal cell carcinomas (RCC). Nonlinear noncurvilinear signal intensity loss on opposed-phase (OP) compared with in-phase (IP) chemical shift MRI (CSI) may be referred to as "microscopic fat" and is due to: a) an insufficient amount of adipocytes, or b) the presence of fat within tumor cells. Determining whether the signal intensity loss observed on CSI is due to insufficient adipocytes or fat within tumor cells cannot be accomplished using CSI alone; however, it can be inferred when other imaging features strongly suggest a particular diagnosis. Fat-poor AML are homogeneously hypointense on T2 -weighted (T2 W) imaging and avidly enhancing; signal intensity loss at OP CSI is uncommon, but when present is usually focal and is caused by an insufficient number of adipocytes within adjacent voxels. Conversely, clear-cell RCC are heterogeneously hyperintense on T2 W imaging and avidly enhancing, with the signal intensity loss observed on OP CSI being typically diffuse and due to fat within tumor cells. Adrenal adenomas, adrenal cortical carcinoma, and adrenal metastases from fat-containing primary malignancies also show signal intensity loss on OP CSI due to fat within tumor cells and not from intratumoral adipocytes. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;49:917-926.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, From the University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Ivan Pedrosa
- Department of Radiology, UT Southwestern, Dallas, Texas, USA
| | - Atul Shinagare
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hersch Chandarana
- Department of Radiology, NYU School of Medicine, New York, New York, USA
| | - Nicole Curci
- Department of Radiology, Michigan University, Ann Arbor, Michigan, USA
| | - Ankur Doshi
- Department of Radiology, NYU School of Medicine, New York, New York, USA
| | - Gary Israel
- Department of Radiology, Yale University, New Haven, Connecticut, USA
| | - Erick Remer
- Department Radiology and Diagnostic Imaging, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jane Wang
- Department of Radiology, UCSF, San Francisco, California, USA
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Albano D, Agnello F, Midiri F, Pecoraro G, Bruno A, Alongi P, Toia P, Di Buono G, Agrusa A, Sconfienza LM, Pardo S, La Grutta L, Midiri M, Galia M. Imaging features of adrenal masses. Insights Imaging 2019; 10:1. [PMID: 30684056 PMCID: PMC6349247 DOI: 10.1186/s13244-019-0688-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/03/2019] [Indexed: 12/14/2022] Open
Abstract
The widespread use of imaging examinations has increased the detection of incidental adrenal lesions, which are mostly benign and non-functioning adenomas. The differentiation of a benign from a malignant adrenal mass can be crucial especially in oncology patients since it would greatly affect treatment and prognosis. In this setting, imaging plays a key role in the detection and characterization of adrenal lesions, with several imaging tools which can be employed by radiologists. A thorough knowledge of the imaging features of adrenal masses is essential to better characterize these lesions, avoiding a misinterpretation of imaging findings, which frequently overlap between benign and malignant conditions, thus helping clinicians and surgeons in the management of patients. The purpose of this paper is to provide an overview of the main imaging features of adrenal masses and tumor-like conditions recalling the strengths and weaknesses of imaging modalities commonly used in adrenal imaging.
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Affiliation(s)
- Domenico Albano
- Unità di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Francesco Agnello
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Federico Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giusy Pecoraro
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Alberto Bruno
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Service, Fondazione Istituto G. Giglio, Contrada Pietrapollastra-Pisciotto, 90015, Cefalu, Italy
| | - Patrizia Toia
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giuseppe Di Buono
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Antonino Agrusa
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Luca Maria Sconfienza
- Unità di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Salvatore Pardo
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Ludovico La Grutta
- Department PROMISE, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Galia
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
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Can Texture Analysis Be Used to Distinguish Benign From Malignant Adrenal Nodules on Unenhanced CT, Contrast-Enhanced CT, or In-Phase and Opposed-Phase MRI? AJR Am J Roentgenol 2019; 212:554-561. [PMID: 30620676 DOI: 10.2214/ajr.18.20097] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study is to determine whether second-order texture analysis can be used to distinguish lipid-poor adenomas from malignant adrenal nodules on unenhanced CT, contrast-enhanced CT (CECT), and chemical-shift MRI. MATERIALS AND METHODS In this retrospective study, 23 adrenal nodules (15 lipid-poor adenomas and eight adrenal malignancies) in 20 patients (nine female patients and 11 male patients; mean age, 59 years [range, 15-80 years]) were assessed. All patients underwent unenhanced CT, CECT, and chemical-shift MRI. Twenty-one second-order texture features from the gray-level cooccurrence matrix and gray-level run-length matrix were calculated in 3D. The mean values for 21 texture features and four imaging features (lesion size, unenhanced CT attenuation, CECT attenuation, and signal intensity index) were compared using a t test. The diagnostic performance of texture analysis versus imaging features was also compared using AUC values. Multivariate logistic regression models to predict malignancy were constructed for texture analysis and imaging features. RESULTS Lesion size, unenhanced CT attenuation, and the signal intensity index showed significant differences between benign and malignant adrenal nodules. No significant difference was seen for CECT attenuation. Eighteen of 21 CECT texture features and nine of 21 unenhanced CT texture features revealed significant differences between benign and malignant adrenal nodules. CECT texture features (mean AUC value, 0.80) performed better than CECT attenuation (mean AUC value, 0.60). Multivariate logistic regression models showed that CECT texture features, chemical-shift MRI texture features, and imaging features were predictive of malignancy. CONCLUSION Texture analysis has a potential role in distinguishing benign from malignant adrenal nodules on CECT and may decrease the need for additional imaging studies in the workup of incidentally discovered adrenal nodules.
