Comparative assessment of ultrasonography and computed tomography in adrenal disorders

Comparative diagnostic assessment by ultrasonography (US) and computed tomography (CT) was performed in each of 17 patients with adrenal disorders. US is better than CT for demonstrating the intratumorous characteristics, the relationship between the tumor and the surrounding organs, and the organ from which large tumors arise, such as pheochromocytoma. On the other hand, CT is better able to detect small adrenal tumors in primary aldosteronism, although US with a sector or linear scanner can also detect small tumors in some cases. Adrenal hyperplasia in both Cushing's disease and congenital adrenogenital syndrome was more easily demonstrated by CT than by US. Of the two US instruments, a sector scanner was more useful in the delineation of the enlarged right nontumorous adrenal by scanning from the right intercostal region, but both scanners were of no use in the delineation of the enlarged nontumorous left adrenal in patients with obesity.     

Accuracy of CT scanning and adrenal vein sampling in the pre-operative localization of aldosterone-secreting adrenal adenomas.

In primary hyperaldosteronism, it is important to distinguish between unilateral and bilateral disease, as management strategies differ. In the period 1983-95, we identified 34 patients with primary hyperaldosteronism. Following further investigations, a diagnosis of aldosterone-secreting adenoma was made in 17 patients, and surgery was performed. Computed tomography clearly localized an apparent adenoma (discrete adenoma=1 cm diameter; normal contralateral gland) in only 10 of these patients (59%); two of these 'adenomas' were subsequently shown to be hyperplastic glands without adenomas. Histological examination showed adrenal adenomas in the remaining 15 patients. An 'adenoma' also appeared to be clearly localized in 3/17 patients later classified as having bilateral adrenal hyperplasia by adrenal vein sampling. CT scanning, therefore clearly localizes adenomas in only 50% of histologically proven cases, and can also produce misleading results. Adrenal vein sampling results altered our management approach in one third of cases. On the basis of our detailed results we would recommend surgery if there is clear evidence of unilateral aldosterone secretion along with CT findings which may not be strictly localizing but are in keeping with the dominant side on adrenal vein sampling. The decision to refer for surgery in primary hyperaldosteronism can be difficult, and we would caution against too heavy a reliance on CT results when recommending adrenalectomy, and suggest that adrenal vein sampling should remain a routine part of the investigation of patients with primary hyperaldosteronism.     

Sonography of the adrenal glands in chronic disseminated histoplasmosis

In this retrospective study, the findings on abdominal sonograms in six patients newly diagnosed as having chronic disseminated histoplasmosis are reported. Five of six patients showed bilateral adrenal gland enlargement that was similar in degree from side to side. The most characteristic feature was the maintenance of a triangular shape in five glands and a cylindrical shape in two glands. Four glands had a nonspecific round or oval shape. All sonographic findings correlated well with the computed tomographic (CT) findings on each patient except that CT detected the one enlarged right adrenal gland not demonstrated sonographically. Abdominal sonography may provide the initial important clue to the diagnosis of chronic disseminated histoplasmosis.     

双层探测器光谱CT碘密度值对不同功能状态下肾上腺的评估

目的 探讨双层探测器光谱CT碘密度定量对肾上腺不同功能状态的评估价值.方法 2018年6月～2020年8月间于我院完成肾上腺光谱CT增强扫描的检查者中,按照不同的肾上腺功能状态收集病例,分为三组:感染性休克(双侧肾上腺肿大)26例(A组);肾上腺增生(双侧或左侧)14例(B组);右侧功能性肾上腺皮质醇腺瘤(左侧肾上腺反...     

Imaging of the major salivary glands

The major salivary glands, submandibular, parotid and sublingual glands play an important role in preserving the oral cavity and dental health. Patients with problems of the major salivary glands may present with symptoms such as dry mouth, dysphagia and obstruction of duct, inflammation, severe dental caries or swelling. Imaging plays an important role in visualization of morphology and function, to establish a diagnosis, for treatment, and for surgical planning. There are several options for diagnostic imaging: plain radiography, sialography, ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), salivary gland scintigraphy and ¹⁸F‐FDG positron emission tomography (PET). We present an overview of the modalities in relation to common salivary gland disease.     

