ESUR 2018, Sept. 13 th.-16 th., 2018 Barcelona, Spain
|
|
- May Rosanna Pitts
- 5 years ago
- Views:
Transcription
1 ESUR 2018, Sept. 13 th.-16 th., 2018 Barcelona, Spain OUR APPROACH Incidental adrenal nodule/mass Isaac R Francis, M.B;B.S University of Michigan, Ann Arbor, Michigan
2 Disclosures None (in memory) M Korobkin, Richard Baron Acknowledgements: H Hussain, M Davenport, E Caoili, RH Cohan Abdominal Imaging Group
3 Incidental Adrenal Mass Overview Imaging features and morphology characterization Review of European Society of Clinical Endocrinology & European Network for Study of Adrenal Tumors Practice Guidelines and American College of Radiology Incidental Findings Project Guidelines CT washout and CSI MRI, technique, pitfalls and comparison Our approach to adrenal nodules/masses
4 Overview Occurs in approx. between 3-7% of subjects undergoing CT- more common in older subjects (approx. 10% in pts. = > 70) - majority are between 1-4 cm in size Majority are benign lesions, with most common incidental adrenal mass being a non functioning adenoma Even in cancer pts. most incidental isolated adrenal masses are benign But can be common site for metastases in some cancer(up to 20%, in some studies) Incidental Adrenal Mass Young WF Jr. NEJM 2007; Grumbach MM et al. Ann Int Med 2003 Frequency of functioning or malignant adrenal lesions in non oncological patients 1049 masses studied ( 96% of masses < 4 cm) 788 adenomas (75%) 68 myelolipomas, 47 hematomas, 13 cysts 3 pheochromocytomas and 1 cortisolproducing adenoma In 973 pts. with incidental adrenal mass and no history of cancer, there were no malignant lesions Majority were adenomas (75%) In the non-oncological pt. most incidental adrenal masses are benign Song JH AJR 2008
5 Definition: Incidental Adrenal Mass Incidentaloma Adrenal mass > 1 cm in size, detected on imaging not performed for suspected adrenal disease Imaging done for evaluation of symptoms not related to adrenal dysfunction Excludes imaging done as screening for hereditary syndromes Strictly also excludes imaging done as part of staging studies in patients with extra-adrenal malignancies Mayo-Smith WW, Song JH, Boland GL, Francis IR et al. JACR 2017
6 Specific features History of cancer Incidental Adrenal Mass Key Issues Biochemical adrenal dysfunction
7 Specific features Fat (Myelolipoma)-other causes: degenerated adenoma, rarely ACC Simple fluid (Cyst) Incidental Adrenal Mass High density unenhanced image (Hemorrhage) 73 Low density (<10 HU) or loss of SI on CSI- Lipid-rich adenoma
8 Incidental Adrenal Mass Using size vs. presence of intracellular lipid to predict malignancy What is more predictive of malignancy: Size or presence of intracellular lipid (< 10 HU or no loss of signal on CSIMRI) 113 adrenal resections- only 20/112 (18%) - small no: of resected masses malignant Imaging features (presence of lipid etc.) are more predictive of benignity than size alone If size criteria alone used (= or > 4 cm), 9/20 (45%) malignancies including 1 ACC would have not undergone surgery or biopsy Yoo JY et al. Ann Surg Oncol 2015
9 Masses > 4 cm Benign Masses < 4 cm Malignant - 54 HU 5.7 cm 4.6 cm Myelolipoma Lipid-Rich Adenoma cm Adrenal Cancer
10 Incidental Adrenal Mass Can morphology predict malignancy? Can morphological features differentiate benign from malignant adrenal masses Gd-T1 211 masses (1-4 cm) Masses with thick enhancing rim or irregular margins are more likely to malignant but there is significant overlap with benign lesions Low sensitivity Song JH et al AJR 2013 Degenerated Pheochromocytoma Adenoma
11 European Society of Clinical Endocrinology & European Network for Study of Adrenal Tumors Practice Guidelines Incidental Adrenal Mass American College of Radiology Incidental Findings Management Project Recommendations and Guidelines have very LOW evidence of support Lack of sufficient data from large prospective studies Fassnacht M et al. Eur J Endocrinology 2016.online. 175:2: G1-G34 Mayo-Smith WW, Song JH, Boland GL, Francis IR et al. JACR 2017
12 European Society of Clinical Endocrinology & European Network for Study of Adrenal Tumors Practice Guidelines Risk of malignancy assessment: Imaging study to determine if adrenal nodule/mass is homogeneous and lipid-rich : Non contrast CT If non contrast CT is consistent with a benign lesions i.e. < 4 cm in size and homogeneous and < 10 HU No additional imaging workup is needed Incidental Adrenal Mass American College of Radiology Incidental Findings Management Project Masses with benign imaging features Masses with features of a myelolipoma, cyst, hemorrhage, require no follow up imaging Masses with features of lipid rich adenoma - < 10 HU on non contrast CT or loss of signal intensity as compared to spleen on out-of-phases (opposed phase) images on MRI Need no further follow up imaging Fassnacht M et al. Eur J Endocrinology 2016.online. 175:2: G1-G34 Mayo-Smith WW, Song JH, Boland GL, Francis IR et al. JACR 2017
13 Masses that do not need follow up imaging 7 HU Lipid-rich adenoma Adrenal Myelolipoma Adrenal Cyst
14 European Society of Clinical Endocrinology & European Network for Study of Adrenal Tumors: Practice Guidelines If the adrenal mass is indeterminate Hormonal workup needed Incidental Adrenal Mass American College of Radiology Incidental Findings Management Project For indeterminate adrenal nodule/mass > 1 cm to < 4 cm (non contrast CT), dedicated adrenal mass CT protocol (using washout ratio calculations) Fassnacht M et al. Eur J Endocrinology 2016.online. 175:2: G1-G34 Mayo-Smith WW, Song JH, Boland GL, Francis IR et al. JACR 2017
15 Incidental Adrenal Mass European Society of Clinical Endocrinology & European Network for Study of Adrenal Tumors: Practice Guidelines And American College of Radiology Guidelines Functioning cortisol producing adenoma 3.2 cm 33HU ESCE & ENSAT- Hormonal eval. ACR- Washout < 60% and then? hormonal eval.
