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Népszerű keresések
Adrenal incidentalomas
*An adrenal mass > 1 cm that is detected on imaging exams not performed for suspected adrenal disease "incidentally discovered"
* They are common and seen in about 3% of abdominal CT's, and 10% in elderly patients
No Follow Up
A 64-year old patient scanned for analysis of an abdominal aneurysm.
The scan in the arterial phase shows bilateral lesions with a density of 50 HU.
On the non-enhanced CT, the density in both adrenal glands was less than 10HU, proving these to be lipid-rich adenomas.
Myelolipomas:
Benign tumors composed of bone marrow elements, easy to recognize on CT or MR because they contain areas of macroscopic fat.
Calcifications are seen in 24% of cases.
Cyst:
well-defined lesion of water density that does not enhance.
with a thin wall and may have thin septa.
It may be an endothelial cyst or a pseudocyst (with thick walls), or a true epithelial or parasitic cyst (both rare)
Malignant tumors with cystic degeneration has an irregular thick wall of 5 mm or more and mural, septal or solid enhancement.
Lipid-rich adenoma
Myelolipoma
Cyst
Lesions with benign calcifications
Hemorrhage (appriopriate history, e.g. trauma or severe illness)
Longterm ( > 6 -12 months) unchanged lesions (+ no history of cancer)
Lesions that do not enhance
Benign calcifications:
Coarse rounded, bilateral, peripheral or septal calcifications.
may be seen in:
Adenoma
Myelolipoma
Trauma
Granulomatous infection
Punctate, dystrophic and irregular calcifiations are not typically benign and can be seen in:
Adrenocortical cancer
Adrenal metastases
Size 1-4 cm
Size >4cm
1-2 cm with no history of cancer>>> Benign
Follow up after 1 year
Adenomas rapidly wash out contrast.
Non-adenomas enhance rapidly, but take longer to washout.
Absolute washout
consists of a non-contrast, a contrast -enhanced scan with a delay of 60-90 sec and a delayed scan at 15 minutes.
Relative washout
Consistent of an enhanced scan and a second scan at 15 minutes after contrast injection
MRI Out-of-phase imaging
Lipid-poor adenomas can also be diagnosed with out-of-phase imaging.
They contain enough microscopic fat to cause a signal drop on out-of-phase imaging compared to in-phase imaging due to the chemical shift artefact.
atypical adenomas
clinical history
biopsy
with history of cancer
PET biopsy