A pictorial essay depicting CT and MR characteristic of adrenal pathologies: Indian study

Transcription

1 A pictorial essay depicting CT and MR characteristic of adrenal pathologies: Indian study Poster No.: C-0703 Congress: ECR 2011 Type: Educational Exhibit Authors: A. J. B. Baxi, K. L. Tourani, N. R. Thanugonda, V. V. Sripathi, M. Belman, K. Rajsekhar ; Hyderabad, An/IN, Hyderabad, Andhra Pradesh/IN Keywords: Adrenals, CT, MR, Imaging sequences, Pathology DOI: /ecr2011/C-0703 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 31

2 Learning objectives 1. To identify and illustrate spectrum of various adrenal lesions on CT and MRI. 2. To review the pathogenesis. 3. To describe and illustrate the CT and MRI appearances of adrenal lesions. 4. To describe advantages of additional MR sequences and contrast technique in the differential diagnosis of adrenal lesions with a similar appearance. Background A diverse range of adrenal pathologies has similar radiological appearance. Even simple incidentalomas can mimic neoplastic lesion.at the same time, infective lesion can mimic malignancy. It is not always possible to biopsy the lesion. Hence it is necessary to have certain characteristic of lesions categorizing them as benign or malignant or infective or incidentalomas noninvasively so that unnecessary intervention can be avoided. This exhibit illustrates indications, technique, procedural protocols for adrenal lesions and describes CT and MRI appearances of these lesions. Imaging findings OR Procedure details We did plain and contrast Ct scan study(adrenal protocol) and MRI of adrenal pathologies.in addition to routine MR adrenal imaging, we did chemical shift imaging (In phase and out of phase sequences) to further characterize adrenal pathologies. Various adrenal lesions that we came across were: 1. Normal Variants, pseudo-tumor 2. Calcification 3. Hyperplasia 4. Adrenal hemorrhage Page 2 of 31

3 5.Adrenal Cysts developmental, post traumatic 6. Tuberculosis 7. Histoplasmosis 8. Adenoma single and multiple 9. Adrenal cortical carcinoma 10. Metastasis 11. Pheochromocytoma 12. Neuroblastoma 13. Ganglioneuroma Images for this section: Fig. 1: Anatomy Page 3 of 31

4 Fig. 2: Introduction to adrenal tumors Page 4 of 31

5 Fig. 3: CT protocol Page 5 of 31

6 Fig. 4: CT Algorithm Page 6 of 31

7 Fig. 5: MR protocol: Chemical shift imaging Page 7 of 31

8 Fig. 6: Adrenal masses classification Page 8 of 31

9 Fig. 7: Adrenal pseudotumors Page 9 of 31

10 Fig. 8: Adrenal Adenoma Page 10 of 31

11 Fig. 9: Adrenal Myelolipoma Page 11 of 31

12 Fig. 10: Adrenal Hemorrhage Page 12 of 31

13 Fig. 11: Granulomatous involvemeny of adrenal glands Page 13 of 31

14 Fig. 12: Adrenal Tuberculosis Page 14 of 31

15 Fig. 13: Adrenal Histoplasmosis Page 15 of 31

16 Fig. 14: Adrenl involvement in shock Page 16 of 31

17 Fig. 15: Adrenal Cyst Page 17 of 31

18 Fig. 16: Adrenal hyperplasia Page 18 of 31

19 Fig. 17: CT and MRI findings of Pheochromocytoma Page 19 of 31

20 Fig. 18: Introduction to Pheochromocytoma Page 20 of 31

21 Fig. 19: Pheochromocytoma Page 21 of 31

22 Fig. 20: Neuroblastoma Page 22 of 31

23 Fig. 21: Ganglioneuroma Page 23 of 31

24 Fig. 22: Ganglioneuroma Page 24 of 31

25 Fig. 23: Introduction to adrenal cortical carcinoma Page 25 of 31

26 Fig. 24: Benign versus malignant adrenal tumors Page 26 of 31

27 Fig. 25: Clinical features and Imaging Page 27 of 31

28 Fig. 26: Spread of adrenal cortical carcinoma Page 28 of 31

29 Fig. 27: Adrenal metastasis Page 29 of 31

30 Conclusion The major teaching points of this educational exhibit are: 1. Normal CT and MR anatomy of adrenal glands and imaging findings of various adrenal lesions 2. Accurate CT characterization of different adrenal pathologies based on early and delayed enhancement patterns 3. Aid of chemical shift imaging (In phase and Out of phase) in characterization of adrenal lesions with a similar radiological appearance Personal Information Dr Ameya Jagdish Baxi Consultant Radiologist Care hospitals, Road no 1, Banjara Hills, Hyderabad : Andhra Pradesh India. Mobile: ameyajbaxi@hotmail.com, ameyajbaxi@gmail.com Page 30 of 31

31 References 1.Imaging of Adrenal Incidentalomas: Current Status N. Reed Dunnick and Melvyn KorobkinAm. J. Roentgenol., Sep 2002; 179: Adrenal Masses: Characterization with Combined Unenhanced and Delayed Enhanced CT Elaine M. Caoili et al.radiology 2002;222: Differentiation of adrenal adenomas from metastases with unenhanced computed tomography.gufler H, Eichner G, Grossmann A, Krentz H, Schulze CG, Sauer S, Grau G.J Comput Assist Tomogr Nov-Dec;28(6): Rozenblit A, Morehouse HT, Amis ES, Jr. Cystic adrenal lesions: CT features. Radiology. 1996;201: Elsayes KM, Mukundan G, Narra VR, et al. Adrenal masses: MR imaging features with pathologic correlation. RadioGraphics. 2004;24(suppl 1):S73-S Dunnick NR, Korobkin M, Francis I. Adrenal radiology: Distinguishing benign from malignant adrenal masses. AJR Am J Roentgenol. 1996;167: Page 31 of 31