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Allam MFAB, Elian MMM, Rahman AMA, Allam FAFAB. The utility of chemical shift imaging and related fat suppression as standalone technique in cryptorchidism using low field MRI. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Using the modified Dixon technique to evaluate incidental adrenal lesions on 3 T MRI. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Thomas AJ, Habra MA, Bhosale PR, Qayyum AA, Ahmed K, Vicens R, Elsayes KM. Interobserver agreement in distinguishing large adrenal adenomas and adrenocortical carcinomas on computed tomography. Abdom Radiol (NY) 2018; 43:3101-3108. [PMID: 29671009 DOI: 10.1007/s00261-018-1603-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Large adrenal masses pose a diagnostic dilemma. The purpose of this study was twofold: first, to assess the degree of interobserver agreement in evaluating the morphology of pathologically proven adrenal adenomas and adrenocortical carcinomas larger than 4 cm in diameter; and second, to identify morphologic characteristics that correlated with the pathologic diagnosis. MATERIALS AND METHODS For this blinded, retrospective study, we collected cases of 25 adrenal adenomas and 33 adrenocortical carcinomas measuring larger than 4 cm. Two radiologists evaluated morphologic characteristics of the lesions on CT. Interobserver agreement was evaluated using kappa statistics, and the correlation of imaging characteristics with the diagnosis was evaluated using a logistic regression model. RESULTS We found the highest interobserver agreement in the assessment of precontrast attenuation (Κ = 0.81) as well as substantial agreement in determining the shape and the presence of calcifications (Κ = 0.69 and 0.74, respectively). Readers agreed less often regarding the presence of fat (Κ = 0.48), as well as regarding the presence of necrosis, heterogeneity, and the overall impression (Κ = 0.15, 0.24, and 0.26, respectively). CT characteristics correlated with benignity included round shape (p = 0.02), an overall radiologic impression of a benign lesion (p < 0.0001), the presence of fat (p = 0.01), and a precontrast attenuation of less than 10 Hounsfield units (p < 0.0001). The latter two of these characteristics were highly specific for benign pathology (93% and 100%, respectively). CONCLUSION Our study suggests that CT has the ability to consistently identify characteristics significantly correlated with benign vs. malignant adrenal tumors.
