Aortic dissection without intimal rupture: diagnosis with MR imaging and CT

Computed tomographic (CT) scans of the adrenal glands were obtained in nine patients with Cushing disease as a result of an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma and macronodular hyperplasia of the adrenal glands. The findings were compared retrospectively with those in six patients with Cushing syndrome as a result of an autonomous adrenal adenoma and 16 with Cushing syndrome as a result of ectopic ACTH production. Seven of nine patients with macronodular adrenal hyperplasia had hyperplastic adrenal glands in addition to single or multiple focal adrenal nodules. The six patients with hypercortisolism caused by an autonomous adrenal adenoma showed atrophic (four patients) or normal (two patients) ipsilateral and contralateral adrenal glands. Fourteen of 16 patients with the ectopic ACTH syndrome had hyperplasia of the adrenal glands without nodularity, and only two had focal nodules.     

Depiction of the normal adrenal gland evaluation with 0.5 tesla MRI

MR studies of the abdomen in 128 patients were reviewed in order to evaluate the normal adrenal glands. The studies were performed on a 0.5-Tesla superconducting unit. T1-weighted spin-echo (T1WI), T2-weighted spin-echo (T2WI) and T2*-weighted gradient-echo (T2*-WI) images were obtained. T1WI demonstrated the normal adrenal glands in 90% of the patients. T2*WI identified the glands in 86%, a higher rate than the 73% for T2WI. On both T1WI and T2WI, the right adrenal gland was demonstrated of a lower rate than the left adrenal gland, because the right retroperitoneal fat layer was narrow in patients with hepatic tumors. T2*WI depicted both adrenal glands equally, because the intensity of the left adrenal gland was the same as that of collateral veins from portal hypertension. It is suggested that both T1WI and T2WI with a gradient echo pulse sequence are more useful in depicting the adrenal glands than both T1WI and T2WI.     

Clinical application of SPECT in adrenal imaging with iodine-131 6 beta-iodomethyl-19-norcholesterol

Forty-one patients with or without adrenocortical disorders were studied to evaluate the clinical usefulness of SPECT in adrenal imaging with I-131 Adosterol. In the SPECT images from this study, all glands with either normally functioning or hyperfunctioning adrenal cortices could be detected, while those glands with hypofunctioning adrenal cortices could not be detected. Particularly in transaxial and sagittal slices, the adrenal gland was identified posteriorly and was clearly distinguished from the gallbladder. In preliminary results using SPECT by a standard method, uptake in 68 detectable glands ranged from 1.7% to 4.9% in four glands with Cushing's syndrome, from 1.1% to 1.3% in seven glands with primary aldosteronism, and were distributed below 1.0% in the remaining glands with normally functioning adrenal cortices. These data show that it is possible to evaluate the adrenocortical functioning status simply by analyzing the SPECT images of the adrenal.     

Usefulness of standardized uptake values for distinguishing adrenal glands with pheochromocytoma from normal adrenal glands by use of 6-18F-fluorodopamine PET.

6-(18)F-Fluorodopamine ((18)F-FDA) PET is a highly sensitive tool for the localization of pheochromocytoma (PHEO). The aim of this study was to establish cutoff values for pathologic and physiologic adrenal gland tracer uptake. METHODS: (18)F-FDA PET with CT coregistration was performed in 14 patients (10 men and 4 women; age [mean +/- SD], 42.9 +/- 13.3 y) with unilateral adrenal gland PHEO and in 13 control subjects (5 men and 8 women; age, 51.7 +/- 12.5 y) without PHEO. Standardized uptake values (SUVs) were compared between adrenal glands with PHEO and normal left adrenal glands in control subjects. RESULTS: (18)F-FDA accumulation was observed in all adrenal glands with PHEO and in 6 of 13 control adrenal glands (P = 0.02). The SUV was higher in adrenal glands with PHEO (mean +/- SD, 16.1 +/- 6.1) than in (18)F-FDA-positive control adrenal glands (7.7 +/- 1.4) (P = 0.005). SUV cutoffs for distinguishing between adrenal glands with PHEO and normal adrenal glands were 7.3 (100% sensitivity) and 10.1 (100% specificity). CONCLUSION: The SUVs of adrenal foci on (18)F-FDA PET facilitate the distinction between adrenal glands with PHEO and normal adrenal glands.     

