Case 6.3

2014 ◽  
pp. 287-288
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Adrenal Gland ◽  
Signal Intensity ◽  
Adrenal Mass ◽  
Chest Ct ◽  
Adrenal Lesion ◽  
Signal Loss ◽  
Chest Discomfort

52-year-old woman with chest discomfort; chest CT showed an indeterminate adrenal lesion A well-circumscribed left adrenal mass shows signal intensity similar to that of the normal adrenal gland on coronal SSFSE (Figure 6.3.1) and axial fat-suppressed FSE T2-weighted (Figure 6.3.2) images. Notice the extensive signal loss within the lesion between IP (...

Case 13.12

2014 ◽  
pp. 636-637
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Skeletal Muscle ◽  
Signal Intensity ◽  
Chest Ct ◽  
Inversion Recovery ◽  
Double Inversion Recovery ◽  
Proton Density ◽  
Chest Discomfort

52-year-old woman with chest discomfort; chest CT revealed an indeterminate mediastinal lesion Axial proton density-weighted double inversion recovery FSE images (Figure 13.12.1) demonstrate a large mildly heterogeneous lesion with moderately increased signal intensity relative to adjacent skeletal muscle and a well-defined low-signal-intensity capsule. Axial T2-weighted triple inversion recovery FSE images (...

Case 6.11

2014 ◽  
pp. 304-305
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Adrenal Gland ◽  
Signal Intensity ◽  
Adrenal Mass ◽  
Large Mass ◽  
Female Infant ◽  
Hepatic Parenchyma ◽  
The Right ◽  
T2 Weighted Images

1-month-old female infant with a renal or adrenal mass Axial fat-suppressed FSE T2-weighted images (Figure 6.11.1) reveal a large mass originating from the right adrenal gland with heterogeneously increased signal intensity. Extensive small hyperintense metastases essentially replace the visualized hepatic parenchyma. Axial fat-suppressed FSE images from the 6-week follow-up examination (...

Case 6.5

2014 ◽  
pp. 291-292
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Signal Intensity ◽  
Adrenal Mass ◽  
Adrenal Lesion ◽  
Ct Urogram ◽  
T2 Weighted Images

33-year-old woman with infertility and hydronephrosis; an adrenal lesion was incidentally noted on a CT urogram Axial fat-suppressed FSE T2-weighted images (Figure 6.5.1) reveal a large left adrenal mass with heterogeneous increased T2-signal intensity. Arterial (Figure 6.5.2A), portal venous (...

scholarly journals SAT-183 Right Adrenal Mass: An Unusual Presentation

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Lyan Gondin-Hernandez ◽  
Jonathan Trejo ◽  
Brenda Sandoval ◽  
Jan M Bruder ◽  
Ramona Granda-Rodriguez
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adrenal Gland ◽  
Needle Biopsy ◽  
Adrenal Mass ◽  
Needle Aspiration ◽  
Adrenal Metastasis ◽  
Adrenal Lesion ◽  
Primary Malignancy ◽  
Ct Guided ◽  
The Right

