Clinical impact of hyperattenuation of adrenal glands on contrast-enhanced computed tomography of polytraumatised patients

Schek, Julia; Macht, Stephan; Klasen-Sansone, Janina; Heusch, Philipp; Kröpil, Patric; Witte, Ingo; Antoch, Gerald; Lanzman, Rotem S.

doi:10.1007/s00330-013-3050-4

Cited by 15 publications

(16 citation statements)

References 21 publications

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“…Data for differences between AUC and significance levels for comparison (p) Absolute adrenal radiodensities in the portal venous phase can also be used to predict patients' mortality with slightly lower power for prediction (MCC 0.64-0.71). As applied in previous studies [10,11], the adrenal-to-IVC ratio was less suitable for mortality prediction, especially if a suggested adrenal-to-IVC ratio of 1 was applied.…”

Section: Discussionmentioning

confidence: 93%

“…Several study groups defined adrenal enhancement as bilateral adrenal attenuation values higher than those of the inferior vena cava (IVC) [2][3][4][5][7][8][9][10][11]. Boos et al [10] and Schek et al [11] showed that adrenal enhancement is associated with a poor outcome. However, Schek's and Boos' inclusion of the IVC in their definition of hyperattenuating raises questions about IVC's suitability as a reference region.…”

Section: Introductionmentioning

confidence: 99%

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Bilateral adrenal enhancement revised—adrenal-to-spleen ratio as an appropriate mortality predictor

Winzer¹,

Martin²,

Kaiser³

et al. 2020

Abdom Radiol

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Purpose To investigate whether adrenal gland radiodensities alone or set in relation to either the inferior vena cava (IVC) or the spleen can predict hospital mortality in intensive care unit patients. Methods One hundred thirty-three intensive care patients (90 males, age: 66.3 ± 14.5 years) with an acute clinical deterioration were included in this retrospective analysis. CT attenuation (Hounsfield units) of adrenal glands, IVC, and spleen was evaluated by 2 radiologists separately. Adrenal-to-IVC and adrenal-to-spleen ratios were calculated. Receiver operating characteristic (ROC) analysis, combined with the Matthews correlation coefficient (MCC) as a classifier, was used to assess which parameter is the most suitable for short-term, intermediate-term, and overall mortality prediction. Interrater agreement was assessed using intraclass correlation coefficient (ICC). Results The highest discriminative power to distinguish between deceased and survivors was found for the adrenal gland-to-spleen ratio for the 72-h mortality. A threshold of > 1.4 predicted 72-h mortality with a sensitivity of 79.31% and a specificity of 98.08% (area und the curve (AUC) = 0.94; p < 0.0001; MCCs = 0.81). The positive likelihood ratio was 41; the positive predictive value was 92.20%. Adrenal gland-to-spleen ratio was also best suited to predict the 24-h and overall mortality. ICCs of HU measurements in adrenal gland, IVC, and spleen indicated a high interrater agreement (ICC 0.95–0.99). Conclusions To conclude, the adrenal-to-spleen ratio in CT in portal venous phase may serve as an imaged-based predictor for short, intermediate, and overall mortality and as reproducible prognostic marker for patient outcome.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Bilateral adrenal enhancement revised—adrenal-to-spleen ratio as an appropriate mortality predictor

Winzer¹,

Martin²,

Kaiser³

et al. 2020

Abdom Radiol

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“…Over time, hematomas tend to decrease in size and attenuation, although adrenal enlargement can be observed in the first few weeks following trauma (36). Within weeks to months, the hematomas decrease in size tending to become centrally hypoattenuating.…”

Section: Ct Featuresmentioning

confidence: 99%

Multi-detector computed tomography in the diagnosis and characterization of adrenal gland traumatic injuries

et al. 2019

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Adrenal gland injuries after a blunt abdominal trauma are rare events and represent important indicators for severe trauma. Multidetector CT evolution with high volumetric resolution and fast acquisition with the use of multiplanar reformatted (MPR) visualization allows for an accurate and fast diagnosis of the adrenal gland for post-traumatic pathologies. While, before its introduction the diagnosis was made mainly postmortem or during surgery. Adrenal injuries are unilateral up to 90% of the cases involving most commonly the right gland; thoracoabdominal organs injuries are often also associated. Bilateral adrenal lesions are asymptomatic, potentially leading to the development of acute adrenal insufficiency. The purpose of the present review was to determine the prevalence, the mechanism of injury and the different CT appearances of adrenal trauma. Prognosis and management of adrenal injury will also be reviewed.

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“…Normally the density of the adrenal glands in contrastenhanced computed tomography (CT) equals the density of other solid abdominal organs such as liver or spleen and is decreased compared to the inferior vena cava (IVC). Density measurements of the adrenal glands are often performed to evaluate adrenal masses [5], but only a few studies have focused on adrenal enhancement in critically ill patients [4,6]. In a recent study, Schek et al [6] demonstrated an association of hyperattenuating adrenal glands with a higher mortality in polytraumatized patients, indicating that hyperattenuation of the adrenal glands might be considered as a predictor of poor clinical outcome.…”

Section: R Esum Ementioning

confidence: 99%

Contrast-Enhanced Computed Tomography in Intensive Care Unit Patients with Acute Clinical Deterioration: Impact of Hyperattenuating Adrenal Glands

Boos

Schek²,

Kröpil

et al. 2017

Can Assoc Radiol J

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Clinical impact of hyperattenuation of adrenal glands on contrast-enhanced computed tomography of polytraumatised patients

Cited by 15 publications

References 21 publications

Bilateral adrenal enhancement revised—adrenal-to-spleen ratio as an appropriate mortality predictor

Bilateral adrenal enhancement revised—adrenal-to-spleen ratio as an appropriate mortality predictor

Multi-detector computed tomography in the diagnosis and characterization of adrenal gland traumatic injuries

Contrast-Enhanced Computed Tomography in Intensive Care Unit Patients with Acute Clinical Deterioration: Impact of Hyperattenuating Adrenal Glands

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