Sonography of the adrenal glands: normal glands and small masses

To evaluate sonographic imaging of the normal adrenal glands, anterior transverse and longitudinal scans were made on 200 patients who had no evidence of adrenal disease. In 78 additional patients who were suspected of having adrenal masses, anterior and posterior transverse and longitudinal scanning and longitudinal oblique scanning were done. Anterior transverse scanning proved to be the best single method of scanning the adrenal gland and small adrenal masses. The normal adrenal gland which is 3-6 mm thick and adrenal masses as small as 1.3 cm can be delineated. Although the frequency of visualizing normal adrenal glands (78.5% on the right and 44% on the left) with sonography is not as high as with CT, masses are more readily detected than the normal glands. The accuracy for detecting adrenal masses is very high, with a false-negative rate of only 3%. Sonography can be a useful screening test for many patients who are suspected of having adrenal masses. However, for obese patients the image is degraded and a higher false-positive rate (3.5%) is obtained. CT provides better resolution for such patients.     

Magnetic resonance imaging of the adrenal glands: a comparison with computed tomography

This investigation compared magnetic resonance imaging (MRI) with computed tomography (CT) in the evaluation of normal and abnormal adrenal glands. Thirty normal volunteers were studied with MRI, and the results were compared with a retrospective review of 30 normal CT examinations. CT identified both adrenal glands in all 30 patients. MRI identified both glands in 29 of 30 volunteers. There were no statistically significant differences between the two imaging techniques using chi-square analysis. Twenty-one patients with abnormal adrenal gland(s) detected with CT were also studied with MRI. The abnormalities studied included bilateral hyperplasia (three patients), adenoma (two), myelolipoma (one), adrenal metastases (six), adrenal hemorrhage (two), and neuroblastoma (seven). MRI detected the abnormal adrenal gland(s) in 20 of 21 patients. MRI was unable to detect calcifications in the lesions studied but more clearly showed the relations of adrenal masses to the major vascular structures. MRI demonstrated corticomedullary differentiation in patients with adrenal hyperplasia and in some normal volunteers. The CT and MRI features of the adrenal lesions are discussed.     

CT of primary hyperaldosteronism (Conn's syndrome): the value of measuring the adrenal gland

OBJECTIVE: The objectives of our study of patients with primary hyperaldosteronism (Conn's syndrome) were to determine whether the adrenal glands are larger in patients with bilateral adrenal hyperplasia than in those with aldosterone-producing adenomas or in healthy control subjects; and whether a CT criterion based on adrenal gland size can be developed to positively diagnose bilateral adrenal hyperplasia. MATERIALS AND METHODS: A retrospective study of CT scans of 28 patients with primary hyperaldosteronism was performed. The means of two observers' measurements of adrenal gland size were recorded and compared with published normal values. In addition, a radiologist experienced in adrenal imaging and unaware of the cause of the primary hyperaldosteronism diagnosed either bilateral adrenal hyperplasia or aldosterone-producing adenoma by visual inspection. RESULTS: The adrenal glands in patients with bilateral adrenal hyperplasia were significantly (p < 0.05) larger than those in patients with aldosterone-producing adenoma or in healthy control subjects. A sensitivity of 100% was achieved when a mean limb width of greater than 3 mm was used to diagnose bilateral adrenal hyperplasia, and a specificity of 100% was achieved when the mean limb width was 5 mm or greater. Receiver operating characteristic curve analysis showed that the overall performance of the radiologist and the mean adrenal limb width in detecting bilateral adrenal hyperplasia were equivalent. CONCLUSION: In patients with primary hyperaldosteronism, adrenal limb measurements on CT can aid in differentiating bilateral adrenal hyperplasia from aldosterone-producing adenoma because the adrenal glands in bilateral adrenal hyperplasia are larger.     

