ABSTRACT
Incidentally discovered adrenal masses are common and the clinical evaluation and surveillance aims to diagnose hormone excess and malignancy. Adrenocortical cancer (ACC) is a very rare malignancy. This study aims to define the imaging characteristics of adrenal tumors preceding the diagnosis of ACC. Patients with prior (>5 months) adrenal tumors (<6 cm) subsequently diagnosed with ACC were identified in a large registry at a tertiary referral center. Retrospective chart and image review for patient characteristics and initial, interval, and diagnostic imaging characteristics (size, homogeneity, borders, density, growth rate, etc.) was conducted. Twenty patients with a diagnosis of ACC and a prior adrenal tumor were identified among 422 patients with ACC. Of these, 17 patients were initially imaged with CT and 3 with MR. Only 2 of the 20 patients had initial imaging characteristics suggestive of a benign lesion. Of initial tumors, 25% were <2 cm in size. Surveillance led to the diagnosis of ACC within 24 months in 50% of patients. The growth pattern was variable with some lesions showing long-term stability (up to 8 years) in size. In conclusion, antecedent lesions in patients with a diagnosis of ACC are often indeterminate by imaging criteria and can be small. Surveillance over 2 years detected only 50% of ACCs. Current practice and guidelines are insufficient in diagnosing ACCs. Given the rarity of ACC, the increased risk and health care costs of additional evaluation may not be warranted.
Subject(s)
Adrenal Cortex Neoplasms/diagnosis , Adrenal Glands/pathology , Adrenal Cortex Neoplasms/pathology , Adult , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Focal incidental renal lesions are commonly encountered on positron emission tomography (PET)/computed tomography (CT) imaging. The vast majority of these lesions are benign. However, the interpretation of renal lesions can be problematic if the imaging criteria of simple cysts are not met. Limited literature exists on the characterisation of renal masses with metabolic imaging. The purpose of this article is to focus on the imaging features of benign and malignant renal masses with PET/CT. The lesions discussed include renal cyst, angiomyolipoma, oncocytoma, renal cell carcinoma, renal metastases and other infiltrating neoplastic processes affecting the kidney. Both the anatomical and metabolic features which characterise these benign and malignant entities are described. We emphasise the importance of viewing the CT component to identify the typical morphological features and discuss how to best use hybrid imaging for management of renal lesions. Metabolic imaging has a promising role in the imaging of renal lesions and can help prevent unnecessary biopsies and ensure optimal management of suspicious lesions.
Subject(s)
Carcinoma, Renal Cell/diagnosis , Fluorodeoxyglucose F18 , Kidney Neoplasms/diagnosis , Positron-Emission Tomography/methods , Radiopharmaceuticals , Tomography, X-Ray Computed/methods , Adenoma, Oxyphilic/diagnosis , Angiomyolipoma/diagnosis , Cysts/diagnosis , Humans , Incidental Findings , Kidney/diagnostic imaging , Kidney Diseases/diagnosis , Leukemia/diagnosis , Lymphoma/diagnosisSubject(s)
Radiology/trends , Education, Medical , Faculty, Medical , Radiology/economics , Radiology/education , United StatesABSTRACT
OBJECTIVE: To describe a quality improvement process that was initiated in a Department of Radiology to reduce the number of incomplete or "lost" imaging studies and decrease the time from the initiation of an imaging study to printing of the final report. METHODS: Incomplete cases were defined as those imaging studies that did not have a signed final report more than 3 days and less than 90 days after imaging. A computer program was written to generate a monthly incomplete case list from the radiology information system database; each step in the process, from patient arrival to final report printing, was analyzed and a list of root causes (for the incomplete cases) was developed. Short- and long-term interventions were introduced and the effects were monitored from 1992-1999. RESULTS: Problems were identified at each step in the process. Although some of the root causes originated outside the authority of the Department of Radiology, interventions we implemented within the department reduced the incomplete list by 72%, from a high of 2.8% of all imaging examinations to less than 0.8%. Continual monitoring of the problem is necessary to maintain this level. CONCLUSION: The number of incomplete or "lost" imaging studies can be decreased using a continuous quality improvement process. This leads to improved patient care and increased revenue.
Subject(s)
Hospital Records/standards , Quality Assurance, Health Care , Radiology Department, Hospital/standards , Radiology Information Systems , Documentation/methods , Humans , Michigan , Software , Time and Motion StudiesABSTRACT
OBJECTIVE: Although representing a minority of adrenal adenomas, the lipid-poor variety cannot be accurately identified on unenhanced CT or chemical shift MR imaging. We compared the delayed contrast-enhanced CT features of lipid-poor adenomas with those of lipid-rich adenomas and of adrenal nonadenomas to determine whether there were differences in the washout features between these groups of lesions. SUBJECTS AND METHODS: Eighteen proven lipid-poor adenomas, 56 lipid-rich adenomas, and 40 adrenal nonadenomas underwent CT before, immediately after, and 15 min delay after IV contrast injection. Region-of-interest measurements were made of all adrenal lesions at the three time points. The degree of enhancement, enhancement washout, percentage enhancement washout, and relative percentage enhancement washout were calculated for each adrenal mass. Pooled data were analyzed statistically. Optimal threshold values for diagnosing adrenal adenomas were also determined. RESULTS: The mean CT attenuation of lipid-poor adenomas was significantly higher than that of lipid-rich adenomas at all three phases but not significantly different from that of nonadenomas. The mean percentage enhancement washout on images obtained 15 min after administration of contrast material was similar for lipid-rich and lipid-poor adenomas but was significantly higher than that of nonadenomas. The mean relative percentage enhancement washout was significantly different among all three groups. CONCLUSION: Lipid-poor adenomas cannot be differentiated from adrenal nonadenomas on the basis of a single mean attenuation value. However, lipid-poor adrenal adenomas show enhancement and enhancement washout features nearly identical to lipid-rich adenomas and can be distinguished from nonadenomas on the basis of a percentage washout threshold value of 60% and a relative percentage washout of 40%.