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Affiliation(s)
- Aaron J Thomas
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Mouhammed A Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aliya A Qayyum
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kareem Ahmed
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rafael Vicens
- Department of Radiology, Hospital Auxilio Mutuo, San Juan, PR, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Diagnostic Performance of In-Phase and Opposed-Phase Chemical-Shift Imaging for Differentiating Benign and Malignant Vertebral Marrow Lesions: A Meta-Analysis. AJR Am J Roentgenol 2018; 211:W188-W197. [DOI: 10.2214/ajr.17.19306] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ecénarro-Montiel A, Baleato-González S, Santiago-Pérez MI, Sánchez-González J, Montesinos P, García-Figueiras R. Using the modified Dixon technique to evaluate incidental adrenal lesions on 3T MRI. RADIOLOGIA 2018; 60:485-492. [PMID: 30078508 DOI: 10.1016/j.rx.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To use the mDIXON-Quant sequence to quantify the fat fraction of adrenal lesions discovered incidentally on CT studies. To analyze the relation between the signal loss between in-phase and out-of-phase T1-weighted sequences and the fat fraction in mDIXON-Quant. To compare the sensitivity and specificity of the two methods for characterizing adrenal lesions. MATERIAL AND METHODS This prospective descriptive study included 31 patients with incidentally discovered adrenal lesions evaluated with 3T MRI using in-phase and out-of-phase T1-weighted sequences and mDIXON-Quant; the fat fraction of the adrenal lesions was measured by mDIXON-Quant and by calculating the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences. RESULTS The percentage of signal loss was significantly higher in the group of patients with adenoma (61.3% ± 20.4% vs. 5.1% ± 5.8% in the group without adenoma, p<0.005). The mean fat fraction measured by mDIXON-Quant was also higher for the adenomas (26.9% ±10.8% vs. 3.4% ± 3.0%, p<0.005).The area under the ROC curve was 0.99 (0.96 - 1.00) for the percentage of signal loss and 0.98 (0.94 - 1.00) for the fat fraction measured by mDIXON-Quant. The cutoffs obtained were 24.42% for the percentage of signal loss and 9.2% for the fat fraction measured by mDIXON-Quant. The two techniques had the same values for diagnostic accuracy: sensitivity 96% (79.6 - 99.9), specificity 100% (39.8 - 100.0), positive predictive value 100% (85.8 - 100.0), and negative predictive value 80% (28.4 - 99.5). CONCLUSION The fat fraction measured by the modified Dixon technique can differentiate between adenomas and other adrenal lesions with the same sensitivity and specificity as the percentage of signal loss between in-phase and out-of-phase T1-weighted sequences.
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Affiliation(s)
- A Ecénarro-Montiel
- Servicio de Radiología, Hospital Clínico Universitario, Santiago de Compostela, España.
| | - S Baleato-González
- Servicio de Radiología, Hospital Clínico Universitario, Santiago de Compostela, España
| | - M I Santiago-Pérez
- Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, España
| | | | - P Montesinos
- Clinic Scientist, Philips Iberia, Madrid, España
| | - R García-Figueiras
- Servicio de Radiología, Hospital Clínico Universitario, Santiago de Compostela, España
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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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Abstract
Various pathologies can affect the adrenal gland. Noninvasive cross-sectional imaging is used for evaluating adrenal masses. Accurate diagnosis of adrenal lesions is critical, especially in cancer patients; the presence of adrenal metastasis changes prognosis and treatment. Characterization of adrenal lesions predominantly relies on morphologic and physiologic features to enable correct diagnosis and management. Key diagnostic features to differentiate benign and malignant adrenal lesions include presence/absence of intracytoplasmic lipid, fat cells, hemorrhage, calcification, or necrosis and locoregional and distant disease; enhancement pattern and washout values; and lesion size and stability. This article reviews a spectrum of adrenal pathologies.
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Affiliation(s)
- Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA.
| | - Sally Emad-Eldin
- Department of Diagnostic and Intervention Radiology, Cairo University, Kasr Al-Ainy Street, Cairo 11652, Egypt
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA
| | - Corey T Jensen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA
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Abstract
Fatty liver disease is characterized histologically by hepatic steatosis, the abnormal accumulation of lipid in hepatocytes. It is classified into alcoholic fatty liver disease and nonalcoholic fatty liver disease, and is an increasingly important cause of chronic liver disease and cirrhosis. Assessing the severity of hepatic steatosis in these conditions is important for diagnostic and prognostic purposes, as hepatic steatosis is potentially reversible if diagnosed early. The criterion standard for assessing hepatic steatosis is liver biopsy, which is limited by sampling error, its invasive nature, and associated morbidity. As such, noninvasive imaging-based methods of assessing hepatic steatosis are needed. Ultrasound and computed tomography are able to suggest the presence of hepatic steatosis based on imaging features, but are unable to accurately quantify hepatic fat content. Since Dixon's seminal work in 1984, magnetic resonance imaging has been used to compute the signal fat fraction from chemical shift-encoded imaging, commonly implemented as out-of-phase and in-phase imaging. However, signal fat fraction is confounded by several factors that limit its accuracy and reproducibility. Recently, advanced chemical shift-encoded magnetic resonance imaging methods have been developed that address these confounders and are able to measure the proton density fat fraction, a standardized, accurate, and reproducible biomarker of fat content. The use of these methods in the liver, as well as in other abdominal organs such as the pancreas, adrenal glands, and adipose tissue will be discussed in this review.
