Preoperative assessment of mitral valve abnormalities in left atrial myxoma patients using cardiac CT.

BACKGROUND: To retrospectively evaluate mitral valve abnormality in left atrial myxoma patients by using cardiac computed tomography (CT). MATERIAL AND METHODS: Cardiac CT was performed in 56 patients with left atrial myxoma and 50 controls. Tumor and mitral valve characteristics were analyzed. The mitral valve parameters differences were compared between patients with myxoma and controls, myxoma with or without mitral valve obstruction, different obstruction degrees, respectively. Receiver operating characteristic analysis was performed to determine the cut-off values of abnormal mitral valve parameters for myxoma patients. Multiple linear regression, logistic regression models and cox regression analysis were used to determine factors associated with mitral valve abnormalities, mitral obstruction, mitral regurgitation and postoperative recovery, respectively. RESULTS: Myxoma induced the dilation of mitral valve, with different results among different degrees of obstruction (p<0.001). Mitral valve parameters had relationship with myxoma parameters. The cut-off values for discriminating mitral valve abnormalities in myxoma patients were found. Some significant predictors for mitral obstruction were tumor pedicle-tumor volume and patient age (HR, 0.886-30.811; p = 0.011-0.043). Moreover, the predictor for mitral regurgitation was mitral annulus diameter in diastolic phase (HR, 20.862; 95%CI,1.331-327.100; p = 0.031). Some predictors associated with postoperative recovery of mitral regurgitation were age, mitral annulus area, mitral annulus diameter and mitral valve diameter cutoff value for diastolic phase (HR, 0.001-119.160; p = 0.012-0.028). CONCLUSION: Cardiac CT is capable of quantitatively assessing myxoma characteristic and mitral valve abnormality induced by myxoma, thus providing guidance of operative management and postoperative evaluation.

Differentiation of renal oncocytoma and renal clear cell carcinoma using relative CT enhancement ratio.

BACKGROUND: The difference between renal oncocytomas (RO) and renal clear cell carcinomas (RCCs) presents the greatest diagnostic challenge. The aim of this study was to retrospectively determine if RO and RCCs could be differentiated on computed tomography (CT) images on the basis of their enhancement patterns with a new enhancement correcting method. METHODS: Forty-six patients with a solitary renal mass who underwent total or partial nephrectomy were included in this study. Fourteen of those were RO and 32 were RCCs. All patients were examined with contrast-enhanced CT. The pattern and degree of enhancement were evaluated. We selected the area that demonstrated the greatest degree of enhancement of the renal lesion in the corticomedullary nephrographic and excretory phase images. Regions of interest (ROI) were also placed in adjacent normal renal cortex for normalization. We used the values of the normal renal cortex that were measured at the same time as divisors. The ratios of lesion-to-renal cortex enhancement were calculated for all three phases. The Student's t-test and Pearson's Chi-square test were used for statistical analyses. RESULTS: All RCCs masses showed contrast that appeared to be better enhanced than RO on all contrast-enhanced phases of CT imaging, but there was no significant difference in absolute attenuation values between these two diseases (P > 0.05). The ratio of lesion-to-cortex attenuation in the corticomedullary phase showed significantly different values between RO and RCCs. The degree of contrast enhancement in RCCs was equal to or greater than that of the normal renal cortex, but it was less than that of the normal cortex in RO in the corticomedullary phase. The ratio of lesion-to-cortex attenuation in the corticomedullary phase was higher than the cut off value of 1.0 in most RCCs (84%, 27/32) and lower than 1.0 in most RO (93%, 13/14) (P < 0.05). In the nephrographic phase, the ratio of lesion-to-cortex attenuation was higher than that in the corticomedullary phase in most RO (71%, 10/14), showing a prolonged enhancement pattern; and was lower than that in most RCCs (97%, 31/32), showing an early washout pattern (P < 0.05). In the differentiation of RO from RCCs, the sensitivity was 93%, specificity 84%, positive predictive value 72%, negative predictive value 84%, and accuracy for RO was 87, if the ratio of lesion-to-cortex attenuation in a cortex phase was lower than the cutoff value of 1.0. The sensitivity was 71%, specificity was 97%, positive predictive value was 91%, negative predictive value was 91%, and accuracy for RO was 89%, if the ratio of lesion-to-cortex attenuation in nephrographic phase was higher than that in the corticomedullary phase. CONCLUSIONS: The ratios of renal lesion-to-cortex attenuation ratios may be helpful in differentiating RO from RCCs.