Adrenal congestion preceding adrenal hemorrhage on CT imaging: a case series

Introduction

Adrenal hemorrhage is an uncommon but potentially life-threatening condition, particularly in cases of bilateral adrenal hemorrhage causing primary adrenal insufficiency. It is difficult to diagnose clinically, particularly in critically ill patients, given its non-specific symptoms and signs, which include abdominal pain, vomiting, fever, weakness, hypotension, and altered conscious state. Non-traumatic adrenal hemorrhage has been observed to occur in times of physiological stress, such as post-surgery, sepsis, burns, and hypotension. This is hypothesized to be due to a combination of increased arterial blood flow to the adrenal glands, the paucity of draining adrenal venules and adrenal vein thrombosis, leading to intra-glandular vascular congestion and subsequent hemorrhage.

Case series

We present four cases of non-traumatic adrenal hemorrhage, which demonstrated features of preceding adrenal congestion (adrenal gland thickening and peri-adrenal fat stranding) on computed tomography (CT) imaging. Comparison was made with 12 randomly selected intensive care patients to observe if these findings were prevalent in this subgroup of patients.

Conclusion

Non-traumatic adrenal hemorrhage is an uncommon condition that is difficult to diagnose clinically. As such, it may be useful to recognize CT features of adrenal congestion as a sign for potential adrenal dysfunction and subsequent adrenal hemorrhage, so early steroid replacement therapy can be commenced to prevent death from adrenal insufficiency.

     

成人肾上腺术中超声表现

目的 观察成人肾上腺术中超声（IOUS）表现。方法 收集71例因肝脏、胆道或胰腺病变而接受外科手术治疗患者,观察肾上腺IOUS表现,并与CT/MRI双侧肾上腺显示率和厚度测值进行比较。结果 成人肾上腺IOUS表现为边界清晰、形态不规则的双侧弱回声结构。CT/MRI肾上腺显示率为97.18%（138/142）。IOUS肾上腺显示率为95.07%（135/142）,右侧92.96%（66/71）、左侧97.18%（69/71）,且可见4侧CT/MRI未能显示的肾上腺;IOUS所测肾上腺厚度均大于CT/MRI（P均<0.05）。结论 IOUS中,成人肾上腺表现为边界清晰、形态不规则的双侧弱回声,左侧显示率高于右侧。     

几种影像学检查对肾上腺醛固酮瘤定位诊断的互补作用研究

目的：探讨Ｂ型超声、ＣＴ及（或）同位素检查对肾上腺醛固酮瘤定位诊断的互补作用。方法：对疑醛固酮瘤者作Ｂ超检查２３８例,其中１４１例同时作过ＣＴ检查,２７例作为核素检查。将各种检查与病理对照,再把其中的假阴性与假阳性病例分别与其他两种检查相对照。结果：发现三种检查对漏诊（假阴性）单瘤具用很强的互补性,而对同侧双瘤则均未能幸免漏检其中之一。对误诊（假阳性）亦有很好的互补性,且本组核素无假阳性,但其样本嫌小（仅２７例）。结论：通过对比研究可以明确采用何种检查方法属最佳选择。     

外伤性肾上腺血肿的CT表现

目的:探讨外伤性肾上腺血肿的形成机制、CT诊断特征及临床应用价值。材料与方法:回顾分析19例经CT复查证实的外伤性肾上腺血肿CT扫描资料。结果:19例肾上腺血肿均发生在单侧,其中右侧16例、左侧3例。CT表现为肾上腺区域长椭圆形、类圆形肿块影,CT值50～69Hu,大多数血肿密度均匀、边缘清楚,长径2～4cm,长径与肾上腺前后径一致。合并肾上腺周围组织器官损伤15例,远离肾上腺的下腹部、盆腔损伤3例,单纯性右侧肾上腺血肿1例。本组19例均在外伤后5～192天内做了1～4次CT复查,其中11例从血肿中央开始密度减低,5例从血肿边缘开始密度减低,其余3例不具备上述特点。本组病例中只有2例追踪到6个月后复查血肿吸收消失,肾上腺形态逐渐恢复正常。结论:外伤性肾上腺血肿应首选CT检查,CT诊断具有特征性,有别于其它肾上腺占位,可避免不必要的腹部手术探查。     

