Contrast-Enhanced Sonography of Adrenal Masses: Differentiation of Adenomas and Nonadenomatous Lesions

Friedrich‐Rust, Mireen; Schneider, Guenther; Bohle, Rainer M.; Herrmann, Eva; Sarrazin, C; Zeuzem, Stefan; Bojunga, Joerg

doi:10.2214/ajr.07.3565

Cited by 47 publications

(32 citation statements)

References 26 publications

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“…The adrenal glands are usually uniformly hypoechoic on ultrasound scans, and they are sometimes difficult to distinguish from vascular structures in the region without Doppler ultrasonography. 27 It is not unusual for the size and shape of the adrenal glands to vary from this general description. The phrenicoabdominal artery passes dorsal to and the phrenicoabdominal vein ventral to each adrenal gland (see Figures 15-2, C, E, and G).…”

Section: Normal Anatomy and Ultrasound Appearancementioning

confidence: 95%

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Adrenal Glands

Nyland¹,

Neelis²,

Mattoon³

2015

Small Animal Diagnostic Ultrasound

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Section: Normal Anatomy and Ultrasound Appearancementioning

confidence: 95%

“…However, other types of tumors also occur. 27,45,57 Mineralization is less common with pheochromocytomas but may occur in approximately 10% of the cases. 38 A nodule or mass causing unilateral enlargement of the adrenal gland is usually identified (see Figures 15-9 and 15-10).…”

Section: Adrenal Gland Enlargement and Massesmentioning

confidence: 99%

Adrenal Glands

Nyland¹,

Neelis²,

Mattoon³

2015

Small Animal Diagnostic Ultrasound

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“…Recent studies documented the use of the contrast-enhanced doppler sonography on characterization of adrenal masses (20,21). Friedrich-Rust et al found an early arterial contrast enhancement and rapid washout in all patients with primary and secondary malignant lesions of adrenal gland and in only 22 % of patients with benign adrenal masses at contrast-enhanced sonography.…”

Section: Diagnosismentioning

confidence: 99%

“…Friedrich-Rust et al found an early arterial contrast enhancement and rapid washout in all patients with primary and secondary malignant lesions of adrenal gland and in only 22 % of patients with benign adrenal masses at contrast-enhanced sonography. In the diagnosis of malignant adrenal mass, the sensitivity and specifi city of contrast-enhanced sonography were 100 % and 82 %, respectively (21). F FDG -PET is another method of distinguishing metastases from benign adrenal lesions.…”

Section: Diagnosismentioning

confidence: 99%

Adrenal metastases

Wagnerova¹,

Lazúrová²,

Felsoci³

2013

BLL

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Abstract:The adrenal gland is a frequent location for metastatic spread of a various number of malignant tumors. Among all tumors, carcinoma of lung, breast, ovary and malignant melanoma count to the most frequent ones. In nononcological and unselected populations, the prevalence of adrenal metastases is 0-21 %. The metastases are mostly discovered in patients during their follow-up carried out in consequence of their antecedent malignant disease. A malignant disease in adrenal gland may occasionally manifest as a solitary metastasis referred to as adrenal incidentaloma. If the malignant disease is disseminated at the time of adrenal mass diagnosis, no further differentiation of lesion is necessary as it does not infl uence the further therapeutic process. If the dissemination is not present, further differentiation of adrenal lesion is essential. CT and MRI characteristics of the adrenal mass play the key role in the differential diagnosis. The examination of adrenal overproduction is not necessary in case of known adrenal metastasis except when performing tests in order to rule out the catecholamine overproduction. In case of bilateral metastases, adrenal insuffi ciency should be also excluded. Surgical treatment is indicated in cases of solitary metastasis. The further management of patients with adrenal metastases belongs to the oncologist. The prognosis of the disease is usually very poor with average survival rate of three months (Fig. 2 The adrenal gland is a frequent location for metastatic spread of a various number of malignant tumors. Theoretically, every primary malignancy may disseminate into adrenal glands. Among all tumors, carcinoma of lung, breast, ovary and malignant melanoma count to the most frequent ones. Stomach cancer represents a less common cause of adrenal metastases while the potential of oncocytoma to spread into adrenal glands has been described as rare (1). Malignant lymphoma is being described as relatively frequent cause of bilateral adrenal infi ltration. EpidemiologyIn nononcological and unselected populations, the prevalence of adrenal metastases is 0-21 %. In oncological patients, the prevalence is referred to be higher, namely in range of 32-73 % (2). Lenert et al report similar rates based on their fi nding that 52 % of adrenal masses in 91patients with a recently diagnosed extraadrenal malignancy were metastatic (3). Meta-analysis of Cawood et al has shown that the estimated real prevalence is approximately 2.3 % while higher occurrence is usually overestimated and originates from differently selected groups (4).Autopsy studies in patients with malignant tumors of epithelial character have documented the prevalence of metastases to be even 27 % (5, 6). The occurrence rates of adrenal metastases in patients with breast carcinoma and lung carcinoma are 39 % and 35 %, respectively (5, 6, 7). Adrenal involvement is found in 46.8-50 % of cases with malignant melanoma (8, 9). The adrenal gland is the second most common site of metastases from hepatocellular carcinoma (10). Lympho...

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“…17). A study by Friedrich-Rust et al 72 showed that, on B-mode US, malignant lesions were significantly more heterogeneous in echotexture (71% vs 18%) and more hypervascular on Doppler images (57% of malignant lesion vs 7% of benign lesions). Another determinant of malignancy in their study was larger diameter of more than 4 cm with sensitivity and specificity of 71% and 79%, respectively.…”

Section: Incidentalomas On Ultrasoundmentioning

confidence: 99%

Adrenal Masses

Zaheer¹,

Fishman²,

Macura³

2013

Journal of Computer Assisted Tomography

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Adrenal masses are among the most common incidentally discovered lesions on cross-sectional imaging with estimated incidence of approximately 5%. In addition, adrenal lesions can also be detected as part of an endocrinology workup with suspicion of a functional adrenal mass. Regardless of the source of detection, it is crucial to differentiate a benign from a malignant process and furthermore utilize characteristic imaging appearance of different adrenal masses to facilitate diagnosis and guide management. There are numerous imaging protocols and postprocessing methods for evaluation of adrenal masses with high sensitivity and specificity with small differences between institutions. Currently, the most widely used imaging modality for evaluation of adrenal mass is computed tomography without and with contrast washout assessment. In this article, we review diagnostic approaches to adrenal masses using computed tomography and magnetic resonance imaging techniques and present imaging strategies utilized at our institution. The advantages and challenges of these imaging modalities for evaluation of adrenal pathologies are discussed.

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Contrast-Enhanced Sonography of Adrenal Masses: Differentiation of Adenomas and Nonadenomatous Lesions

Abstract: Contrast-enhanced sonography can be used to differentiate adenomas and nonadenomatous lesions with a sensitivity comparable with that of CT and MRI and may be a cost-effective method for preselection of patients with adrenal masses.

Cited by 47 publications

References 26 publications

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