Gastric hepatoid adenocarcinoma: a computed tomography report of six cases.

We describe the computed tomography (CT) imaging findings in six cases (five males and one female; age range 61-78 years; mean age 67.3 years) with histologically proven hepatoid adenocarcinoma of the stomach (HAS). Five of the six patients had elevated serum alpha-fetoprotein levels. The most common type of gross appearance HAS on CT is a polypoid mass (83%, 5/6). The most common contrast enhancement pattern was heterogeneous. All six patients had a regional lymphadenopathy larger than 6 mm in its short axis. Liver metastases (n = 3) were noted. Venous tumor thrombosis was identified in the portal vein (n = 2) of the regions near primary gastric tumors or metastatic masses. Our findings suggest in an elderly, male patients with a large heterogeneous enhancement tumor, the presence of distant metastases, regional lymphadenopathy and characteristically increased serum alpha-fetoprotein levels indicates a high likelihood of HAS.

Assessment of myocardial bridge and mural coronary artery using ECG-gated 256-slice CT angiography: a retrospective study.

Recent clinical reports have indicated that myocardial bridge and mural coronary artery complex (MB-MCA) might cause major adverse cardiac events. 256-slice CT angiography (256-slice CTA) is a newly developed CT system with faster scanning and lower radiation dose compared with other CT systems. The objective of this study is to evaluate the morphological features of MB-MCA and determine its changes from diastole to systole phase using 256-slice CTA. The imaging data of 2462 patients were collected retrospectively. Two independent radiologists reviewed the collected images and the diagnosis of MB-MCA was confirmed when consistency was obtained. The length, diameter, and thickness of MB-MCA in diastole and systole phases were recorded, and changes of MB-MCA were calculated. Our results showed that among the 2462 patients examined, 336 have one or multiple MB-MCA (13.6%). Out of 389 MB-MCA segments, 235 sites were located in LAD2 (60.41%). The average diameter change of MCA in LAD2 from systole phase to diastole phase was 1.1 ± 0.4 mm, and 34.9% of MCA have more than 50% diameter stenosis in systole phase. This study suggested that 256-slice CTA multiple-phase reconstruction technique is a reliable method to determine the changes of MB-MCA from diastole to systole phase.

[Morphological and quantitative evaluation of myocardial bridge and mural coronary artery with 256-slice CT angiography: initial clinical experience].

OBJECTIVE: To determine the morphological characteristics of myocardial bridge and mural coronary artery (MB-MCA) and initially quantify the changes of MB-MCA in diastole and systole phase with multiple-phase reconstruction technique using 256-slice CT angiography (256-slice CTA). METHODS: We retrospectively collected the coronary artery imaging data of 861 patients undergoing 256-slice CTA with suspected or documented coronary artery disease. The images were reviewed by two independent radiologists, the diagnosis of MB-MCA was confirmed when consistency was obtained. The length, diameter and thickness of MB-MCA in the middle segment of LAD (LAD2) in diastole and systole phase were recorded, and changes of MB-MCA were calculated. RESULTS: Among the 861 patients, 150 MB-MCA were found in 131 patients (15.2%). 99 MB-MCA (66.0%) were located in LAD2, the remaining 51 (34.0%) in the other segments of coronary arteries. The average length and thickness of MB was (17.6 ± 5.7) mm and (2.6 ± 0.7) mm, respectively. The average diameter change of MCA in LAD2 from systole phase to diastole phase was (1.2 ± 0.5) mm, and 41% of MCA have diameter stenosis more than 50% in systole phase. CONCLUSION: The changes of MB-MCA from diastole to systole phase could be determined to some extent by 256-slice CTA multiple-phase reconstruction technique.

Effects of formoterol-budesonide on airway remodeling in patients with moderate asthma.