Hypopituitarism

The pituitary regulates the body's endocrine system, including the thyroid gland, adrenal cortex, ovaries and testes, through the release of numerous hormones. Pituitary function, in turn, is regulated through complex feedback loops involving the hypothalamus and the target endocrine glands. Hypopituitarism may result from multiple causes, including primary and metastatic cancer, ischemic and granulomatous disease, infection, developmental abnormalities and trauma, which may affect the gland itself (primary hypopituitarism) or the hypothalamus (secondary hypopituitarism). Depending on the anatomic lesion, patients with hypopituitarism may present with signs or symptoms of multiple endocrine abnormalities, such as hypothyroidism, adrenal insufficiency, diabetes insipidus, hypoglycemia, sexual dysfunction and growth retardation. A thorough clinical history, detailed examination, laboratory evaluation of endocrine function and radiographic views of the pituitary and sella turcica can suggest the diagnosis and etiology. Treatment, usually lifelong, may include hormone replacement and medical or surgical correction of the underlying disease.     

Delineation of adrenal in controls and nontumorous adrenal disorders by real-time ultrasonic-scanner

In 90 control subjects, 90% of the right adrenal and 38% of the left were delineated by sector US scanner. A longitudinal scan from an intercostal space in the mid-axillary line and a right-anterior-transverse scan from the intercostal space were useful in displaying the right adrenal, and an anterior-transverse scan from the epigastrium was also useful in showing the left adrenal. The latter was not as clear as the right. Moreover, a transverse scan from the left flank did not fully display the whole image of the left adrenal. The sizes of both adrenal images were somewhat smaller than those made by computerized tomography (CT), as shown in our previous study. Although the left adrenal in one case of congenital adrenogenital syndrome and those in three cases of Cushing's disease could not be delineated, all of the enlarged right adrenals in these cases were demonstrated by ultrasonic scanning (US). These results suggest the clinical usefulness of US for the detection of affected, nontumorous right adrenals.     

Cushing's syndrome. How to pinpoint and treat the underlying cause

In addition to prolonged glucocorticoid therapy (not discussed here), at least five other conditions cause Cushing's syndrome. They are excessive corticotropin secretion by the pituitary gland (which results in Cushing's disease), ectopic production of corticotropin by malignant nonpituitary tumors, benign adrenal adenoma, adrenal carcinoma, and primary adrenocortical nodular dysplasia. Each can be distinguished by a specific pathophysiologic process that triggers the adrenal glands to overproduce glucocorticoids. At present, diagnosis of Cushing's syndrome or disease relies heavily on the dexamethasone (Decadron, Hexadrol) suppression test. After diagnosis, other studies, including computed tomography, magnetic resonance imaging, and corticotropin radioimmunoassay, can be used to localize the site of the lesion. Treatment, of course, depends on the underlying cause.     

Pediatric chest disease: evaluation by computerized tomography, magnetic resonance imaging, and ultrasonography.

The initial method for evaluating pediatric chest disease remains the plain chest roentgenogram. When more precise definition of chest disease is required, computerized tomography (CT), magnetic resonance imaging (MRI), or ultrasonography (US) may be useful. In general, CT offers the widest spectrum of applicability. MRI is especially useful because no ionizing radiation is used and images can be acquired in multiple planes. MRI is most valuable when vascular anatomy needs to be defined or when tumor invasion of the spinal canal is suspected. US is helpful in evaluating diseases of the pleura and for characterizing and localizing pleural fluid and masses. US can differentiate normal thymus from other anterior mediastinal masses. Doppler techniques are valuable in evaluating suspected pulmonary sequestration and identifying the feeding vessel.     

