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__NOTOC__
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{{Adrenocortical carcinoma}}
{{Adrenocortical carcinoma}}
{{CMG}} {{AE}} {{AAM}}
{{CMG}}; {{AE}} {{AAM}} {{MAD}}
==Overview==
==Overview==
Adrenal CT scan may be helpful in the diagnosis of Adrenocortical carcinoma.
Adrenal CT scan may be helpful in the diagnosis of Adrenocortical carcinoma (ACC) and in differentiating it from other diseases, such as [[adrenocortical adenoma]]. [[Signs]] such as internal [[hemorrhage]], [[Calcification|calcifications]], [[Computed tomography|CT]] density >10 HU or [[necrosis]] increase the chances of ACC. [[Contrast enhanced CT|Contrast-enhanced CT]] scan is a reliable method of disease staging, identifying common [[metastatic]] sites such as regional and [[Paraaortic lymph node|para-aortic]] [[lymph nodes]], [[lungs]], [[Liver|liver,]] and [[bones]].<ref name="pmid21606258" /> [[Computed tomography|CT imaging]] of the [[chest]], [[liver]], and [[bone scan]] are used for staging workup to detect [[metastasis]].  
==Key CT Findings in adrenocortical carcinoma==
==Key CT Findings in adrenocortical carcinoma==
*[[CT scan]] of the abdomen is useful for:
[[CT scan]] of the [[abdomen]] is useful for:
:* Identifying the site of the tumor
*Identifying the site of the [[tumor]],
:* Differentiating it from other diseases, such as [[adrenocortical adenoma]]
*Differentiating it from other diseases, such as [[adrenocortical adenoma]],
:* Determining the extent of invasion of the tumor into surrounding organs and tissue
*Determining the extent of [[invasion]] of the [[tumor]] into surrounding [[organs]] and [[tissues]].
:* Ct=T scan of the [[chest]] are routinely performed to look for[[metastasis|metastases]] to the [[lung]]s  Signs can be detected on CT scan:  ACCs are large, heterogeneous enhancing masses of soft tissue attenuation.    Internal hemorrhage is seen as ill-defined areas of increased attenuation on non-contrast-enhanced CT and as areas of high signal intensity on T1-weighted images
:Areas of necrosis have low attenuation on non–contrast-enhanced CT, high signal intensity on T2-weighted images and do not enhance after administration of iv contrast (105).
* Calcifications, which are best detected on CT imaging as high attenuation foci, can be present in approximately30%of cases. These are either coarse calcifications or microcalcifications and usually centrally located. Calcification is also present in other adrenal pathologies such as myelolipoma and 10% of pheochromocytomas and hence is not a distinguishing feature (106).  