AIM: To evaluate the effect of inhaled formoterol-budesonide on airway remodeling in adult patients with moderate asthma. METHODS: Thirty asthmatic patients and thirty control subjects were enrolled. Asthmatic subjects used inhaled Symbicort 4.5/160 µg twice daily for one year. The effect of formoterol-budesonide on airway remodeling was assessed with comparing high-resolution computer tomography (HRCT) images of asthmatic patients and controls, as well as expression levels of cytokines and growth factors, inflammatory cell count in induced sputum, and airway hyper-responsiveness. RESULTS: The differences in age and gender between the two groups were not significant. However, differences in FVC %pred, FEV(1) %pred, and PC(20) between the two groups were significant. After treatment with formoterol-budesonide, the asthma patients' symptoms were relieved, and their lung function was improved. The WT and WA% of HRCT images in patients with asthma was increased, whereas treatment with formoterol-budesonide caused these values to decrease. The expression of MMP-9, TIMP-1, and TGF-ß(1) in induced sputum samples increased in patients with asthma and decreased dramatically after treatment with formoterol-budesonide. The WT and WA% are correlated with the expression levels of cytokines and growth factors, inflammatory cell count in induced sputum, and airway hyper-responsiveness, while these same values are correlated negatively with FEV(1)/FVC and FEV(1)%. CONCLUSION: Formoterol-budesonide might interfere in chronic inflammation and airway remodeling in asthmatic patients. HRCT can be used to effectively evaluate airway remodeling in asthmatic patients.

Accuracy and reproducibility of assessing right ventricular function with 64-section multi-detector row CT: comparison with magnetic resonance imaging.

BACKGROUND: Right ventricular (RV) function is very important for those patients with respiratory and cardiovascular disorders that can result in RV impairments. Because of complex geometry of the chamber, it is difficult to accurately measure the RV volumetric parameters with conventional imaging modalities. The purpose of this study was to evaluate whether the 64-MDCT can assess RV function with high accuracy and reproducibility when compared to the results with those of MRI. METHODS: Forty-seven consecutive subjects underwent retrospectively ECG-gated 64-MDCT and MRI for assessing the ventricular function. Right ventricular end diastolic and end-systolic volume, stroke volume, and ejection fraction were measured with dedicated cardiac analysis software on 64-MDCT and compared with values measured on MRI which served as the reference standard. Agreement between two modalities was assessed with Bland and Altman analysis and linear regression analysis. Repeated measurements were performed to determine intraobserver and interobserver variability. RESULTS: No significant differences were revealed in calculated RV volumes and EF between the two modalities. Agreement and correlation were similar for RV-EDV (0.4 ± 8.2 ml; r=0.95), RV-ESV (-0.6 ± 4.8; r=0.95), RV-SV (1.1 ± 6.7 ml; r=0.93), and RV-EF (0.9 ± 4.4; r=0.88). The difference of SV of right and left ventricle with 64-MDCT was not statistically significant (p=0.40) and good correlation was obtained (r=0.96). The variability in 64-MDCT measurements was lower than those in MRI. CONCLUSIONS: ECG-gated 64-MDCT can assess the RV function with high accuracy and reproducibility without geometric assumptions about right ventricle.

Correlation of calcium measurement with low dose 64-slice CT and angiographic stenosis in patients with suspected coronary artery disease.

Coronary artery calcium is a sensitive marker of coronary artery disease (CAD). This study was to determine the relationship between coronary calcium score (CCS) and angiographic stenosis on a patient-based or vessel-based analysis. 91 consecutive patients underwent both low dose 64-slice CT calcium scoring scan and conventional angiography of the heart. The total CCS of abnormal coronary angiogram (n=45) was 297.38+/-416.93, whereas that of normal coronary angiogram (n=46) was 5.37+/-9.35 (P<0.001). The CCS and degree of stenosis were moderately correlated on patient-based or vessel-based analysis (r=0.517, 0.521, respectively; both P<0.001). In conclusion, CCS could reflect the degree of vessel stenosis to some extent, but CCS of zero could not rule out CAD.

[Assessment of regional left ventricular function with 64 multi-detector row computed tomography].

To evaluate the regional left ventricular function (LVF) and to establish the reference data of LVF parameters in the normal people with retrospective ECG gating 64-detector row CT, ten time phases in the cardiac cycle were reconstructed. Scanning was performed on 42 normal adult, and short axis images of the left ventricular were acquired. Endo-cardium and epi-cardium were delineated along with function parameters based on the cardiac analysis software. End-systolic thickness (EST) was thicker than end-diastolic thickness (EDT) (P<0.05). EDT and EST increased, but thickness decreased from apical, mid-ventricular to basal segments. Statistically significant difference was noted between mid-ventricular and basal segments (P<0.05). EDT, EST, thickness and motion of anterior, lateral and inferior segments were greater than those of septal segments in the same ventricular slices (P<0.05). 64-detector row CT could depict the regional LVF accurately. The LVF parameters of normal adults might be useful in diagnosing abnormal left ventricular function.