Abstract Background: Adrenal masses may be incidentally found on imaging done for other reasons. The prevalence is 4.4% and up to 10% in older patients. Malignancy is an uncommon cause in patients without a known diagnosis of cancer. The frequency of primary adrenal carcinoma in patients with adrenal incidentalomas is approximately 2.0 to 5.0%; another 0.7 to 2.5% have non-adrenal metastases to the adrenal gland. Clinical Case: 54-year-old man with Hepatitis C, prior alcohol abuse, and cirrhosis was found to have an increase in the alpha-fetoprotein (AFP) level from normal to 244 ng/ml (nl<15.1) over a 6-month period. Liver MRI was consistent with a cirrhotic liver without focal enhancing lesions and showed a new indeterminate 7.6 cm right retroperitoneal lesion arising from the adrenal gland compared to a prior CT of the abdomen a year early. Further imaging confirmed a 9.6 x 9 x 7.6 cm heterogeneously enhancing right adrenal lesion with a necrotic center, concerning for a primary malignancy; up to 11.1cm a month later. Patient referred to Endocrine for further evaluation. There were no symptoms suggestive of Cushing’s, pheochromocytoma or primary hyperaldosteronism. On exam there were no hypertension, dorsal fat pad, supraclavicular fullness, skin thinning or purplish striae. Biochemical workup was consistent with a non-functioning adrenal mass. DHEA-S was 11 (38-313 mcg/dl). CT-guided core needle biopsy of right adrenal gland was consistent with metastatic hepatocellular carcinoma. CT pelvis with contrast re-demonstrated the right adrenal mass now measuring 11.4 x 10 x 10 cm with new enlarged retrocaval lymph node and no focal arterially enhancing lesions. During embolization of adrenal lesion/ hepatic angiogram, multiple liver lesions not previously identified were reported with the largest of 2.9cm size and enhancing lesions in the sacrum and bilateral iliac bones; decrease in size of the necrotic right adrenal mass measuring 8.2 x 9.1 x 9.1 cm 1-month post-embolization. Patient following with Oncology. Conclusion:Unilateral isolated adrenal metastasis from occult hepatocellular carcinoma (HCC) is extremely rare. Adrenal gland is the second most common site of hematogenous spread from HCC after the lung and has been found in up to 8.4% of cases at autopsy. In our case, the adrenal metastasis was the first clinical presentation of HCC with no evident hepatic lesion until 9 months of adrenal finding; few cases have been reported. Fine needle aspiration/needle biopsy of suspected malignancy is useful to detect primary tumor in case of metastatic disease that is silent at this stage. Adrenal metastasis in HCC are seldom treated by surgery as by the time of diagnosis the tumor is usually far advanced and/or patients are poor surgical candidates. This case highlights the importance of suspecting underlying HCC in isolated adrenal mass in a patient with high risk factors.

Could we assess the functional status, of hormone secreting, or non-secreting of the adrenal masses regarding their Magnetic Resonance Imaging (MRI) characteristics?

2021 ◽  
Vol 22 ◽  
Author(s):  
Gamze Akkus ◽  
Ferhat Piskin ◽  
Barış Karagun ◽  
Murat Sert ◽  
Mehtap Evran ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Chemical Shift ◽  
Functional Status ◽  
Signal Intensity ◽  
Adrenal Mass ◽  
Resonance Imaging ◽  
Intensity Index ◽  
Adrenal Masses ◽  
Magnetic Resonance Imaging Mri

Background: Diagnostic imaging techniques including magnetic resonance imaging (MRI) should also perform on all patients with incidentalomas. However, there is a limited study whether the quantitative measurements (signal intensity index, adrenal to spleen ratio) in MRI could predict the functional status of adrenal adenomas. Material-Method: Between 2015-2020; 404 patients (265 females, 139 males) with adrenal mass who were referred to the university hospital for further investigation were included. After detailed diagnostic hormonal evaluation, all patients underwent MRI 1.5 T device (Signa, GE Medical Systems; Milwaukee, USA). The signal intensities of the adrenal lesions on T2W images were qualitatively evaluated and noted as homogenous or heterogeneous in comparison with the liver signal intensity (SI). A chemical-shift SI index and chemical shift adrenal-to-spleen SI ratio were also calculated. Results: While 331(81.9%) of the patients had nonfunctional adrenal mass, the rest of them (n=73, 18.1%) were patients with functional (autonomous cortisol secretion-ACS, cushing syndrome-CS, pheochromocytoma, primary hyperaldosteronism-PA) adrenal masses. In phase vs phase values of patients with NFAI, Pheo(n=17), ACS (n=30), CS (n=11), and PA (n=15) were 474.04±126.7 vs 226.6±132.4, 495.3±182.8 vs 282.17±189.1, 445.2±134.8 vs 203.3±76.2, 506.8±126.5 vs 212.2±73.6 and 496.2±147.5 vs 246.6±102.1, respectively. Mean signal intensity index (SII) and adrenal to spleen ratio (ASR) of all groups (NFAI, Pheo, ACS, CS, PA) were 52.0±24.8 and 0.51, 44.9±22.5 and 0.55, 49.5±24.5 and 0.53, 56.2±16.4 and 0.43, 47.6±25.1 and 0.54, respectively. Based the current accepted measurements in the case of ASR and SII, all lesions were similar and shown as fat rich adenomas (p*= 0.552, p** = 0.45). Conclusion: The quantitative assessment (SII, ASR) of intracellular lipids in an incidentally discovered adrenal tumour could only help distinguish adrenal masses in case of adenomas or non-adenomas As initial diagnostic evaluation, clinical and laboratory assessment ,to distinguish hormone secretion, should be taken in all patients with adrenal incidentalomas.