* Some ACCs may contain areas of intracellular lipid and rarely macroscopic fat resulting in CT density measurements of 10 HU in portions of the tumor (107).
Following [[signs]] can be detected on [[CT scan]]: <ref name="pmid216062582">{{cite journal| author=Bharwani N, Rockall AG, Sahdev A, Gueorguiev M, Drake W, Grossman AB et al.| title=Adrenocortical carcinoma: the range of appearances on CT and MRI. | journal=AJR Am J Roentgenol | year= 2011 | volume= 196 | issue= 6 | pages= W706-14 | pmid=21606258 | doi=10.2214/AJR.10.5540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21606258  }}</ref> 
*ACCs are large, [[heterogeneous]] enhancing masses of [[soft tissue]] attenuation.
*Internal [[hemorrhage]] is seen as ill-defined areas of increased attenuation on non-[[Contrast enhanced CT|contrast-enhanced]] [[Computed tomography|CT]] and as areas of high signal intensity on T1-weighted images.
*Areas of [[necrosis]] have low attenuation on non–[[Contrast enhanced CT|contrast-enhanced CT]], high signal intensity on T2-weighted images and do not enhance after administration of [[intravenous]] [[contrast]]. <ref name="pmid9821192">{{cite journal| author=Krebs TL, Wagner BJ| title=MR imaging of the adrenal gland: radiologic-pathologic correlation. | journal=Radiographics | year= 1998 | volume= 18 | issue= 6 | pages= 1425-40 | pmid=9821192 | doi=10.1148/radiographics.18.6.9821192 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9821192  }}</ref>
*[[Calcification|Calcifications]] can be present in 30% of cases. These may be [[Microcalcification|micro-calcifications]] and usually centrally located. [[Calcification]] is also present in other [[Adrenal gland|adrenal]] pathologies such as [[myelolipoma]] and 10% of [[Pheochromocytoma|pheochromocytomas]]; therefore, it is not a specific sign.<ref name="pmid3492881">{{cite journal| author=Fishman EK, Deutch BM, Hartman DS, Goldman SM, Zerhouni EA, Siegelman SS| title=Primary adrenocortical carcinoma: CT evaluation with clinical correlation. | journal=AJR Am J Roentgenol | year= 1987 | volume= 148 | issue= 3 | pages= 531-5 | pmid=3492881 | doi=10.2214/ajr.148.3.531 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3492881  }}</ref> [[Computed tomography|CT]] [[imaging]] is the best [[imaging]] for [[Calcification|calcification.]] 
*Some ACCs may contain [[intracellular]] [[lipid]] and [[macroscopic]] [[fat]] resulting in [[Computed tomography|CT]] density measurements of 10 HU in portions of the [[tumor]].<ref name="pmid21067996">{{cite journal| author=Egbert N, Elsayes KM, Azar S, Caoili EM| title=Computed tomography of adrenocortical carcinoma containing macroscopic fat. | journal=Cancer Imaging | year= 2010 | volume= 10 | issue=  | pages= 198-200 | pmid=21067996 | doi=10.1102/1470-7330.2010.0029 | pmc=2999409 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21067996  }}</ref>
*[[Contrast enhanced CT|Contrast-enhanced]] [[imaging]] often demonstrates [[heterogeneous]], irregular peripheral enhancement with central non-enhancing areas secondary to [[hemorrhage]] or [[necrosis]].
*[[Contrast enhanced CT|Contrast-enhanced CT]] scan is a reliable method of disease staging, identifying common [[metastatic]] sites such as regional and [[Paraaortic lymph node|para-aortic]] [[lymph nodes]], [[lungs]], [[Liver|liver,]] and [[bones]].<ref name="pmid21606258">{{cite journal| author=Bharwani N, Rockall AG, Sahdev A, Gueorguiev M, Drake W, Grossman AB et al.| title=Adrenocortical carcinoma: the range of appearances on CT and MRI. | journal=AJR Am J Roentgenol | year= 2011 | volume= 196 | issue= 6 | pages= W706-14 | pmid=21606258 | doi=10.2214/AJR.10.5540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21606258  }}</ref>
*[[Computed tomography|CT imaging]] of the [[chest]], [[liver]], and [[bone scan]] are used for staging workup to detect the [[metastasis]].
{| class="wikitable"
|-
! Properities
! Adrenocortical carcinoma
! [[Adrenocortical adenoma]]
|-
|Size                 
|>4 cm
|<4 cm
|-
|[[Necrosis]]
| +
| -
|-
|[[Hemorrhage]]
| +
| -
|-
|[[Calcification]]
| +
| -
|-
| [[Computed tomography|CT density]]
|[[Heterogeneous]], >10 HU
|[[Homogeneous]], <10 HU
|-
|[[Chemical shift|Chemical-shift]] [[MRI]]
|[[Heterogeneous]] signal drop +/-
|[[Homogeneous]] signal drop
|-
|Chemical-shift [[Contrast enhanced CT|contrast enhancement]]
|[[Heterogeneous]], absolute % washout <60%
|[[Homogeneous]], absolute % washout >60%
|-
|SUV on [18F]FDG [[PET scan|PET/CT]]
|[[Adrenal gland|Adrenal]] to [[liver]] SUV ratio >1.45
|[[Adrenal gland|Adrenal]] to [[liver]] SUV ratio <1.45
|}