[Accuracy of 64-slice multi-detector row CT angiography in the diagnosis of coronary artery lesions].

OBJECTIVE: To determine the accuracy of 64-slice computed tomography angiography (CTA) in the diagnosis of coronary artery lesions. METHODS: We retrospectively collected the coronary artery imaging data of 49 patients who underwent 64-slice CTA and conventional catheter-based selective coronary angiography (SCA) during July 2006 and May 2007. The CTA and SCA diagnosis were compared. RESULTS: The 64-slice CTA enabled the visualization of the entire coronary tree with diagnostic image quality in 46 of the 49 patients. The CTA had a sensitivity of 54.88%, 47.50% and 93.15%, and a specificity of 99.42%, 95.68% and 97.13% for detecting less than 50% stenosis, 50%-75% stenosis, and greater than 75% stenosis, respectively. The overall Pearson's correlation coefficient between the degree of stenosis detected by quantitative SCA and 64-slice CTA was 0.941. CONCLUSION: 64-slice CTA is a good instrument for assessing coronary artery lesions.

[Influence of cardiac rhythm on image quality of 64-slice multidetector-row CT coronary angiography and clinic value of post-processing technology with image].

OBJECTIVE: To evaluate the influence of cardiac rhythm on 64-slice multi-detector row CT coronary angiography and clinic value of imaged post-processing technology. METHODS: 687 patients with suspected coronary heart disease who underwent 64-slice multi-detector row CT coronary angiography were retrospectively analyzed with their CT images. Four group images of patients were analyzed and compared according to the fluctuation of cardiac rhythm. Multi-phase reconstruction (n = 76) and the ECG-edit software (n = 21) were performed in those patients with arrhythmia. RESULTS: The statistical differences were found among the imaging quality of each group (chi2 = 225.040, P < 0.001). As the fluctuation of cardiac rhythm increased, the quality of CT images dropped down concomitantly. After images processed with ECG-edit software, the quality of CT coronary angiography images got improved (Z = - 3.385, P = 0.001). In 76 patients with multi-phase reconstruction, the image quality of right coronary artery got improved in 40% R-R interval when high quality images couldn't be obtained in 75% R-R interval (Z = - 4.209, P < 0.001). CONCLUSION: Cardiac rhythm is an important factor to affect the CT coronary angiography, but post-processing technology may be useful for improving the imaging quality.

[The clinical application of coronary artery calcification score with 64-slice MDCT in the diagnosis of coronary artery disease].

OBJECTIVE: To study the clinical value of coronary artery calcification score with 64-slice MDCT in the diagnosis of coronary artery disease (CAD). METHODS: 96 subjects including 49 with confirmed CAD (CAD group) and 47 asymptomatic people as control group were recruited between May 2006 and December 2006 by the department of radiology in our hospital. The selective coronary angiography was also performed in 30 subjects including 25 with CAD and 5 asymptomatic people and subsequently divided into three groups (< 50%, 50%-75% and > 75% of maximum degree of vessel occlusion). We investigated the correlation of calcification score (CS) and the maximum degree of vessel occlusion measured by coronary angiography were investigated. RESULTS: The larger CS and more numbers of regions of interest of calcification in the right coronary artery and left anterior descending artery in 96 subjects were observed. The total mean CS of CAD (462 +/- 314) was higher than that of control group (83 +/- 52) (P < 0.001). There was a moderate correlation between degree of vessel stenosis and CS for individual vessels in patients with positive calcium scan(r = 0. 445, P < 0.01). CONCLUSION: Although CS measured by MDCT is not an accurate marker of the degree of vessel stenosis in CAD, it can be applied as a screening tool for high risk CAD patients and could greatly reduce the expense on coronary angiography.

[Clinical value of 64-slice CT angiography in detecting coronary artery anomalies].

