CT time-attenuation washout curves of adrenal adenomas and nonadenomas.

Korobkin, M; Brodeur, F J; Francis, Isaac R.; Quint, Leslie E.; Dunnick, N. Reed; Londy, Frank J.

doi:10.2214/ajr.170.3.9490968

Cited by 356 publications

(206 citation statements)

References 8 publications

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“…In such cases, where the contrast-enhanced phase does not allow for an accurate diagnosis, it is recommended that the patient be recalled for a new evaluation with a non-contrast-enhanced phase and, if necessary, with a protocol directed towards the study of adrenal nodule, thus without any direct clinical impact (23) . However, it is important to also consider that, in spite of incidental adrenal nodules being considered of high clinical relevance when indeterminate (15) , it has been demonstrated that, in non-oncologic patients, the occurrence of malignancy is extremely rare in such group of lesions (24) .…”

Section: Discussionmentioning

confidence: 99%

When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

et al. 2013

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Objective: To evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis. Keywords: Computed tomography; Ionizing radiation; Abdomen; Contrast media.Objetivo: Avaliar a necessidade da fase sem contraste nos exames de tomografia computadorizada de abdome. Materiais e Métodos: Foi realizado estudo retrospectivo, transversal e observacional, no qual foram avaliados 244 exames consecutivos de tomografia computadorizada de abdome realizados sem e com a injeção do meio de contraste. Procurou-se estabelecer, mediante análise das fases com o uso do meio de contraste (primeira análise), e posteriormente com o acréscimo da avaliação da fase sem meio de contraste (segunda análise), o diagnóstico principal e os secundá-rios em função da indicação clínica do exame (estadiamento tumoral, abdome agudo, pesquisa de coleção abdominal e hepatocarcinoma, entre outros). Foram medidas as mudanças nos diagnósticos principais e secundários, decorrentes do acréscimo da fase sem meio de contraste. Resultados: Dos 244 casos avaliados, apenas um (0,4%; p > 0,999; não significante) teve o seu diagnóstico modificado após a leitura da fase sem meio de contraste. Com relação aos diagnósticos secundários, 35 exames (14%) foram modificados após a segunda análise, sendo: nefrolitíase (10%), esteatose (3%), nódulo de adrenal (0,7%) e colelitíase (0,3%). Conclusão: Para as indicações clínicas de estadiamento tumoral, abdome agudo, pesquisa de coleção abdominal e carcinoma hepatocelular, a supressão da fase sem meio de contraste não apresentou impacto diagnóstico expressivo. Unitermos: Tomografia computadorizada; Radiação ionizante; Abdome; Meio de contraste.

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Section: Discussionmentioning

confidence: 99%

When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

et al. 2013

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“…mas do not contain sufficient lipid to be of low density on unenhanced CT, i.e., the lipid-poor adenomas [5][6][7]. Histogram analysis (evaluating microscopic levels of lipid on a pixel-by-pixel basis) has been used to differentiate adenomas from metastases on non-contrast-and contrastenhanced CT [8].…”

Section: Key Pointsmentioning

confidence: 99%

Adrenal Imaging

Francis¹,

Mayo-Smith²

2018

IDKD Springer Series

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“…Adenomas and metastases both enhance rapidly after injection of iodinated contrast or gadolinium, but contrast material typically washes out more rapidly in adenomas than metastases, allowing for washout value calculations. 39 For CT, absolute percentage washout values (noncontrast compared with delayed) ‡ 60% or relative percentage washout values (enhanced compared with delayed) > 40% are considered diagnostic for adrenal adenoma (Fig. 2), with reported sensitivity of 83% to 93% and specificity of 93% to 98%.…”

Section: Lung Cancer and Adrenal Metastasismentioning

confidence: 99%

Fluorodeoxyglucose-Positron-Emission Tomography/Computed Tomography Imaging for Adrenal Masses in Patients with Lung Cancer: Review and Diagnostic Algorithm

Stone

Wymer

Canales

2014

Journal of Endourology

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Background and Purpose: Positron-emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) is used as first-line staging for patients with newly diagnosed non-small cell lung cancer (NSCLC). Our purpose was to review the accuracy of FDG-PET/CT to predict adrenal gland metastasis, explain the causes for false-positive PET, and provide a diagnostic algorithm. Patients and Methods: Two patients with incidentally discovered lung masses were found to have hypermetabolic adrenal activity by FDG-PET/CT with maximal standard uptake value (SUV) of 4.5 and 6.5. A MEDLINE search was performed on the topic of FDG-PET/CT, adrenal gland metastasis, and NSCLC. Literature was reviewed with regard to diagnosis, accuracy, outcomes, and alternative imaging or diagnostic strategies. Results: Both patients underwent transabdominal laparoscopic adrenalectomy and were found to have nodular hyperplasia without evidence of adrenal tumor. A total of seven articles containing 343 patients were identified as having pertinent oncologic information for NSCLC patients with adrenal lesions. Sensitivity and specificity of PET/CT for distant metastasis was 94% and 85%, respectively, but only 13% (44/343) of these patients had histologically confirmed adrenal diagnoses. Based on this, a diagnostic algorithm was created to aid in decision making. Conclusions: Although PET/CT has high sensitivity and specificity for adrenal metastasis in the setting of NSCLC, adrenal biopsy or other secondary imaging should be considered to confirm the finding. Adrenalectomy in lieu of biopsy may have both diagnostic and therapeutic benefit in cases where the adrenal mass is ‡ 10 mm with high PET maximum SUV ( ‡ 3.1) and SUV ratios ( > 2.5), where washout CT or chemical shift MRI is positive, or where percutaneous biopsy is deemed too difficult or unsafe.

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CT time-attenuation washout curves of adrenal adenomas and nonadenomas.

Cited by 356 publications

References 8 publications

When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

Adrenal Imaging

Fluorodeoxyglucose-Positron-Emission Tomography/Computed Tomography Imaging for Adrenal Masses in Patients with Lung Cancer: Review and Diagnostic Algorithm

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