16 Incidental Adrenal Mass European Society of Clinical Endocrinology & European Network for Study of Adrenal Tumors: Practice Guidelines Indeterminate adrenal mass with negative hormonal workup Biopsy NOT recommended Three options: - Imaging with another modality/technique - Follow up (CT or MRI) - Surgery American College of Radiology Incidental Findings Management Project CT Washout- adenoma (lipid rich and lipid poor)- stop If washout indeterminate DO NOT BIOPSY? Hormonal evaluation Repeat CT or MRI in 12 months for small > 1 to < 2 cm masses and 6 months for masses 2-4 cm Fassnacht M et al. Eur J Endocrinology 2016.online. 175:2: G1-G34 Mayo-Smith WW, Song JH, Boland GL, Francis IR et al. JACR 2017
17 Follow up for patients not undergoing surgery after initial assessment- ESCE &ENSA Surgical resection if lesion grows more than 20% (> 5 mm/0.5-1 yr.). If less repeat follow up imaging at same time interval In pts. with autonomous cortisol secretion without overt Cushing s, reassess for cortisol excess Incidental Adrenal Mass ACR- Masses without diagnostic ( indeterminate ) features - Size > 1 cm and < 4 cm Masses that are unchanged over 1 yr. period - likely benign Depending on rate of growth considersurgery if rapid growth rate (> 5mm/0.5-1yr.) [exc. ACC] and if growth rate slow consider biochemical evaluation Fassnacht M et al. Eur J Endocrinology 2016.online. 175:2: G1-G34 Mayo-Smith WW, Song JH, Boland GL, Francis IR et al. JACR 2017
18 Enlarging Adrenal Nodule in cancer pt. Sept May 2017 Bx. Met. Urothelial malignancy
19 Adrenal mass showing in non cancer pt. - Interval growth Nogueira TM et al Horm Canc 2015 Courtesy: T Else, MD Surgery Adrenal cortical cancer
20 Incidental Adrenal Mass American College of Radiology Management of Incidental Findings Project Masses without diagnostic ( indeterminate ) features Size > 4cm Isolated adrenal mass with no h/o cancer Surgery Isolated adrenal mass with h/o cancer PET/CT or biopsy Mayo-Smith WW, Song JH, Boland GL, Francis IR et al. JACR 2017
21 History Adrenal mass Pt. with h/o colon malignancy Colon cancer diagnosed in 2004 Treated with LAR Developed lung met in 2015 Now presents with new R adrenal mass Metastases from colon cancer
22 Adenomas vs. Non Adenomas Quantitative CT Densitometry With Unenhanced and Washout Features Unenhanced = < 10 H Sensitivity of 71% and specificity of 98% (lipid rich adenoma) Percentage enhancement washout: (E-D) x 100 E-D x 100 (E-U) Threshold for adenoma (lipid rich and poor) diagnosis: Absolute washout = or > 60% Relative washout = or > 40% Specificity nearly 95% * E= 60 secs. enhanced, D= Delayed 15 min. U=unenhanced Korobkin M et al. AJR 1998; Caioli EM et al. Radiology 2002 E
23 Pitfalls ROI- include about 2/3 rds. of lesion without extending to include adjacent fat Ensure the image is artifact free Necrotic masses- Leads to false + ve diagnosis of adenoma No data for inhomogeneous adrenal nodules Adenoma vs. Nonadenoma CT Densitometry * Johnson PT et al. Radiographics 2009 *Choi YA et al Radiology 2013
24 Lipid Poor Adenoma 22 HU 85 HU 42HU UNENHANCED PORTAL VENOUS PHASE 15 MINS. DELAYED Adrenal Washout = 68% 60% APW = Benign adenoma Unenhanced HU = > 10 HU
25 Adrenal Metastasis from Renal Cell Carcinoma UNENHANCED PORTAL VENOUS PHASE 15 MINS. DELAYED Washout = 47% (<60%) Diagnosis? Not a typical adenoma Pt. with h/o renal cell carcinoma- Adrenal Bx
26 CT Densitometry Pitfalls Adrenal cysts may show absolute washout of less than 60%- mimic washout of non-adenomas Some of the lipid-containing vascular metastases- clear cell RCC, well-differentiated HCC
27 Metastatic Clear Cell Renal Cancer 32 HU 139 HU 62 HU Washout = 72% > 60% = benign? Has h/o partial nephrectomy for clear cell RCC Lipid-containing vascular metastases can show washout similar to benign adenomas
28 Incidental Adrenal Mass Dual energy CT In small series virtual unenhanced images show equal sensitivity to true unenhanced images for adenoma diagnosis Virtual unenhanced derived from early (portal venous phase) DECT images, show attenuation numbers of adrenal nodules which are always higher than those obtained on true unenhanced images Less overlap on delayed DECT images Some lipid rich adenomas are not diagnosed due to problems with technical failure (incomplete iodine removal) from the early portal venous phase dual energy CT images Kim YK et al. Radiology 2013; Helck A et al Eur Radiol 2014
