ABSTRACT
Aim: To characterize incidentally detected adrenal masses by CT attenuation values and 15 minutes wash out characteristics at contrast-enhanced CT. Method : Prospective observational study from March 2012 -2013 was done, with all the abdominal scan evaluated for adrenal masses. Departmental protocol was followed with15 minutes delayed scan added. CT attenuation values at different phases were used to calculate absolute percentage washout (APW) and relative percentage washout (RPW). The masses with attenuation value <10HU on unenhanced scans were diagnosed as lipid rich adenomas and masses with attenuation values >10 on plain scan with APW of >60% and RPW>40% were diagnosed as lipid poor adenomas; rest being nonadenomas, metastasis if there was known malignancy. The masses were evaluated in terms of their sizes, site of involment, stastical significance (p<0.05) in attenuation values at different phases and washout studies. Results: 96 lesions were detected in 84 patients from March 2012 -2013.M:F ratios of 1.7:1, mean age being 46 years. Lipid poor adenomas (LPA) were the commonest mass followed by metastasis. 64% of patients with malignancy had adrenal metastasis while 36% had adenomas. There was no significant difference in size(p=0.23) between LPA and non-adenomas (NA) whereas statistical difference was noted in mean attenuation values on unenhanced, delayed, wash-in and wash-out values(p <0.05).There was no significant difference on enhanced scan (p=0.95),but absolute percentage washout (APW) and relative percentage washout (RPW) was statistically significant between LPA and NA (p<0.05).Conclusion: CT attenuation values, absolute and relative percentage washout values characterize the adrenal masses.
ABSTRACT
Aim: The aim of our study was to analyze the role of Multidetector computed Tomography (MDCT) in the classification and management of high energy blunt abdominal trauma. Material And Method: A Prospective study of 140 patients of all age groups was conducted from October 2010 to October 2012. Rectal and IV contrast were used. Angiography was performed in cases of suspected vascular trauma. Three dimensional reconstructions were done. CT findings were correlated and confirmed by either operative findings or follow-up CT. Result: 140 cases of blunt abdominal trauma were included in this study. Abdominal USG (Ultrasound) and MDCT were performed. Abdominal injuries were more common in males seen in 119 cases (89%). Spleen was the most common organ to be injured, affected in 40 patients (23%). Liver injury was seen in 36 cases, renal involvement in 30 cases, bowel in 20 cases, urinary bladder in 7 cases, a pancreatic injury in 3 cases and retro peritoneum involvement in 2 cases. Out of 140 patients 135 had free intraperitoneal fluid. USG findings and MDCT findings were compared with per operative findings. Patients managed conservatively were compared with repeat follow up CT findings. USG showed a sensitivity of 55 % and specificity of 75 % in solid organs injury and sensitivity of 95 % and specificity of 99 % in free fluid detection. MDCT showed a sensitivity of 97 % and specificity of 98 % in solid organs injury and 100%in hemoperitoneum. Conclusion: MDCT is the modality of choice to evaluate abdominal injury when there is doubt in clinical and USG findings, and to offer patient conservative management.