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Accuracy of Opposed-phase Magnetic Resonance Imaging for the Evaluation of Treated and Untreated Spinal Metastases. Acad Radiol 2018; 25:877-882. [PMID: 29398437 DOI: 10.1016/j.acra.2017.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/18/2017] [Accepted: 11/29/2017] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES To assess whether the accuracy of opposed-phase magnetic resonance (MR) imaging to differentiate spinal metastases from benign lesions is influenced by treatment. MATERIALS AND METHODS We retrospectively evaluated 25 benign lesions, 25 untreated spinal metastases, and 89 treated spinal metastases in 101 patients who underwent opposed-phase MR spine imaging at our institution. The largest possible region of interest was placed over the lesion in question on out-of-phase and in-phase MR sequences, and the signal intensity ratio (SIR) of the lesions was calculated. The SIRs were compared between benign, untreated, and treated lesions. Receiver operator characteristic (ROC) curves were used to identify the optimal threshold to differentiate benign lesions from untreated spinal metastases, and the accuracy of this threshold was assessed for treated spinal metastases, chemotherapy-treated spinal metastases, and radiated spinal metastases. RESULTS Benign lesions had lower mean SIR than untreated (P = 2.4 × 10-8, 95% confidence interval [0.29, 0.51]) and treated spinal metastases (P = .51; 95% confidence interval [-0.13, 0.06]). A cutoff SIR of 0.856 had an accuracy of 88.00% for untreated lesions, 77.48% for previously treated lesions, and 70.45% for previously radiated lesions. The ROC curve to differentiate benign lesions from radiated spinal metastases was significantly different from the ROC curve to differentiate benign lesions from untreated spinal metastases (P = .0180). The ROC curve to differentiate benign lesions from lesions treated with chemotherapy only was significantly different from the ROC curve to differentiate between benign lesions and radiated spinal metastases (P = .041). CONCLUSIONS Opposed-phase imaging is less accurate for treated spinal metastases, in particular after radiation.
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Priola AM, Priola SM, Gned D, Giraudo MT, Veltri A. Nonsuppressing normal thymus on chemical-shift MR imaging and anterior mediastinal lymphoma: differentiation with diffusion-weighted MR imaging by using the apparent diffusion coefficient. Eur Radiol 2017; 28:1427-1437. [PMID: 29143106 DOI: 10.1007/s00330-017-5142-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/14/2017] [Accepted: 10/18/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To prospectively evaluate usefulness of the apparent diffusion coefficient (ADC) in differentiating anterior mediastinal lymphoma from nonsuppressing normal thymus on chemical-shift MR, and to look at the relationship between patient age and ADC. METHODS Seventy-three young subjects (25 men, 48 women; age range, 9-29 years), who underwent chemical-shift MR and diffusion-weighted MR were divided into a normal thymus group (group A, 40 subjects), and a lymphoma group (group B, 33 patients). For group A, all subjects had normal thymus with no suppression on opposed-phase chemical-shift MR. Two readers measured the signal intensity index (SII) and ADC. Differences in SII and ADC between groups were tested using t-test. ADC was correlated with age using Pearson correlation coefficient. RESULTS Mean SII±standard deviation was 2.7±1.8% for group A and 2.2±2.4% for group B, with no significant difference between groups (P=.270). Mean ADC was 2.48±0.38x10-3mm2/s for group A and 1.24±0.23x10-3mm2/s for group B. A significant difference between groups was found (P<.001), with no overlap in range. Lastly, significant correlation was found between age and ADC (r=0.935, P<.001) in group A. CONCLUSIONS ADC of diffusion-weighted MR is a noninvasive and accurate parameter for differentiating lymphoma from nonsuppressing thymus on chemical-shift MR in young subjects. KEY POINTS • SII cannot differentiate mediastinal lymphoma from nonsuppressing normal thymus at visual assessment • ADC is useful for distinguishing nonsuppressing normal thymus from mediastinal lymphoma • ADC is more accurate than transverse-diameter and surface-area in this discrimination • ADC of normal thymus is age dependent and increases with increasing age.
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Affiliation(s)
- Adriano Massimiliano Priola
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy.
| | - Sandro Massimo Priola
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Dario Gned
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Maria Teresa Giraudo
- Department of Mathematics, "Giuseppe Peano", University of Torino, Via Carlo Alberto 10, 10123, Torino, Italy
| | - Andrea Veltri
- Department of Diagnostic Imaging, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
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Role of quantitative chemical shift magnetic resonance imaging and chemical shift subtraction technique in discriminating adenomatous from non adenomatous adrenal solid lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2016.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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