29 Adenoma: Intracellular Lipid on MRI Signal loss on OP Qualitative Quantitative Dual-echo sequence Signal Intensity Index (SII) OP SII = IP OP X 100 IP Adenoma >16.5% (or 20%) IP Fujiyoshi F, et al. AJR 2003; Haider MA, et al. Radiology 2004; Schindera ST Radiology 2008
30 Pitfall: CSI MRI Lipid containing metastasis from clear cell renal cell carcinoma (RCC) Prior right nephrectomy for RCC New left adrenal nodule SII = 35% Mimics of lipid-containing adenomas: Metastatic (clear cell) renal cell carcinoma Metastases from HCC can also contain lipid However usually have higher T2 signal and are heterogeneous Schieda N et al AJR 2017 OP IP
31 Incidental Adrenal Mass CT Densitometry (Washout) vs. CS-MRI for adenoma diagnosis 37 lipid poor adenomas and 15 non adenomas studied with washout CT and CSI MR CS-MRI equivalent to CT for adenomas measuring up to 20 HU ; washout CT superior to CS-MRI for masses measuring > 20 HU Other groups also have shown greater sensitivity and specificity for differentiating between lipid poor adenomas and non adenomas especially for masses measuring > HU on washout CT as compared to CS- MRI Seo JM et al AJR 2014: Koo HJ et al. Eur Radiol 2014: Warda MHA et al. Clin Imaging 2016
32 CT Densitometry Washout vs. CS-MRI for lipid poor adenoma diagnosis Seo JM et al AJR 2014 Koo HJ et al. Eur Radiol 2014
33 OUR APPROACH Adrenal nodule > 1 cm detected on enhanced abdominal CT cancer and non cancer pts. Compare with prior CT or MR if available If no change - assume benign - no additional workup New mass in cancer pt. likely met- in non cancer pt.? Malignancy-confirm with PET/CT or biopsy/resection If no prior imaging and characterization needed- adrenal protocol CT (portal venous and 15 min. delayed images) If less than 10 HU (non contrast CT)- stop- if more than 10 HU, perform washout CT
34 OUR APPROACH If CT benign washout characteristic- stop. If indeterminate additional workup in cancer pts- PET/CT/ biopsy Eval. for functioning lesion in non cancer pts.- Hormonal assessment Also based on size and appearance of adrenal lesion- additional workup in non cancer pts. - Small nodules (1-2 cm) with no h/o cancer Follow up in 12 monthsassess for growth - Larger nodules > 2- < 4 cm, short term follow up (6 months) or PET/CT/surgery based on suspicion for cancer and discussion with pt. > 4 cm- non cancer pt.- surgery; h/o cancer- PET/CT/biopsy
35 Incidental Adrenal Mass Overview Imaging features and morphology characterization Review of European Society of Clinical Endocrinology & European Network for Study of Adrenal Tumors Practice Guidelines and American College of Radiology Incidental Findings Project Guidelines CT washout and CSI MRI, technique, pitfalls and comparison Our approach to adrenal nodules/masses
36 MOLTES GRACIES BONA NIT MUCHAS GRACIAS BUENAS TARDES THANK YOU Have a good evening
37 Chicago
STANDARDIZED MANAGEMENT RECOMMENDATIONS FOR ADRENAL NODULES: EVIDENCE-BASED CONSENSUS POWERSCRIBE MACROS FROM AN ACADEMIC/PRIVATE PRACTICE
STANDARDIZED MANAGEMENT RECOMMENDATIONS FOR ADRENAL NODULES: EVIDENCE-BASED CONSENSUS POWERSCRIBE MACROS FROM AN ACADEMIC/PRIVATE PRACTICE COLLABORATIVE Pamela Johnson 1, Darcy Wolfman 2, Upma Rawal 3,
More informationREVIEW. Distinguishing benign from malignant adrenal masses
Cancer Imaging (2003) 3, 102 110 DOI: 10.1102/1470-7330.2003.0006 CI REVIEW Distinguishing benign from malignant adrenal masses Isaac R Francis Professor of Radiology, Department of Radiology, University
More informationOdise Cenaj, Harvard Medical School Year III. Gillian Lieberman, MD
February 2012 Radiologic evaluation of adrenal masses and an atypical radiologic presentation of adrenocortical carcinoma in a patient with primary aldosteronism Odise Cenaj, Harvard Medical School Year
More informationADRENAL LESIONS 10/09/2012. Adrenal + lesion. Introduction. Common causes. Anatomy. Financial disclosure. Dr. Boraiah Sreeharsha. Nothing to declare
ADRENAL LESIONS Financial disclosure Nothing to declare Dr. Boraiah Sreeharsha MBBS;FRCR;FRCPSC Introduction Adrenal + lesion Adrenal lesions are common 9% of the population Increase in the detection rate
More information8/3/2016. Consultant for / research support from: Astellas Bayer Bracco GE Healthcare Guerbet Medrad Siemens Healthcare. Single Energy.