Adrenocorticotropin-independent macronodular adrenal hyperplasia: an uncommon cause of primary adrenal hypercortisolism

PURPOSE: To describe the imaging findings in the adrenal glands of 12 patients with adrenocorticotropin (ACTH)-independent macronodular adrenocortical hyperplasia (AIMAH). MATERIALS AND METHODS: Computed tomographic (CT) and magnetic resonance (MR) imaging findings in the adrenal glands were reviewed retrospectively in 12 patients (three men, nine women) with ACTH-independent Cushing syndrome and with bilateral nonpigmented multinodular adrenal hyperplasia. The results of pituitary MR imaging, adrenal scintigraphy, and petrosal sampling were available in nine, five, and six patients, respectively. Eleven patients underwent bilateral and one patient underwent unilateral adrenalectomy. RESULTS: Eleven patients had enlarged multinodular adrenal glands: Nodules were 0.1-5.5 cm. The combined weight of both adrenal specimens for the 11 bilateral adrenalectomy specimens was 28-297 g, with a mean weight of 122 g. Glands were hypointense compared with the liver on T1-weighted images and were hyperintense on T2-weighted images. Pituitary MR imaging findings were negative in nine of nine patients. Iodomethylnorcholesterol scintigraphy showed bilateral uptake in four of five patients. Petrosal sinus sampling revealed no petrosal-to-peripheral ACTH gradients before corticotropin-releasing hormone (CRH) stimulation in six of six patients, but three patients had gradients after CRH stimulation. After undergoing bilateral or unilateral adrenalectomy, all patients were cured. CONCLUSION: AIMAH is a rare cause of ACTH-independent Cushing syndrome, with characteristic CT findings of massively enlarged multinodular adrenal glands. Bilateral adrenalectomy is indicated on the basis of clinical and CT findings.     

Minor morphologic abnormalities of adrenal glands at CT: prognostic importance in patients with lung cancer

PURPOSE: To determine the prognostic importance of minor morphologic abnormalities of the adrenal glands at computed tomography (CT) in patients with lung cancer. MATERIALS AND METHODS: The study was approved by the committee on human research; written informed consent was not required. The authors retrospectively identified 197 patients with lung cancer who underwent serial chest or abdominal CT and did not have a focal adrenal mass at baseline CT. Two readers independently classified the morphologic features of each adrenal gland as normal, smoothly enlarged, or nodular at initial CT examination. They separately recorded the presence or absence of metastases to the adrenal glands (ie, any new focal adrenal mass) at final CT examination; a third independent reader arbitrated when interpretations were discordant (n = 11). Multivariate Cox proportional hazard models were used to assess for associations between baseline adrenal gland morphologic features and subsequent development of adrenal metastases. RESULTS: At initial CT, reader 1 classified 253 (64%), 70 (18%), and 71 (18%) of the 394 adrenal glands and reader 2 classified 258 (65%), 45 (11%), and 91 (23%) of these glands as normal, smoothly enlarged, or nodular, respectively. The readers had moderate interobserver agreement regarding the classification of adrenal gland morphologic features (kappa = 0.54). Metastases subsequently developed in 13 adrenal glands in 11 patients. Cox proportional hazard models revealed no significant association between baseline adrenal gland morphologic features and subsequent development of adrenal metastases (P = .50 and P = .20 for readers 1 and 2, respectively). CONCLUSION: In patients with lung cancer, smooth enlargement or nodularity of the adrenal glands at baseline CT is not associated with increased risk of subsequently developing adrenal metastases.     