Hemangiosarcoma of the adrenal glands: CT findings in two cases

Hemangiosarcomas of the adrenal gland, both benign and malignant, are exceedingly rare; only a dozen of them have been reported in literature to our knowledge. We describe herein the findings at CT of 2 primary hemangiosarcomas of the adrenal glands. We also discuss their etiology, incidence, and differential diagnosis, particularly in relation to more frequent primary adrenal lesions, such as adrenal adenomas and carcinomas. CT will generally show a heterogeneous mass with frequent necrosis, contrast-enhancement, and occasional calcifications. A prospective diagnosis cannot be made by imaging alone, and pathology represents the discriminating method for a correct diagnosis.     

Nongynecologic findings on pelvic ultrasound: focus on gastrointestinal diseases

Ultrasound (US) is considered the first-line imaging modality of choice in women presenting with pelvic complaints. Although imaging is focused on detecting abnormalities of the uterus and adnexa, occasionally nongynecologic findings are detected, which may or may not explain the patient's symptoms. Many of these findings are related to the gastrointestinal (GI) tract. Although most of these GI abnormalities are better diagnosed with computed tomography (CT), symptoms are often nonspecific and US may be the first imaging modality requested by referring clinicians. Sonographers should be aware of the possibility of nongynecologic diseases in patients with pelvic symptoms, particularly if US evaluation of the female reproductive tract does not provide an answer to the clinical question. Careful attention to the bowel when performing a pelvic US may allow the sonographer to diagnose GI pelvic diseases such as appendicitis, diverticulitis, colitis, bowel obstruction, mesenteric adenitis, epiploic appendagitis, Crohn disease, and even GI malignancy. As concerns grow regarding the radiation dose of pelvic CT, the use of iodinated contrast material, and imaging costs, US examination may be increasingly requested as an initial imaging study in patients in whom GI diseases is primarily suspected in the pelvis, and familiarity with the various sonographic manifestations will aid considerably in establishing the correct diagnosis.     

Expression of p21(WAF1/CIP1/SDI1) and p53 in apoptotic cells in the adrenal cortex and induction by ischemia/reperfusion injury.

p21(WAF1/CIP1/SDI1), an inhibitor of cyclin-dependent kinases, is expressed at varying levels in human adrenal glands removed during surgery or organ recovery. In glands with p21 mRNA, nuclear p21 immunoreactivity, which was occasionally extensive, colocalized with p53 immunoreactivity and DNA damage, as evidenced by in situ end-labeling. Many cells showed morphological features of apoptosis when observed by fluorescent DNA dye staining and electron microscopy. This pattern was also associated with high levels of cytoplasmic heat shock protein 70. To address the question of the origin of p21 expression in some human adrenal glands, rat adrenal glands were subjected to 30 min of ischemia followed by 8 h of reperfusion. Cells with nuclear p21 and p53 appeared in the adrenal cortex together with DNA damage detected by in situ end-labeling. Nuclear p21 immunoreactivity was also produced in adrenal tissue fragments incubated at 37 degrees C in vitro. However, in this case, p21 expression was confined to the cut edge of the tissue. In contrast, p21 in human adrenal glands, as in ischemic rat glands, was within the inner regions of the cortex, supporting an origin of the protein in vivo rather than postmortem. The p53/p21 pathway of reaction to cellular injury, potentially leading to apoptosis, may play a role in tissue damage such as that resulting from ischemia/reperfusion. In the human adrenal cortex this process may be a precursor of adrenal failure.     