U. Joseph Schoepf, MD Prof. (h.c.), FAHA, FSCBT-MR, FNASCI, FSCCT Professor of Radiology, Medicine, and Pediatrics Director, Division of Cardiovascular Imaging Consultant for / research support from: Astellas
More informationADRENAL MR: PEARLS AND PITFALLS
ADRENAL MR: PEARLS AND PITFALLS Frank Miller, M.D. Lee F. Rogers MD Professor of Medical Education Chief, Body Imaging Section and Fellowship Medical Director, MR Imaging Professor of Radiology Northwestern
More informationSA CME Information SA CME INFORMATION. Target Audience
SA CME INFORMATION SA CME Information Description Adrenal Imaging: A Three-category Approach To Managing The Adrenal "Incidentaloma" Imaging plays a critical role in the work-up and clinical management
More informationCase Based Urology Learning Program
Case Based Urology Learning Program Resident s Corner: UROLOGY Case Number 4 CBULP 2010 004 Case Based Urology Learning Program Editor: Associate Editors: Manager: Case Contributors: Steven C. Campbell,
More informationEndocrine MR. Jan 30, 2015 Michael LaFata, MD
Endocrine MR Jan 30, 2015 Michael LaFata, MD Brief case 55-year-old female in ED PMH: HTN, DM2, HLD, GERD CC: Epigastric/LUQ abdominal pain, N/V x2 days AF, HR 103, BP 155/85, room air CMP: Na 133, K 3.6,
More informationAdrenal incidentaloma guideline for Northern Endocrine Network
Adrenal incidentaloma guideline for Northern Endocrine Network Definition of adrenal incidentaloma Adrenal mass detected on an imaging study done for indications that are not related to an adrenal problem
More informationTraumatic and Non Traumatic Adrenal Emergencies
Traumatic and Non Traumatic Adrenal Emergencies Michael N. Patlas, MD, FRCPC (1), Christine O. Menias, MD (2), Douglas S. Katz, MD, FACR (3), Ania Z. Kielar, MD, FRCPC (4), Alla M. Rozenblit, MD (5), Jorge
More informationEvaluation of Thyroid Nodules
Evaluation of Thyroid Nodules Stephan Kowalyk, MD January 25 28, 2018 1 Primary goal Exclude malignancy Incidental thyroid nodules If found on CT, MRI, PET scan, carotid Doppler ULTRASOUND!! January 25
More informationADRENAL INCIDENTALOMA. Jamii St. Julien
ADRENAL INCIDENTALOMA Jamii St. Julien Outline Definition Differential Evaluation Treatment Follow up Questions Case Definition The phenomenon of detecting an otherwise unsuspected adrenal mass on radiologic
More information11/1/2014. Radiologic incidentalomas Ordering pitfalls Newer technology and applications
Bilal Tahir, MD Gitasree Borthakur, MD Indiana University School of Medicine Department of Radiology & Imaging Sciences October 31, 2014 ACP 2014 Dr. V. Aaron Nuclear (vaaron@iupui.edu) Dr. S. Westphal
More informationAdrenal Imaging. Isaac R. Francis and William W. Mayo-Smith. 9.1 Introduction Detection of Biochemically Active Adrenal Tumor
Adrenal Imaging Isaac R. Francis and William W. Mayo-Smith 9 Learning Objectives To provide an overview as how to approach the evaluation of adrenal mass in various clinical scenarios To provide an understanding
More informationCharacterization of Adrenal Lesions at Chemical-Shift MRI: A Direct Intraindividual Comparison of In- and Opposed- Phase Imaging at 1.
Genitourinary Imaging Original Research Ream et al. In- and Opposed-Phase Chemical-Shift 1.5 T and 3 T MRI of Adrenal Lesions Genitourinary Imaging Original Research Justin M. Ream 1 Byron Gaing 1 Thais
More informationEvaluation of Incidental Lesions Discovered at Imaging
Evaluation of Incidental Lesions Discovered at Imaging Radiology Associates of Indianapolis Richard L Scales MD Indeterminate Lesions Current Discussion Future Discussion Thyroid nodule Adrenal nodule
More informationCharacterization of adrenal lesions on CT and MRI: all that a radiologist must know
Characterization of adrenal lesions on CT and MRI: all that a radiologist must know Poster No.: C-2476 Congress: ECR 2013 Type: Educational Exhibit Authors: N. Benzina, S. MAJDOUB, C. H. ZARRAD, H. Zaghouani,
More information(2/3 PRCC!) (2/3 PRCC!)
Approach to the Incidental Solid Renal Mass Stuart G. Silverman, MD, FACR Professor of Radiology Harvard ard Medical School Director, Abdominal Imaging and Intervention Brigham and Women s Hospital Boston,
More informationContrast Enhanced Ultrasound of Parenchymal Masses in Children
Contrast Enhanced Ultrasound of Parenchymal Masses in Children Sue C Kaste, DO On behalf of Beth McCarville, MD St. Jude Children s Research Hospital Memphis, TN Overview Share St. Jude experience with
More informationReview Article Incidental Adrenal Nodules and Masses: The Imaging Approach
International Endocrinology Volume 2015, Article ID 410185, 6 pages http://dx.doi.org/10.1155/2015/410185 Review Article Incidental Adrenal Nodules and Masses: The Imaging Approach J. Willatt, 1,2 S. Chong,
More informationThe Management of adrenal incidentaloma
The Management of adrenal incidentaloma Dimitrios Linos, MD Director of Surgery, Hygeia Hospital, Athens, Greece Consultant in Surgery, Massachusetts General Hospital, Boston, USA 8 th Postgraduate Course
More informationADRENAL MEDULLARY DISORDERS: PHAEOCHROMOCYTOMAS AND MORE
ADRENAL MEDULLARY DISORDERS: PHAEOCHROMOCYTOMAS AND MORE DR ANJU SAHDEV READER AND CONSULTANT RADIOLOGIST QUEEN MARY UNIVERSITY AND ST BARTHOLOMEW S HOSPITAL BARTS HEALTH, LONDON, UK DISCLOSURE OF CONFLICT
More informationINTERDISCIPLINARY DISCUSSIONS IN LOCALISED RCC DIAGNOSIS AND SURGICAL STRATEGIES FOR ATYPICAL RENAL CYSTIC LESIONS. Maria Cova
INTERDISCIPLINARY DISCUSSIONS IN LOCALISED RCC DIAGNOSIS AND SURGICAL STRATEGIES FOR ATYPICAL RENAL CYSTIC LESIONS Maria Cova Radiology Department University of Trieste (IT) Eleventh European International
More informationThe Incidental Renal lesion
The Incidental Renal lesion BACKGROUND Increase in abdominal CT/US in last 15 years Resulted in detection of many (small) renal lesions 50% > 50yrs has at least 1 lesion majority simple cysts Renal lesions
More informationMDCT combined parameters in characterization of adrenal masses in cancer patients; A prospective study in South Egypt Cancer Institute
walaa et al. SECI Oncology 2018 MDCT combined parameters in characterization of adrenal masses in cancer patients; A prospective study in South Egypt Cancer Institute Walaa Talaat 1, Haisam A.Samy 2, Hosam
More informationRecommendations for cross-sectional imaging in cancer management, Second edition
www.rcr.ac.uk Recommendations for cross-sectional imaging in cancer management, Second edition Renal and adrenal tumours Faculty of Clinical Radiology www.rcr.ac.uk Contents Renal cell carcinoma 3 Clinical
More informationDiagnostic performance of unenhanced computed tomography and 18 F- fluorodeoxyglucose positron emission tomography in indeterminate adrenal tumours
Received: 8 June 2017 Revised: 3 August 2017 Accepted: 11 August 2017 DOI: 10.1111/cen.13448 ORIGINAL ARTICLE Diagnostic performance of unenhanced computed tomography and 18 F- fluorodeoxyglucose positron
More informationState of the art imaging of typical and atypical adrenal adenomas.