Osteosarcoma invading adrenal gland: Rare cause of adrenal mass

Urology ◽  
2005 ◽  
Vol 65 (6) ◽  
pp. 1226 ◽  
Author(s):  
Jacques Kpodonu ◽  
Michael A. Warso ◽  
Malek G. Massad
Keyword(s):  
Adrenal Gland ◽  
Adrenal Mass

scholarly journals SAT-199 Diagnostic Dilemma: An Adrenal Incidentaloma in a Young Adult

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sonia Sharma ◽  
Steven N Levine ◽  
Xin Gu
Keyword(s):  
Adrenal Gland ◽  
Adrenal Mass ◽  
Adrenal Adenoma ◽  
Adrenal Incidentaloma ◽  
Significant Loss ◽  
Phase Imaging ◽  
African American Female ◽  
Hounsfield Units ◽  
Diagnostic Dilemma ◽  
Ki 67

Abstract Introduction: In an adult endocrine clinic, the majority of patients referred for evaluation of an adrenal incidentaloma are older than 30 years of age. It is important to be reminded that a patient may be diagnosed with an adrenal mass at any age but the etiology may vary depending on the age at presentation. Clinical case: An 18 year-old African American female with no significant past medical problems presented with a 2 month history of flank and abdominal pain associated with nausea and vomiting. An abdominal CT scan and a dedicated adrenal CT showed a right adrenal mass measuring 2.2 x 2.6 cm. The noncontrast Hounsfield units were 23, enhanced Hounsfield units 210, and delayed Hounsfield units 72. The calculated washout was 44%, not consistent with an adrenal adenoma. An MRI of the abdomen showed a 2.5 cm right adrenal nodule. The lesion did not demonstrate significant loss of signal between in and out of phase imaging, therefore the characteristics were not consistent with a lipid rich adenoma. Laboratory tests included an ACTH of 31 pg/mL (6-48 pg/mL), cortisol 8.7 ug/mL at 10:57 am (7-9 am 5.27-22.45 ug/mL), aldosterone 10.1 ng/dL (6-48 ng/dL), renin 2.2 ng/mL/hr (upright 0.5-4.0 ng/mL/hr), DHEA-sulfate 129 ug/dL (44-248 ug/dL), plasma free metanephrine 0.10 nmol/L (0.00-0.49 nmol/L), and plasma free normetaneprhine 0.41 nmol/L (0.00-0.89 nmol/L). The 24-hour urine norepinephrine, epinephrine, and metanephrine were all normal, however the 24-hour urine dopamine was elevated, 824 ug/24 hrs (52-480 ug/24 hrs). Subsequently, plasma dopamine, norepinephrine, and epinephrine were all within the reference range. The patient had a robotic-assisted right adrenalectomy removing a 5.7 x 3.5 x 1.7 cm gland, weighing 16.3 grams. The pathology demonstrated a ganglioneuroma within the right adrenal gland measuring 2.2 x 2.0 x 2.7 cm, negative for neuroblastoma or blastic components. Focal hemorrhage was noted, there was no tumor necrosis, and no mitotic figures were present. The tumor appeared to be encapsulated in the adrenal gland and the Ki-67 stain was negative in ganglioneuroma cells. Conclusion: Adrenal adenomas that appear as incidentalomas in young adulthood are extremely rare. Evaluating younger versus older adults found to harbor an adrenal “incidentaloma“ requires a unique approach for each age group, as the differential diagnosis varies widely. In our patient, the imaging was extremely concerning and diagnostic considerations included neuroblastoma, adrenocortical malignancy, pheochromocytoma, or ganglioneuroma. Adrenal ganglioneuromas are most frequently diagnosed in fourth and fifth decades of life. In younger adults ganglioneuromas are usually found in the retroperitoneum and posterior mediastinum. For our patient, surgical resection of the adrenal mass confirmed the pathologic diagnosis and provided definitive cure.