Abdominal CT in the staging of small cell carcinoma of the lung

Small cell carcinoma of the lung (SCCL) is a fulminant disease process with early extrathoracic dissemination. Surgery for cure has generally been abandoned and combined chemotherapy is the treatment of choice. The staging of SCCL is designed to identify areas of involvement for (1) comparison of therapeutic techniques, (2) prognostic determinations, (3) determination of sites of disease to use for assessment of response, and (4) for determination of areas that may require additional local therapy such as radiation or surgery. The staging evaluation, therefore, is designed to evaluate the extent of extrathoracic disease rather than just the presence of chest involvement. CT scanning has made a valuable contribution to the delineation of intrathoracic and metastatic disease and is now included in the staging workup of patients with SCCL since metastatic involvement of the liver, bone, bone marrow, CNS, and adrenal glands is common.     

The radiologic evaluation of renal metastases

Renal metastases can arise from practically any primary neoplasm and should no longer be considered rare. Such lesions are usually detected during surveillance US or CT examinations. Appearances favoring metastases over an additional renal carcinoma are multiplicity, bilaterality, metastatic disease elsewhere, and perinephric disease. Since not all renal metastases behave predictably and may even appear as single, exophytic lesions, guided fine-needle aspiration may be required when such information will alter patient management.     

Clinical importance of intraperitoneal fluid in patients with blunt intra-abdominal injury

The purpose of this study was to determine the prevalence of intraperitoneal fluid (IF) in blunt trauma patients with intra-abdominal injuries, to determine the rate of exploratory laparotomy in patients with and without IF, and to identify the location of this IF. We retrospectively reviewed the records of 604 patients with intra-abdominal injuries after blunt trauma who were admitted to a level 1 trauma center over a 42-month period. Patients were considered to have intra-abdominal injuries if an injury to the spleen, liver, urinary tract, pancreas, adrenal glands, gallbladder, or gastrointestinal tract was identified on abdominal computed tomography (CT) or at exploratory laparotomy. Patients were considered to have IF if fluid was identified on abdominal CT or during exploratory laparotomy. In patients undergoing abdominal CT or abdominal ultrasound (US), the specific location of the IF was identified. Four hundred forty-three (73%, 95% confidence interval [CI] 69 - 77%) of the 604 patients with intra-abdominal injuries had IF. Patients with IF had an increased risk of laparotomy (344/443 [78%] v 44/161 [27%], odds ratio = 9.2, 95% CI 6.1-13.9). Of the 539 patients undergoing abdominal CT or abdominal US, IF was identified in 389 (72%) and was visualized in the following locations: 258 of 389 (66%) in Morison's pouch, 216 of 389 (56%) in the left upper quadrant, 187 of 389 (48%) in the pelvis, and 139 of 390 (36%) in paracolic gutters. Three patients with IF visualized solely in the paracolic gutters underwent laparotomy. The majority of patients with intra-abdominal injuries have IF, and these patients are more likely to undergo laparotomy. Morison's pouch is the most common location for IF to be detected with radiologic imaging. However, visualization of the paracolic gutters with abdominal US may detect IF in patients with intra-abdominal injuries that would otherwise not be detected by US.     

Evaluation of the gastro-oesophageal junction: defining the incompetent cardio-oeosophageal angle non-invasively with ultrasound and computerized tomography

This study aimed to demonstrate the presence of gastro-oesophageal reflux disease (GORD) non-invasively using ultrasound (US) and computerized tomography (CT). Intra-abdominal oesophageal length (IAOL) and cardio-oesophageal angle (COA) were measured by US in 25 patients with known reflux and in 25 healthy subjects (control group). CT images of 42 patients with reflux disease and 44 controls were reviewed retrospectively, and IAOL and COA were measured on curved multiplanar format images. Using a cut-off value for IAOL of 20.5 mm, the sensitivity to detect GORD with US was 96% and the specificity was 80% and, with CT, the sensitivity was 95% and the specificity was 78%. A cut-off value of 138.5° for COA yielded sensitivity and specificity values for GORD detection of 76% and 72% with US and 83% and 80% with CT, respectively. In conclusion, with equivocal diagnostic findings, IAOL and COA are useful parameters that can be determined non-invasively by US or CT and may aid diagnosis and treatment choices for patients with suspected GORD.