State of the art imaging of typical and atypical adrenal adenomas. Poster No.: C-0896 Congress: ECR 2012 Type: Educational Exhibit Authors: N. LAUNAY, S. Silvera, F. Tissier, L. Groussin, A. Oudjit, A.
More informationCurrent Management of Adrenal Cortical Carcinoma
Current Management of Adrenal Cortical Carcinoma American Association of Clinical Endocrinologists Texas Chapter of the AACE Annual Meeting And Texas Endocrine Surgery Symposium August 4, 2017 Jeffrey
More informationRole of imaging in RCC. Ultrasonography. Solid lesion. Cystic RCC. Solid RCC 31/08/60. From Diagnosis to Treatment: the Radiologist Perspective
Role of imaging in RCC From Diagnosis to Treatment: the Radiologist Perspective Diagnosis Staging Follow up Imaging modalities Limitations and pitfalls Duangkamon Prapruttam, MD Department of Therapeutic
More informationJMSCR Vol 05 Issue 04 Page April 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i4.103 Imaging of Adrenal Tumors Using CT: Comparison
More informationRenal Mass Biopsy: Needed Now More than Ever
Renal Mass Biopsy: Needed Now More than Ever Stuart G. Silverman, MD, FACR Professor of Radiology Harvard Medical School Director, Abdominal Imaging and Intervention Brigham and Women s Hospital Boston,
More informationDaniela Faivovich K., MS VII Universidad de Chile Gillian Lieberman, MD Harvard Medical School
Daniela Faivovich K., MS VII Universidad de Chile Gillian Lieberman, MD Harvard Medical School May 21st, 2010 56 year old male patient History of hypertension, hyperlipidemia and insulin-resistance 2009:
More informationMeasure #405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions National Quality Strategy Domain: Effective Clinical Care
Measure #405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION:
More informationAdrenal Incidentaloma Management
Adrenal Incidentaloma Management Full Title of Guideline: Author Management of Incidentally-discovered Adrenal Lesions ( Incidentalomas ) Mr David Chadwick Consultant Endocrine Surgeon david.chadwick2@nuh.nhs.uk
More informationThe Work-up and Treatment of Adrenal Nodules
The Work-up and Treatment of Adrenal Nodules Lawrence Andrew Drew Shirley, MD, MS, FACS Assistant Professor of Surgical-Clinical Department of Surgery Division of Surgical Oncology The Ohio State University
More informationMANAGEMENT RECOMMENDATIONS
1 MANAGEMENT RECOMMENDATIONS 1. Adrenal masses!!!!!!! page 2 2. Liver Masses!!!!!!! page 3 3. Obstetric US Soft Markers for Aneuploidy!! pages 4-6 4. Ovarian and Adnexal Cysts!!!!! pages 7-10 5. Pancreatic
More informationPitfalls and Limitations of Breast MRI. Susan Orel Roth, MD Professor of Radiology University of Pennsylvania
Pitfalls and Limitations of Breast MRI Susan Orel Roth, MD Professor of Radiology University of Pennsylvania Objectives Review the etiologies of false negative breast MRI examinations Discuss the limitations
More informationAcknowledgements. Update of Focal Liver Lesions Goals. Focal Liver Lesions. Imaging Choices For Liver Lesions. Focal Liver Lesions
Acknowledgements Update of Focal Liver Lesions 2012 Giles Boland Massachusetts General Hospital Harvard Medical School No disclosures Dushyant Sahani Mukesh Harisinghani Goals Focal liver lesions Imaging
More informationPediatric Retroperitoneal Masses Radiologic-Pathologic Correlation
Acta Radiológica Portuguesa, Vol.XVIII, nº 70, pág. 61-70, Abr.-Jun., 2006 Pediatric Retroperitoneal Masses Radiologic-Pathologic Correlation Marilyn J. Siegel Mallinckrodt Institute of Radiology, Washington
More informationSCBT-MR 2015 Incidentaloma on Chest CT
SCBT-MR 2015 Incidentaloma on Chest CT Reginald F. Munden MD, DMD, MBA I have no conflicts of interest to report Incidentaloma Pulmonary Nodule Mediastinal Lymph Node Coronary Artery Calcium Incidental
More informationRenal Masses in Patients with Known Extrarenal Primary Primary Cancer Primary Primary n Met Mets s RCC Beni L mphoma Lung Breast Others
The Importance of Stuart G. Silverman, MD, FACR Professor of Radiology Harvard ard Medical School Director, Abdominal Imaging and Intervention Brigham and Women s Hospital Boston, MA The Importance of
More informationUsefulness of Positron Emission Tomography for Characterization of the Indeterminate Adrenal Tumor
WJOES Usefulness of Positron Emission Tomography for Characterization of the Indeterminate Adrenal Tumor REVIEW ARTICLE Usefulness of Positron Emission Tomography for Characterization of the Indeterminate
More informationEvaluation and Management of Thyroid Nodules. Nick Vernetti, MD, FACE Palm Medical Group Las Vegas, Nevada
Evaluation and Management of Thyroid Nodules Nick Vernetti, MD, FACE Palm Medical Group Las Vegas, Nevada Disclosure Consulting Amgen Speaking Amgen Objectives Understand the significance of incidental
More informationUpdate on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD
Update on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD Section of Pediatric Radiology C.S. Mott Children s Hospital University of Michigan ethans@med.umich.edu Disclosures No relevant
More informationInteresting Cases from Liver Tumor Board. Jeffrey C. Weinreb, M.D.,FACR Yale University School of Medicine
Interesting Cases from Liver Tumor Board Jeffrey C. Weinreb, M.D.,FACR Yale University School of Medicine jeffrey.weinreb@yale.edu Common Liver Diseases Hemangioma Cyst FNH Focal Fat/Sparing THID Non-Cirrhotic
