Adrenocortical carcinoma CT: Difference between revisions
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{{CMG}}; {{AE}} {{AAM}} {{MAD}} | {{CMG}}; {{AE}} {{AAM}} {{MAD}} | ||
==Overview== | ==Overview== | ||
Adrenal CT scan may be helpful in the diagnosis of Adrenocortical carcinoma and differentiating it from other diseases, such as [[adrenocortical adenoma]]. Signs such as | Adrenal CT scan may be helpful in the diagnosis of Adrenocortical carcinoma (ACC) and differentiating it from other diseases, such as [[adrenocortical adenoma]]. Signs such as Internal [[hemorrhage]], [[Calcification|calcifications]], CT density > 10 HU or [[necrosis]] increase the chances of ACC. | ||
==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: | ||
| Line 22: | Line 22: | ||
! Properities | ! Properities | ||
! Adrenocortical carcinoma | ! Adrenocortical carcinoma | ||
! Adrenocortical adenoma | ! [[Adrenocortical adenoma]] | ||
|- | |- | ||
|Size | |Size | ||
| Line 28: | Line 28: | ||
|<4 cm | |<4 cm | ||
|- | |- | ||
|Necrosis | |[[Necrosis]] | ||
| + | | + | ||
| - | | - | ||
|- | |- | ||
|Hemorrhage | |[[Hemorrhage]] | ||
| + | | + | ||
| - | | - | ||
|- | |- | ||
|Calcification | |[[Calcification]] | ||
| + | | + | ||
| - | | - | ||
|- | |- | ||
| | | CT density | ||
|Heterogeneous, >10 HU | |Heterogeneous, >10 HU | ||
|Homogeneous, <10 HU | |Homogeneous, <10 HU | ||
|- | |- | ||
|Chemical-shift MRI | |[[Chemical shift|Chemical-shift]] [[MRI]] | ||
|Heterogeneous signal drop +/- | |Heterogeneous signal drop +/- | ||
|Homogeneous signal drop | |Homogeneous signal drop | ||
|- | |- | ||
|Chemical-shift contrast enhancement | |Chemical-shift [[Contrast enhanced CT|contrast enhancement]] | ||
|Heterogeneous, absolute % washout <60% | |Heterogeneous, absolute % washout <60% | ||
|Homogeneous, absolute % washout >60% | |Homogeneous, absolute % washout >60% | ||
|- | |- | ||
|SUV on [18F] | |SUV on [18F]FDG [[PET scan|PET/CT]] | ||
|Adrenal to liver SUV ratio >1.45 | |[[Adrenal gland|Adrenal]] to [[liver]] SUV ratio >1.45 | ||
|Adrenal to liver SUV ratio <1.45 | |[[Adrenal gland|Adrenal]] to [[liver]] SUV ratio <1.45 | ||
|} | |} | ||
Revision as of 14:32, 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 (ACC) and 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.
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. (look at the table)
- Determining the extent of invasion of the tumor into surrounding organs and tissues
- 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 intravenous contrast.[1]
- Calcifications, which are best detected on CT imaging as high attenuation foci, can be present in approximately 30%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 so, it is not a specific sign.[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.
| 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 |
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.