Adrenal magnetic resonance imaging in Addison's disease

Magnetic resonance imaging of the adrenal glands was performed in 9 patients with Addison's disease to evaluate the role of magnetic resonance (MR) in this entity. All patients had bilateral adrenal masses demonstrated by computed tomography (CT); etiologies included adrenal hemorrhage (2 patients), granulomatous disease (1 patient), adrenal lymphoma (3 patients), and adrenal metastases (3 patients). Spin-echo axial images were obtained at repetition times (TR) 0.5, 2.0 s and TE 28, 56 ms, using a Diasonics superconducting magnet operating at 0.35 T. In the patients with lymphoma, metastases, and granulomatous disease, the adrenal masses appeared hypointense or isointense with liver on the T1-weighted images (TR 0.5 s, TE 28 ms). In cases of adrenal hemorrhage, areas of hyperintensity were seen on TR 0.5, TE 56 ms sequences, due to shortening of T1 values. In both groups of patients the masses were hyperintense on T2 weighted sequences. Mean calculated T1 of the hemorrhagic glands was 449 ms, compared with a mean of 782 ms for metastases and lymphoma. While MR is not capable of distinguishing between acute inflammatory and metastatic diseases of the adrenal glands, it may be equally efficacious as CT in suggesting the diagnosis of adrenal hemorrhage in patients with Addison's disease.     

Use of CT in metastatic adrenal gland tumor

The autopsy findings and CT scans on patients with adrenal metastatic tumor over a six year period were analyzed. No pattern on CT was felt to be specific for metastatic tumor to the adrenal glands. Bilateral adrenal metastatic disease was found more common than unilateral disease by CT and by autopsy. All patients with adrenal metastatic disease had metastatic disease elsewhere. CT showed the other metastatic disease in approximately 90% of the cases. All our patients with follow-up scans showed change in the size of the tumor. CT remains the modality of choice for evaluation of the adrenal glands.     

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

Objective

To evaluate the prognostic value of hyperattenuating adrenal glands on contrast-enhanced CT of polytraumatised patients.

Methods

Two hundred ninety-two patients (195 men and 97 women, mean age 45.3?±?23.3 years) were included in this retrospective study. CT examinations were performed 60 s after intravenous injection of contrast material. Image analysis was performed by two radiologists. Patients were assigned to one of two groups according to the attenuation of the adrenal gland [group 1: adrenal glands ≥ inferior vena cava (IVC); group 2: adrenal glands < IVC].

Results

Eighteen patients (42.2 years?±?24.2) were assigned to group 1 and 274 patients (48.4 years?±?22.4) to group 2. The average adrenal density was 150.8?±?36.1 HU in group 1 and 83.7?±?23.6 HU in group 2 (P?<?0.0001). Eight of the 18 patients in group 1 (44.4 %) and 33 of the 274 patients in group 2 (12.4 %) died during hospitalisation (P?<?0.05). Mean adrenal enhancement was significantly higher in patients who died (101.9?±?40.6 HU) compared with survivors (86.1?±?27.0 HU; P?<?0.001).

Conclusion

Hyperattenuation of adrenal glands is associated with a higher mortality rate in polytraumatised patients and may serve as a predictor of poor clinical outcome.

Key points

? Hyperattenuating adrenal glands can be observed in 6.2 % of polytraumatised patients. ? Hyperattenuating adrenal glands indicate poor clinical outcome in polytraumatised patients. ? In polytraumatised patients, hyperattenuating adrenal glands are associated with a high mortality rate. ? Adrenal enhancement is higher amongst patients who died than amongst survivors.     

Adrenal magnetic resonance imaging in addison’s disease

Magnetic resonance imaging of the adrenal glands was performed in 9 patients with Addison’s disease to evaluate the role of magnetic resonance (MR) in this entity. All patients had bilateral adrenal masses demonstrated by computed tomography (CT); etiologies included adrenal hemorrhage (2 patients), granulomatous disease (1 patient), adrenal lymphoma (3 patients), and adrenal metastases (3 patients). Spin-echo axial images were obtained at repetition times (TR) 0.5, 2.0 s and TE 28, 56 ms, using a Diasonics superconducting magnet operating at 0.35 T. In the patients with lymphoma, metastases, and granulomatous disease, the adrenal masses appeared hypointense or isointense with liver on the T₁-weighted images (TR 0.5 s, TE 28 ms). In cases of adrenal hemorrhage, areas of hyperintensity were seen on TR 0.5, TE 56 ms sequences, due to shortening of T₁ values. In both groups of patients the masses were hyperintense on T₂ weighted sequences. Mean calculated T₁ of the hemorrhagic glands was 449 ms, compared with a mean of 782 ms for mestastases and lymphoma. While MR is not capable of distinguishing between acute inflammatory and metastatic disases of the adrenal glands, it may be equally efficacious as CT in suggesting the diagnosis of adrenal hemorrhage in patients with Addison’s disease.     