More informationRenal masses - the role of diagnostic imaging
Renal masses - the role of diagnostic imaging Poster No.: C-2471 Congress: ECR 2015 Type: Educational Exhibit Authors: V. Rai#; Bjelovar/HR Keywords: Cysts, Cancer, Structured reporting, Ultrasound, MR,
More informationA pictorial essay depicting CT and MR characteristic of adrenal pathologies: Indian study
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,
More information18F-FDG PET for the Identification of Adrenocortical Carcinomas among Indeterminate Adrenal Tumors at Computed Tomography Scanning
World J Surg (2010) 34:1506 1510 DOI 10.1007/s00268-010-0576-3 18F-FDG PET for the Identification of Adrenocortical Carcinomas among Indeterminate Adrenal Tumors at Computed Tomography Scanning Marie Laure
More informationCOPYRIGHTED MATERIAL. Adrenal Imaging. 1.1 Introduction. Khaled M. Elsayes 1, Isaac R. Francis 1, Melvyn Korobkin 1 and Gerard M.
1 Adrenal Imaging Khaled M. Elsayes 1, Isaac R. Francis 1, Melvyn Korobkin 1 and Gerard M. Doherty 2 1 Department of Radiology, University of Michigan 2 Department of Radiology and Surgery, University
More informationDimitrios Linos, M.D., Ph.D. Professor of Surgery National & Kapodistrian University of Athens
Dimitrios Linos, M.D., Ph.D. Professor of Surgery National & Kapodistrian University of Athens What is an adrenal incidentaloma? An adrenal incidentaloma is defined as an adrenal tumor initially diagnosed
More informationDisclosures. Diffusion and Perfusion Imaging in the Head and Neck. Learning objectives ???
Disclosures No relevant financial disclosures Diffusion and Perfusion Imaging in the Head and Neck Ashok Srinivasan, MD Associate Professor Director of Neuroradiology University of Michigan Health System
More informationDifferentiation of Benign From Metastatic Adrenal Masses in Patients With Renal Cell Carcinoma on Contrast-Enhanced CT
Genitourinary Imaging Original Research Sasaguri et al. CT Differentiation of Adrenal Masses in Patients With RCC Genitourinary Imaging Original Research Kohei Sasaguri 1,2 Naoki Takahashi 1 Mitsuru Takeuchi
More informationCASE 1 11/1/2016 HEPATOBILIARY IMAGING CASE PRESENTATIONS DECLARATION. Dr. Chirag Patel ORGAN IMAGING yr old lady
HEPATOBILIARY IMAGING CASE PRESENTATIONS DECLARATION No financial disclosures or affiliations with commercial organisations No discussion of investigational or off-label use of medical devices, products
More informationABDOMINAL DIFFUSION WEIGHTED MR
ABDOMINAL DIFFUSION WEIGHTED MR Frank Miller, M.D. FACR Professor of Radiology Chief, Body Imaging Section Medical Director, MR Imaging Northwestern University Feinberg School of Medicine fmiller@northwestern.edu
More informationClinical Characteristics for 348 Patients with Adrenal Incidentaloma
Original Article Endocrinol Metab 2013;28:20-25 http://dx.doi.org/10.3803/enm.2013.28.1.20 pissn 2093-596X eissn 2093-5978 Clinical Characteristics for 348 Patients with Adrenal Incidentaloma Jongho Kim,
More informationInterventional Radiology Case Conference Massachusetts General Hospital
Interventional Radiology Case Conference Massachusetts General Hospital Adrenal Biopsy in a Patient with Lung Cancer: Imaging Algorithm and Biopsy Indications, Technique, and Complications C ase History
More informationCT & MRI of Benign Liver Neoplasms Srinivasa R Prasad
CT & MRI of Benign Liver Neoplasms Srinivasa R Prasad No financial disclosures Acknowledgements Many thanks to Drs. Heiken, Narra & Menias (MIR) Dr. Sahani (MGH) for sharing images Benign Liver Tumors:
More informationLUNG NODULES: MODERN MANAGEMENT STRATEGIES
Department of Radiology LUNG NODULES: MODERN MANAGEMENT STRATEGIES Christian J. Herold M.D. Department of Biomedical Imaging and Image-guided Therapy Medical University of Vienna Vienna, Austria Pulmonary
More informationNeuro-endocrine and pancreatic non-adenocarcinomas. Marc Engelbrecht, AMC, Amsterdam
Neuro-endocrine and pancreatic non-adenocarcinomas Marc Engelbrecht, AMC, Amsterdam Pancreatic Tumors q Epithelial Exocrine q Mesenchymal Ductal Adenocarcinoma (85-95%) Metastasis Lymfoma Acinar Cell Carcinoma
More informationIncidental adrenal masses A primary care approach
CLINICAL Incidental adrenal masses A primary care approach Rasha Gendy, Prem Rashid Background The common use of cross-sectional imaging for the investigation of abdominal and thoracic illness has resulted
More informationImaging Pancreatic Neuroendocrine Tumors (PNETs): CT, MRI, EUS, Nuclear
Imaging Pancreatic Neuroendocrine Tumors (PNETs): CT, MRI, EUS, Nuclear Eric Tamm, M.D. Department of Diagnostic Radiology Division of Diagnostic Imaging MD Anderson Cancer Center Houston, TX Disclosure
More informationobjectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University
objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University To determine the regions of physiologic activity To understand
More informationAdrenal gland Incidentaloma
Adrenal gland Incidentaloma Topic review 17 sep 2008 Anatomy 1 Anatomical consideration Blood supply Artery: small branches from Inf. phrenic, renal artery and aorta Vein: Rt : medial aspect to IVC Lt
More informationHEPATOCYTE SPECIFIC CONTRAST MEDIA: WHERE DO WE STAND?