* Contrast-enhanced imaging often demonstrates heterogeneous, predominantly irregular peripheral enhancement with central nonenhancing areas secondary to
[[File:Non-contrast CT.gif|300px|center|thumb|Non-contrast CT showing ACC with calcifications, source: Case courtesy of Dr Arshdeep Sidhu, Radiopaedia.org, rID: 22048 ct without]]
hemorrhage or necrosis. Contrast-enhanced CT scan is a reliable method of disease staging, identifying common metastatic sites such as regional and para-aortic lymph nodes, lungs, liver, and bones (98).
[[File:CT angiography.gif|300px|center|thumb|CT angiography shows Case courtesy of Radswiki, Radiopaedia.org, rID: 11176 ct with angio]]
* CT imaging of the chest, liver, and bone scan are used for staging workup to detect metastasis.
{| class="wikitable" ! !Adrenocortical carcinoma !Adrenocortical adenoma |- |Size                  |>4 cm |<4 cm |- |Necrosis | + | - |- |Hemorrhage | + | - |- |Calcification | + | - |- |CT density |Heterogeneous, >10 HU |Homogeneous, <10 HU |- |Chemical-shift MRI |Heterogeneous signal drop +/- |Homogeneous signal drop |- |Chemical-shift contrast enhancement |Heterogeneous, absolute % washout <60% |Homogeneous, absolute % washout >60% |- |SUV on [18F]FDGPET/CT |Adrenal to liver SUV ratio >1.45 |Adrenal to liver SUV ratio <1.45 |}


==References==
==References==
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[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Types of cancer]]
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Latest revision as of 19:12, 30 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2] Mohammed Abdelwahed M.D[3]

Overview

Adrenal CT scan may be helpful in the diagnosis of Adrenocortical carcinoma (ACC) and in differentiating it from other diseases, such as adrenocortical adenoma. Signs such as internal hemorrhage, calcifications, CT density >10 HU or necrosis increase the chances of ACC. Contrast-enhanced CT scan is a reliable method of disease staging, identifying common metastatic sites such as regional and para-aortic lymph nodes, lungs, liver, and bones.[1] CT imaging of the chest, liver, and bone scan are used for staging workup to detect metastasis.

Key CT Findings in adrenocortical carcinoma

CT scan of the abdomen is useful for:

Following signs can be detected on CT scan: [2]

Properities Adrenocortical carcinoma Adrenocortical adenoma
Size >4 cm <4 cm
Necrosis + -
Hemorrhage + -
Calcification + -
CT density Heterogeneous, >10 HU Homogeneous, <10 HU
Chemical-shift MRI Heterogeneous signal drop +/- Homogeneous signal drop
Chemical-shift contrast enhancement Heterogeneous, absolute % washout <60% Homogeneous, absolute % washout >60%
SUV on [18F]FDG PET/CT Adrenal to liver SUV ratio >1.45 Adrenal to liver SUV ratio <1.45
Non-contrast CT showing ACC with calcifications, source: Case courtesy of Dr Arshdeep Sidhu, Radiopaedia.org, rID: 22048 ct without
CT angiography shows Case courtesy of Radswiki, Radiopaedia.org, rID: 11176 ct with angio

References

  1. ↑ 1.0 1.1 Bharwani N, Rockall AG, Sahdev A, Gueorguiev M, Drake W, Grossman AB; et al. (2011). "Adrenocortical carcinoma: the range of appearances on CT and MRI". AJR Am J Roentgenol. 196 (6): W706–14. doi:10.2214/AJR.10.5540. PMID 21606258.
  2. ↑ Bharwani N, Rockall AG, Sahdev A, Gueorguiev M, Drake W, Grossman AB; et al. (2011). "Adrenocortical carcinoma: the range of appearances on CT and MRI". AJR Am J Roentgenol. 196 (6): W706–14. doi:10.2214/AJR.10.5540. PMID 21606258.
  3. ↑ Krebs TL, Wagner BJ (1998). "MR imaging of the adrenal gland: radiologic-pathologic correlation". Radiographics. 18 (6): 1425–40. doi:10.1148/radiographics.18.6.9821192. PMID 9821192.
  4. ↑ Fishman EK, Deutch BM, Hartman DS, Goldman SM, Zerhouni EA, Siegelman SS (1987). "Primary adrenocortical carcinoma: CT evaluation with clinical correlation". AJR Am J Roentgenol. 148 (3): 531–5. doi:10.2214/ajr.148.3.531. PMID 3492881.
  5. ↑ Egbert N, Elsayes KM, Azar S, Caoili EM (2010). "Computed tomography of adrenocortical carcinoma containing macroscopic fat". Cancer Imaging. 10: 198–200. doi:10.1102/1470-7330.2010.0029. PMC 2999409. PMID 21067996.
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