Adrenocortical carcinoma CT: Difference between revisions
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==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 | |||
*Differentiating it from other diseases, such as [[adrenocortical adenoma]] | |||
*Determining the extent of invasion of the tumor into surrounding organs and tissue | |||
*Signs can be detected on CT scan: | *Signs can be detected on CT scan: | ||
**ACCs are large, heterogeneous enhancing masses of soft tissue attenuation. | **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 | **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 | **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.<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> | ||
**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 | **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.<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> | ||
**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 | **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.<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 imaging often demonstrates heterogeneous, predominantly irregular peripheral enhancement with central nonenhancing areas secondary to 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 | **Contrast-enhanced imaging often demonstrates heterogeneous, predominantly irregular peripheral enhancement with central nonenhancing areas secondary to 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.<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> | ||
**CT imaging of the chest, liver, and bone scan are used for staging workup to detect metastasis. | **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 |} | ||
[[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]] | [[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]] | ||
[[File:CT angiography.gif|300px|center|thumb|CT angiography shows Case courtesy of Radswiki, Radiopaedia.org, rID: 11176 ct with angio]] | [[File:CT angiography.gif|300px|center|thumb|CT angiography shows Case courtesy of Radswiki, Radiopaedia.org, rID: 11176 ct with angio]] | ||
Revision as of 14:00, 20 September 2017
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Adrenocortical carcinoma Microchapters |
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Differentiating Adrenocortical carcinoma from other Diseases |
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Diagnosis |
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Treatment |
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Case Study |
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Adrenocortical carcinoma CT On the Web |
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American Roentgen Ray Society Images of Adrenocortical carcinoma CT |
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Risk calculators and risk factors for Adrenocortical carcinoma CT |
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.
Key CT Findings in adrenocortical carcinoma
- CT scan of the abdomen is useful for:
- Identifying the site of the tumor
- Differentiating it from other diseases, such as adrenocortical adenoma
- Determining the extent of invasion of the tumor into surrounding organs and tissue
- 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.[1]
- 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.[2]
- 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.[3]
- Contrast-enhanced imaging often demonstrates heterogeneous, predominantly irregular peripheral enhancement with central nonenhancing areas secondary to 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.[4]
- 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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.