HEPATOCYTE SPECIFIC CONTRAST MEDIA: WHERE DO WE STAND? Andrew T. Trout, MD @AndrewTroutMD Disclosures No relevant disclosures Outline Review of hepatocyte specific contrast media Review of hepatocellular
More informationTHE WORK-UP OF ADRENAL INCIDENTALOMA
THE WORK-UP OF ADRENAL INCIDENTALOMA Maria Cristina De Martino Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia Università Federico II di Napoli Definition and epidemiology Most
More informationWashout ratio on contrast-enhanced CT for adrenal lesion: A comparison of 5 min and 10 min delay after IV contrast injection
Washout ratio on contrast-enhanced CT for adrenal lesion: A comparison of 5 min and 10 min delay after IV contrast injection Poster No.: C-1165 Congress: ECR 2010 Type: Topic: Scientific Exhibit Genitourinary
More informationNephtali R. Gomez, M.D. To The Incidental Adrenal Mass
Nephtali R. Gomez, M.D. To The Incidental Adrenal Mass The Complete Idiot s Guide to The Incidental Adrenal Mass Defini:on Any adrenal mass 1cm or more in diameter discovered on a radiologic exam performed
More informationCharacterization of Adrenal Masses With Diffusion-Weighted Imaging
Genitourinary Imaging Original Research Sandrasegaran et al. Diffusion-Weighted Imaging of Adrenal Masses Genitourinary Imaging Original Research Kumaresan Sandrasegaran 1 Aashish A. Patel 1 Raja Ramaswamy
More informationSELF-ASSESSMENT MODULE REFERENCE SPR 2018 Oncologic Imaging Course Adrenal Tumors November 10, :00 12:10 p.m.
SELF-ASSESSMENT MODULE REFERENCE SPR 2018 Oncologic Imaging Course Adrenal Tumors November 10, 2018 10:00 12:10 p.m. Staging Susan E. Sharp, MD 1. In the International Neuroblastoma Risk Group Staging
More informationIndex. radiologic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACC. See Adrenal cortical carcinoma. Acromegaly and the pituitary gland, 551 Acute suppurative thyroiditis, 405, 406 Addison, Thomas and
More informationTrust Guideline for the Investigation of Incidental Adrenal Masses in Adults
A clinical guideline recommended for use For Use in: A&E, Medical Assessment Unit, ITU/HDU Medical and Surgical wards By: Medical, Clinical investigation unit and Surgical staff For: Investigation of incidental
More informationFinancial Disclosure
Benign Liver Masses Adil Abdalla, MBBS Creighton University-CHI Health August 25, 2018 Financial Disclosure Nothing to disclose Financial Disclosure 1 Objectives To assess patients with benign liver tumors
More informationEvaluating and managing adrenal incidentalomas
REVIEW CME CREDIT THOTTATHIL GOPAN, MD Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic ERICK REMER, MD Department of Radiology, Cleveland Clinic AMIR H. HAMRAHIAN, MD Department
More informationManagement of the Incidental Renal Mass on CT: A White Paper of the ACR Incidental Findings Committee
ORIGINAL ARTICLE Management of the Incidental Renal Mass on CT: A White Paper of the ACR Incidental Findings Committee Brian R. Herts, MD a, Stuart G. Silverman, MD b, Nicole M. Hindman, MD c, Robert G.
More informationMultidisciplinary management of retroperitoneal sarcomas
Multidisciplinary management of retroperitoneal sarcomas Eric K. Nakakura, MD UCSF Department of Surgery UCSF Comprehensive Cancer Center San Francisco, CA 7 th Annual Clinical Cancer Update North Lake
More informationEvaluation of Adrenal Masses in Lung Cancer Patients Using F-18 FDG PET/CT
Nucl Med Mol Imaging (211) 45:52 58 DOI 1.17/s13139-1-64-6 ORIGINAL ARTICLE Evaluation of Adrenal Masses in Lung Cancer Patients Using F-18 FDG PET/CT A. Ra Cho & Ilhan Lim & Im Il Na & Du Hwan Choe &
More informationTHYROID NODULES: THE ROLE OF ULTRASOUND
THYROID NODULES: THE ROLE OF ULTRASOUND NOVEMBER 2017 DR. DEAN DURANT DEFINITION Thyroid nodule: Focal area within the thyroid gland with echogenicity different from surrounding parenchyma. THYROID NODULES
More informationApproach to Pulmonary Nodules
Approach to Pulmonary Nodules Edwin Jackson, Jr., DO Assistant Professor-Clinical Director, James Early Detection Clinic Department of Internal Medicine Division of Pulmonary, Allergy, Critical Care and
More informationHepatic Imaging: What Every Practitioner Should Know
Hepatic Imaging: What Every Practitioner Should Know Shuchi K. Rodgers, MD Section Chief, Abdominal Imaging Director of Ultrasound Department of Radiology Einstein Medical Center rodgerss@einstein.edu
More information1/25/13 Right partial nephrectomy followed by completion right radical nephrectomy.