Case 1.7

2014 ◽  
pp. 13-14
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Signal Intensity ◽  
High Signal Intensity ◽  
High Signal ◽  
Signal Loss ◽  
Quadrant Pain ◽  
Hepatic Lobe ◽  
P 75 ◽  
The Right ◽  
Dual Echo ◽  
Delayed Phase

75-year-old man with right upper quadrant pain Axial fat-suppressed dual echo FSE T2-weighted images (Figure 1.7.1) reveal a lobulated mass in the right hepatic lobe with diffuse high signal intensity. Note that on the dual echo images, there is little signal loss between the first (TE, 80 ms) and second (TE, 160 ms) echoes. Axial arterial, portal venous, equilibrium, and 5-minute delayed phase postgadolinium 3D SPGR images (...

scholarly journals Integrated slice-specific dynamic shimming for whole-body diffusion-weighted MR imaging at 1.5 T

2020 ◽  
Author(s):  
Sarah McElroy ◽  
Jessica M. Winfield ◽  
Olwen Westerland ◽  
Geoff Charles-Edwards ◽  
Joanna Bell ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Image Quality ◽  
Signal Intensity ◽  
Distortion Correction ◽  
Whole Body ◽  
Signal Loss ◽  
Diffusion Weighted ◽  
Average Signal Intensity ◽  
3D Volume ◽  
Induced Signal

Abstract Objective To compare integrated slice-specific dynamic shim (iShim) with distortion correction post-processing to conventional 3D volume shim for the reduction of artefacts and signal loss in 1.5 T whole-body diffusion-weighted imaging (WB-DWI). Methods Ten volunteers underwent WB-DWI using conventional 3D volume shim and iShim. Forty-eight consecutive patients underwent WB-DWI with either volume shim (n = 24) or iShim (n = 24) only. For all subjects, displacement of the spinal cord at imaging station interfaces was measured on composed b = 900 s/mm2 images. The signal intensity ratios, computed as the average signal intensity in a region of high susceptibility gradient (sternum) divided by the average signal intensity in a region of low susceptibility gradient (vertebral body), were compared in volunteers. For patients, image quality was graded from 1 to 5 (1 = Poor, 5 = Excellent). Signal intensity discontinuity scores were recorded from 1 to 4 (1 = 2 + steps, 4 = 0 steps). A p value of < 0.05 was considered significant. Results Spinal cord displacement artefacts were lower with iShim (p < 0.05) at the thoracic junction in volunteers and at the cervical and thoracic junctions in patients (p < 0.05). The sternum/vertebra signal intensity ratio in healthy volunteers was higher with iShim compared with the volume shim sequence (p < 0.05). There were no significant differences between the volume shim and iShim patient groups in terms of image quality and signal intensity discontinuity scores. Conclusion iShim reduced the degree of spinal cord displacement artefact between imaging stations and susceptibility-gradient-induced signal loss.

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