Subject(s)
Adenoma/diagnostic imaging , Adrenal Gland Neoplasms/diagnostic imaging , Lipids/analysis , Radiographic Image Enhancement/methods , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Contrast Media/administration & dosage , Diatrizoate/administration & dosage , Female , Follow-Up Studies , Humans , Injections, Intravenous , Male , Middle Aged , Sensitivity and Specificity , Time FactorsSubject(s)
Adenocarcinoma, Mucinous/diagnosis , Mucins/metabolism , Pancreatic Neoplasms/diagnosis , Adenocarcinoma, Mucinous/metabolism , Aged , Cholangiopancreatography, Endoscopic Retrograde , Female , Humans , Magnetic Resonance Imaging , Pancreatic Ducts/diagnostic imaging , Pancreatic Ducts/pathology , Pancreatic Neoplasms/metabolism , Tomography, X-Ray Computed , UltrasonographySubject(s)
Bone Neoplasms/diagnosis , Giant Cell Tumor of Bone/diagnosis , Hyperparathyroidism, Secondary/complications , Tendon Injuries , Tendon Injuries/diagnosis , Adult , Arthrography , Bone Neoplasms/complications , Diagnosis, Differential , Femur/diagnostic imaging , Femur/pathology , Giant Cell Tumor of Bone/complications , Humans , Hyperparathyroidism, Secondary/diagnosis , Magnetic Resonance Imaging , Male , Patella/diagnostic imaging , Patella/pathology , Rupture, Spontaneous , Tendon Injuries/etiology , Tendons/pathology , Tibia/diagnostic imaging , Tibia/pathologySubject(s)
Deglutition Disorders/etiology , Esophageal Diseases/diagnostic imaging , Pemphigoid, Benign Mucous Membrane/diagnostic imaging , Administration, Oral , Barium Sulfate/administration & dosage , Contrast Media/administration & dosage , Deglutition Disorders/diagnostic imaging , Deglutition Disorders/therapy , Diagnosis, Differential , Dilatation , Esophageal Diseases/complications , Esophagoscopy , Humans , Male , Middle Aged , Pemphigoid, Benign Mucous Membrane/complications , Radiography, ThoracicSubject(s)
Adenocarcinoma/diagnostic imaging , Juxtaglomerular Apparatus/diagnostic imaging , Kidney Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Adenocarcinoma/complications , Adenocarcinoma/surgery , Angiography , Diagnosis, Differential , Female , Humans , Hypertension, Renovascular/diagnostic imaging , Hypertension, Renovascular/etiology , Hypertension, Renovascular/surgery , Kidney Neoplasms/complications , Kidney Neoplasms/surgery , Middle Aged , NephrectomySubject(s)
Brain Neoplasms/diagnosis , Frontal Lobe , Ganglioglioma/diagnosis , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Contrast Media/administration & dosage , Diagnosis, Differential , Frontal Lobe/diagnostic imaging , Frontal Lobe/pathology , Humans , Infant , Injections, IntravenousSubject(s)
Hematopoiesis, Extramedullary , Magnetic Resonance Imaging , Tomography, X-Ray Computed , beta-Thalassemia/diagnosis , Adult , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/pathology , Humans , Male , Ribs/diagnostic imaging , Ribs/pathology , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/pathologyABSTRACT
Nontraumatic hemorrhage of the adrenal gland is uncommon. The causes of such hemorrhage can be classified into five categories: (a) stress, (b) hemorrhagic diathesis or coagulopathy, (c) neonatal stress, (d) underlying adrenal tumors, and (e) idiopathic disease. Computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging play an important role in diagnosis and management. CT is the modality of choice for evaluation of adrenal hemorrhage in a patient with a history of stress or a hemorrhagic diathesis or coagulopathy (anticoagulant therapy). CT may yield the first clue to the diagnosis of adrenal insufficiency secondary to bilateral massive adrenal hemorrhage; such insufficiency is rare but life threatening. US is the modality of choice for evaluation of neonatal hematoma, and MR imaging is helpful for further characterization. MR imaging is also useful in the diagnosis of coexistent renal vein thrombosis. When an adrenal abscess is suspected, percutaneous aspiration and drainage under imaging guidance should be performed. Hemorrhage into an adrenal cyst or tumor can cause acute onset of symptoms and signs in a patient without discernible risk factors for adrenal hemorrhage. A hemorrhagic adrenal tumor should be suspected when CT or MR imaging reveals a hemorrhagic adrenal mass of heterogeneous attenuation or signal intensity that demonstrates enhancement.