History and Physical Case Scenario 1 45 year old white male presents with complaints of nausea, weight loss, and back pain. A CT of the chest, abdomen and pelvis was done on 12/8/12 that revealed a 12
More informationDual Energy CT of the Liver
34th Annual Course October 2011 Washington, DC Dual Energy CT of the Liver Vassilios Raptopoulos, MD Beth Israel Deaconess Medical Center Harvard Medical School Dual Energy CT (DECT) Different materials
More informationGUIDELINES FOR PULMONARY NODULE MANAGEMENT : RECENT CHANGES AND UPDATES
Venice 2017 GUIDELINES FOR PULMONARY NODULE MANAGEMENT : RECENT CHANGES AND UPDATES Heber MacMahon MB, BCh Department of Radiology The University of Chicago Disclosures Consultant for Riverain Medical
More informationCase Rep Oncol 2010;3: DOI: /
416 This is an Open Access article licensed under the terms of the Creative Commons Attribution- NonCommercial-NoDerivs 3.0 License (www.karger.com/oa-license), applicable to the online version of the
More informationCT Urography. Bladder. Stuart G. Silverman, M.D.
CT Urography Stuart G. Silverman, M.D. Professor of Radiology Harvard Medical School Director, Abdominal Imaging and Intervention Brigham and Women s Hospital Bladder Boston, MA CT Urography Stuart G.
More informationPULMONARY NODULES AND MASSES : DIAGNOSTIC APPROACH AND NEW MANAGEMENT GUIDELINES. https://tinyurl.com/hmpn2018
PULMONARY NODULES AND MASSES : DIAGNOSTIC APPROACH AND NEW MANAGEMENT GUIDELINES Heber MacMahon MB, BCh Department of Radiology The University of Chicago https://tinyurl.com/hmpn2018 Disclosures Consultant
More informationInteresting case. Vikas Kundra, M.D., Ph.D. October Vikas Kundra, M.D., Ph.D.
Interesting case October 2012 Disclosure Information Vikas Kundra, M.D, Ph.D. I have no financial relationships to disclose. I WILL NOT include discussion of investigational or off-label use of a product
More informationLiver MRI in 30 minutes
X Liver MRI in 30 minutes SCBT/MR Annual Meeting Salt Lake City September 18, 2016 Scott B. Reeder, MD, PhD Department of Radiology University of Wisconsin Madison, WI Disclosures University of Wisconsin-Madison
More informationLIVER IMAGING TIPS IN VARIOUS MODALITIES. M.Vlychou, MD, PhD Assoc. Professor of Radiology University of Thessaly
LIVER IMAGING TIPS IN VARIOUS MODALITIES M.Vlychou, MD, PhD Assoc. Professor of Radiology University of Thessaly Hepatocellular carcinoma is a common malignancy for which prevention, screening, diagnosis,
More informationDisclosure. Acknowledgement. What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Rectal cancer imaging. None
What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Zhen Jane Wang, MD Assistant Professor in Residence UC SF Department of Radiology Disclosure None Acknowledgement Hueylan Chern, MD, Department
More informationAdrenal Incidentalomas. Dr A Tabarin University Hospital of Bordeaux (France)
Adrenal Incidentalomas Dr A Tabarin University Hospital of Bordeaux (France) Adrenal Incidentalomas - Basics Definition : Incidental Discovery Rate of discovery # 4 % over 50 yo Bilateral AI : 10-15 %
More informationRadiology reporting of adrenal incidentalomas who requires further testing?
CLINICAL PRACTICE Clinical Medicine 2014 Vol 14, No 1: 16 21 Radiology reporting of adrenal incidentalomas who requires further testing? Authors: Fiona Paterson, A Aikaterini Theodoraki, B Adaugo Amajuoyi,
More informationAdrenocortical Carcinomas and Adrenal Pheochromocytomas: Mass and Enhancement Loss Evaluation at Delayed Contrast-enhanced CT 1
Genitourinary Imaging Radiology Dieter H. Szolar, MD Melvyn Korobkin, MD Pia Reittner, MD Andrea Berghold, PhD Thomas Bauernhofer, MD Harald Trummer, MD Helmut Schoellnast, MD Klaus W. Preidler, MD Hellmuth
More informationMILD HYPERCORTISOLISM DUE TO ADRENAL ADENOMA: IS IT REALLY SUBCLINICAL?
MILD HYPERCORTISOLISM DUE TO ADRENAL ADENOMA: IS IT REALLY SUBCLINICAL? Alice C. Levine, MD Professor of Medicine Division of Endocrinology, Diabetes and Bone Diseases Georgia-AACE 2017 Annual Meeting
More informationThyroid Ultrasonography: clinical and radiological correlations
Thyroid Ultrasonography: clinical and radiological correlations Dr.M.Thijs Radiology Anatomy Inflammatory Thyroid Disease Benign lesions Thyroid tumors Thyroglossal duct cyst Anatomy Transverse Longitudinal
More informationDiffusion Weighted Imaging in Prostate Cancer
Diffusion Weighted Imaging in Prostate Cancer Disclosure Information Vikas Kundra, M.D, Ph.D. No financial relationships to disclose. Education Goals and Objectives To describe the utility of diffusion-weighted
More informationPatients with lung cancer are at risk for adrenal metastasis.
MRI as an Alternative to CT-Guided Biopsy of Adrenal Masses in Patients With Lung Cancer Lawrence H. Schwartz, MD, Michelle S. Ginsberg, MD, Michael E. Burt, MD, PhD,* Karen T. Brown, MD, George I. Getrajdman,
More informationLearning Objectives. 1. Identify which patients meet criteria for annual lung cancer screening
Disclosure I, Taylor Rowlett, DO NOT have a financial interest /arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context
More information