Scintigraphic portrayal of the syndrome of multiple endocrine neoplasia type-2B

The scintigraphic appearance of the neoplasms in multiple endocrine neoplasia type 2B (MEN-2B) and the interpretations of the image patterns are described. An 18-year-old male patient with the MEN-2B syndrome underwent TI-201 imaging that showed concentrations of TI-201 in the primary medullary thyroid carcinoma (MTC) tumor and in cervical lymph node metastases. After total thyroidectomy and lymph node dissection, the TI-201 image was normal. Catecholamine levels in the blood and urine were only borderline elevated. Yet, greater than normal concentrations of I-131 metaiodobenzylguanidine (I-131 MIBG) were present in both adrenal glands. Computed tomography of the abdomen showed normal adrenal glands. These results were consistent with the diagnosis of adrenal medullary hyperplasia, a precursor of pheochromocytoma. No operation was indicated to remove the adrenal glands. Imaging with TI-201 appears to be useful in identifying sites of MTC in patients with the MEN-2B syndrome. I-131 MIBG imaging, in conjunction with computed tomography of the adrenal glands and appropriate catecholamine measurements, should be performed in patients with the MEN-2B syndrome to determine the status of the adrenal medullae, which then may be classified as normal, hyperplastic, or tumorous with pheochromocytoma.     

肾上腺结核所致艾迪生病的CT表现

分析并总结活动性结核所致艾迪生病（Ａｄｄｉｓｏｎ ｄｉｓｅａｓｅ）的肾上腺ＣＴ表现。材料和方法：分析１８例经手术或随访证实的结核所致艾迪生病肾上腺ＣＴ表现。结果：本组活动性结核所致艾迪生病双侧肾上腺均受累,３５个活动性结核肾上腺增大,１个非活动性结核肾上腺萎缩并钙化。３４个（１７例）增大的肾上腺造影剂增强后内见坏死区,其中１９个肾上腺显示中央大片坏死及周边环状增强。３５个增大的肾上腺吕,２５个保持     

Diagnosis of multiple endocrine neoplasia type 2A in patients with positive thyroid imaging by iodine-131 metaiodobenzylguanidine scintigraphy

We retrospectively analyzed iodine-131 metaiodobenzylguanidine (I-131 MIBG) scintigraphy in 320 patients (male, 108 cases; female, 211 cases; average age, 45±15 years). All patients received thyroid block before examination between 2007 and 2010 in our department. Various degrees of radioactivity were found in the thyroid glands or thyroid region after bilateral thyroid surgery, in addition to bilateral or unilateral abnormal radioactivity in the adrenal glands in 3 patients. These cases were confirmed for medullary thyroid carcinoma and adrenal pheochromocytoma by pathology after surgical removal of the glands, and the diagnosis of multiple endocrine neoplasia type 2A was established from the patients' history and genetic examination. The possibility of medullary thyroid carcinoma should be considered on the finding of abnormal radioactivity in the thyroid or thyroid region by I-131 MIBG scintigraphy after excluding normal radioactivity in the thyroid. When significant abnormal radioactivity is seen in the adrenal gland on I-131 MIBG scintigraphy, the possibility of adrenal pheochromocytoma should be considered. Adrenal pheochromocytoma cannot be excluded when adrenal uptake is increased. The possibility of multiple endocrine neoplasia type 2A should be considered taking into account the history of these patients.     

Characterization of the normal adrenal gland with 18F-FDG PET/CT.

