| 1. Objective:1) The purpose of this study was to update a long-term study that explores the appearance of adrenal tumors on Color Doppler Ultrasound and evaluates the accuracy of Color Doppler Ultrasound imaging in the characterization of adrenal tumors.2) The objective of our study was to determine whether incidentally discovered pheochromocytomas imaging characteristics differ from those of pheochromocytomas in symptomatic patients, and to improve the clinical value of ultrsonography in diagnosing Pheochromocytomas.3) The aim of the study was to explore the appearance of adrenal tumors on Contrast-enhanced Ultrasound and to evaluate contrast-enhanced ultrasound for the characterization of adrenal masses.2. Materials and Methods1) Value of Color Doppler ultrasonography in diagnosis and differentiation of tumors of adrenal glandThe final study group consisted of911adrenal masses in889patients. All images were reviewed by an experienced investigator who was blinded to the clinical history and the results of prior imaging studies. All patients received ultrasound examination two weeks before surgery. Ultrasound characteristics of adrenal tumor (including the size, the location, the shape, the border, echo pattern and vascularity) were documented using color Doppler imaging. In all patients, ultrasound findings were correlated with histopathologic results.2) Comparison of Ultrasound Findings in Symptomatic and Incidentally Discovered PheochromocytomasThe records from2005to2013were reviewed, and163pheochromocytomas were identified. All patients had Ultrasound examinations performed at our institution that were available for retrospective review. From electronic medical records, patient age and sex, the indications for ultrasound imaging, were recorded. Pheochromocytomas were classified as symptomatic or incidental on the basis of clinical presentation. These groups were compared for differences in patient sex, age, hypertension, adrenal mass maximal diameter based on ultrasound dimensions, characteristics of adrenal masses based on ultrasound (the presence of calcifications, area of haemorrhage or cystic changes, texture of echoic and supply of blood flow) and Statistical significance was assessed with the Student’s t test or chi-square test, as appropriate.3) Contrast-enhanced Ultrasonography in the diagnosis and differential diagnosis of adrenal massesWith the same examinations parameters, fifty-one patients with adrenal masses were evaluated by contrast-enhanced ultrasound using the microbubble contrast agent Sonovue under a low mechanical index. The characteristics of enhancement were observed from five aspects including enhancement time, enhancement pattern, enhancement order, the proportion of unenhanced area and enhancement intensity. The contrast enhancement pattern of all adrenal lesions was analysed based on pathology examination.2. Results:1) Value of Color Doppler ultrasonography in diagnosis and differentiation of tumors of adrenal glandHistopathology confirmed that all911adrenal masses with imaging characteristics suggesting. Benign adenoma were included551(60.5%) benign adrenal adenomas and163(17.9%) benign Pheochromocytoma lesions.41adrenal masses were not detected by ultrasound, including adenoma (n=38) pheochromocytoma (n=2), myelolipoma (n=1). Adrenal adenomas are usually small, well-defined margins and hypoechoic on sonography, Adrenal pheochromocytomas tend to be large tumors in the study. They are usually heterogeneous due to the degree of internal hemorrhage or necrosis. Most adrenocortical carcinomas and metasteses are larger and inhomogeneous hypoechoic. Demonstration of a fat-filled mass of high echogenicity on sonography is the key factor for diagnosis myelolipoma. CDFI showed flow signal in149(17.91%) benign adrenal masses,but could be seen in27(34.18%)malignant masses.The sensitivity of ultrasound for the differentiation of adrenal cortical adenoma was88.7%, the specificity95.3%, and the accuracy was91.3%. This results in a positive predictive value (PPV) of96.6%and a negative predictive value (NPV) of95.3%. Pheochromocytomas were diagnosed with a sensitivity of91.4%, a specificity of97.5%, and an accuracy of96.4%(PPV=88.7%, NPV=97.5%). Myelolipomas had a sensitivity of93.9%, a specificity of100%and an accuracy of99.6%(PPV=100%, NPV=99.7%)The sensitivity for adrenal carcinomas was86.7%, the specificity was98.8%, and the accuracy was98.6%(PPV=54.2%, NPV=98.8%). Adrenal metastases were diagnosed with a sensitivity of78.4%, a specificity of98.7%, and an accuracy of97.9%(PPV=72.5%, NPV=98.7%).2) Comparison of Ultrasound Findings in Symptomatic and Incidentally Discovered Pheochromocytomas35incidental (21.5%) adrenal pheochromocytomas were in the study. There was a significant difference between the two groups as to whether hypertension was present(p=0.000). No statistically significant difference was noted in the mean patient age (p=0.430)、sex (p=0.068). There was a significant difference between the two groups as to area of haemorrhage or cystic changes (p=0.000). No statistically significant difference was noted in the maximal diameter based on ultrasound dimensions (p=0.028),the presence of calcifications or not (p=0.865), texture of echoic (p=0.178) and supply of blood flow (p=0.622).3) Contrast-enhanced Ultrasonography in the diagnosis and differential diagnosis of adrenal masses51adrenal masses include adrenocortical adenoma (n=18), pheochromocytoma (n=17), metastases (n=9),myelolipoma (n=2), adrenal cortical carcinoma (n=1), lymphoma (n=1), and adrenal cyst(n=3). Our study show that both adrenal malignant masses and pheochromocytomas with abundant blood supply, contrast-agent perrusion fast and heterogeneous enhancement, medium or high enhancement; however, adrenal adenoma and myelolipomas with poor blood supply, contrast-agent perfusion slow and show homoogeneous enhancement, low enhancement.4. Conclusion:1) Value of Color Doppler ultrasonography in diagnosis and differentiation of tumors of adrenal glandOur study confirms the great variability of the clinical and imaging picture of adrenal masses. The sonographic changes of adrenal myelolipomas have certain characteristics, which may be helpful in differential diagnosis. Ultrasound examination is helpful to detect the lesion of adrenal gland, and will improve, together with clinical manifestation and laboratory data.2) Comparison of Ultrasound Findings in Symptomatic and Incidentally Discovered PheochromocytomasIn our study population,21.5%of the pheochromocytomas were incidental, more than in most reported series. A history of hypertension was more frequent in the symptomatic group (p=0.000), area of haemorrhage or cystic changes may help differentiation of incidental and symptomatic pheochromocytomas. Because of their varied clinical, imaging, and pathologic appearances, expecially tipical clinical appearances do not existed in incidentally discovered pheochromocytomas, part of pheochromocytomas have to be diagnosed after surgery.3) Contrast-enhanced Ultrasonography in the diagnosis and differential diagnosis of adrenal massesContrast-enhanced ultrasound facilitates the visualization of vascularity in adrenal masses, supply more information before surgery. CEUS could be an effective tool in differential diagnosing pheochromocytomas from other adrenal benign masses and malignant masses. |
PDF Full Text Request