Prior studies have documented increased (18)F-FDG adrenal activity in both benign and malignant pathologic conditions. When whole-body PET imaging is performed without CT anatomic coregistration, however, the normal adrenal gland is difficult to recognize. The purpose of this study was to investigate the normal adrenal appearance and standardized uptake value (SUV) using (18)F-FDG PET/CT imaging. METHODS: Twenty patients with lymphoma with normal-appearing adrenal glands on prior CT examination (less than a 5% pretest likelihood of adrenal involvement) were studied. PET/CT imaging was performed 2 h after intravenous administration of (18)F-FDG. Unenhanced CT scans were acquired for attenuation correction and anatomic coregistration. PET images were reconstructed using an ordered-subsets expectation maximization algorithm and were corrected for body weight, dose, and radioactive decay. Ability to confirm visualization of the adrenal glands was determined for (18)F-FDG PET alone and for (18)F-FDG PET/CT by a consensus of 2 readers, and uptake of (18)F-FDG in the adrenal gland was compared with liver activity and scored visually (0 = no visualization, 1 = activity less than in liver, 2 = activity equal to liver activity, and 3 = activity greater than in liver). RESULTS: The 2 readers agreed on visualization of the adrenal glands with PET alone for 2 of 40 (5%) glands. With PET/CT, the readers agreed on visualization of 27 of 40 (68%) adrenal glands. Visual scores for normal adrenal activity ranged from 0 to 3, and maximum SUVs ranged from 0.95 to 2.46. Visual scoring of adrenal activity correlated well with both mean and maximal SUV (mean SUV vs. visual score: slope = 0.96, r = 0.88; maximum SUV vs. visual score: slope = 0.99, r = 0.87). CONCLUSION: PET/CT permits more reliable visualization of normal adrenal glands than does PET alone. Visual assessment of adrenal uptake correlates well with SUV measurement, and readers of PET/CT need to be aware of the wide range of normal adrenal uptake.     

Post-mortem histopathology of pituitary and adrenals of COVID-19 patients

BackgroundKnowledge of the exact organ manifestation is essential for a comprehensive understanding of COVID-19 infection. Here, the histopathological changes in the pituitary and adrenal glands were analyzed.MethodsIn this series, the formalin-fixed tissues of 63 pituitary glands and 50 adrenal glands were examined. We performed HE and PAS staining and examined COVID-19 nucleocapsid antibody immunohistochemically in the pituitary glands and adrenals.ResultsHistologically, there was no evidence of COVID-19-specific changes in the pituitary and adrenal glands. Large pituitary necrosis may be interpreted as a shock reaction. Independent of infection, we found one T-cell lymphoma, two adenomas, and four Rathke-type cysts in the pituitary glands, and 70% of the adrenal glands showed decreased lipid content and an increase in compact cells as a stress response. In addition, a cortical adenoma in one adrenal gland and small cortical nodules in three adrenal glands were detected independently of COVID-19.ConclusionPituitary and adrenal glands do not appear histologically predominant in the course of COVID-19.     

Computed tomography in adrenal tumors.

Computed tomography (CT) was used to evaluate 26 patients with a variety of adrenal lesions. Surgical proof was available in 22 patients and clinical confirmation with a variety of other studies in the other four patients. Nine patients ahd aldosterone-producing adrenal adenomas and CT correctly identified seven. Four patients had cortisol-producing adenomas and five patients had cortisol-producing carcinomas; CT identified each of these tumors. Prominent but normal shaped glands were seen in each of the four patients with adrenal hyperplasia. Adrenal metastases from malignant melanoma in two patients were identified. Only one of two pheochromocytomas in two patients could be seen on CT. CT is a noninvasive method of localizing adrenal tumors and may be helpful in distinguishing adenomas from adrenal hyperplasia.     

肾上腺结核的CT诊断和分期

目的 探讨肾上腺结核患者的肾上腺CT特征与病程长短的关系，并提出新的分期标准。方法 对临床确诊的28例肾上腺结核患者的CT特征进行回顾性分析。按病程长短分A组（10例，病程短于1年）、B组（13例，病程1－4年）和C组（5例，病程长于4年）分析肾上腺大小、形态、钙化及局限性低密度等变化。结果 肾上腺增大：A组10例，B组13例，C组1例；形态：A组可分辨肾上腺轮廓，B组和C组完全失去肾上腺正常形态；钙化：A组2例，B组11例，C组5例；局限性低密度：仅见于A组3例。结论 肾上腺结核的CT特征与病程长短有关。根据CT表现不同将肾上腺结核分为Ⅰ期、Ⅱ期和Ⅲ期更为合理。