OBJECTIVE: To determine the clinical value of 64-slice computed tomography angiography (CTA) in the diagnosis of coronary artery anomalies. METHODS: The coronary artery imaging data of 852 patients who underwent 64-slice CTA from July 2006 to May 2007 were retrieved. The imaging features of coronary artery anomalies confirmed by selective coronary angiography were reviewed. RESULTS: Eight (0.9%) coronary artery anomalies were found in the patients, which included 3 cases of anomalous aortic origin of coronary arteries, 3 cases of anomalous origin of the left main coronary artery from pulmonary artery, 1 case of coronary fistula from the right coronary artery to right atrium, and 1 case of coronary aneurysm. CONCLUSION: The 64-slice CTA can detect coronary anomalies and delineate the anatomic relationships among the peripheral structures, which can be considered as an early screening for coronary anomalies.

Extramedullary plasmacytoma involving the bilateral adrenal glands on MR imaging.

We report here on a 64-year-old woman with extramedullary plasmacytoma involving the bilateral adrenal glands. Primary adrenal extramedullary plasmacytoma is extremely rare and only three cases of extramedullary plasmacytoma in the unilateral adrenal gland have currently been reported on. This case is of interest in that the bilateral adrenals were involved. In this article, we present the MRI findings and we briefly review the relevant literature.

Uncommon adrenal masses: CT and MRI features with histopathologic correlation.

Adrenal glands are common sites of diseases. With dramatically increased use of computed tomography (CT) and magnetic resonance (MR) imaging, more and more uncommon adrenal masses have been detected incidentally at abdominal examinations performed for other purposes. In this article, uncommon adrenal masses are classified as cystic masses (endothelial cysts, epithelial cysts, parasitic cysts, and pseudocysts), solid masses (ganglioneuroma, ganglioneuroblastoma, extramedullary plasmacytoma (EMP), neurilemmoma, and lymphoma), fat-containing masses (myelolipoma, teratoma), and infectious masses (tuberculoma), and the imaging features of these uncommon masses are demonstrated. Although most of these lesions do not have specific imaging features, some fat-containing masses and cystic lesions present with characteristic appearances, such as myelolipoma, teratoma, and hydatid. Combination with histopathologic characteristic of these uncommon masses of adrenal gland, radiological features of these lesions on CT and MR imaging can be accurately understood with more confidences. Moreover, CT and MRI are highly accurate in localization of uncommon adrenal masses, and useful to guide surgical treatments.

Tuberculous Addison's disease: morphological and quantitative evaluation with multidetector-row CT.

OBJECTIVE: To determine the characteristics of tuberculous Addison's disease on the axial and multiplanar reformatted (MPR) images of the multidetector-row computed tomography (MDCT). MATERIALS AND METHODS: The unenhanced and contrast-enhanced MDCT features in 19 patients with tuberculous Addison's disease were retrospectively assessed for the location, contour, size, calcification, attenuation, and enhancement patterns. The correlation between the duration of Addison's disease and the percentage of calcification presence was evaluated. RESULTS: The adrenal glands were infected bilaterally in all of the 19 cases (100%, 38 glands). Enlargement of the glands appeared in 18 cases (94.7%, 36 glands) and the remaining one case (5.3%, two glands) showed atrophy bilaterally. Of the 36 enlarged adrenals, 13 (36.1%) had preserved contours, and the other 23 (63.9%) were mass-like. The size of the adrenals ranged from 0.6 to 4.8 cm (mean 1.92+/-0.96 cm). Calcification was revealed in 16 adrenals (16/38, 42.1%), increasing in incidence with disease progression. Fourteen of the 36 (38.9%) enlarged adrenals showed peripheral enhancement while the remaining 22 (61.1%) demonstrated heterogeneous enhancement. The DeltaCT value, the attenuation measurement of mass-like lesions, was less in the central area (7+/-4 HU) than that in the peripheral area (32+/-14 HU) (P<0.01) between the unenhanced and contrast-enhanced scan. CONCLUSION: MDCT can reveal the characteristic morphology and CT attenuation in the tuberculous Addison's disease. Combined with its clinical presentations and biochemical findings, we can diagnose and stage adrenal tuberculosis with high specificity and accuracy on MDCT.

Distribution and characteristics of hematogenous disseminated tuberculosis within the abdomen on contrast-enhanced CT.

BACKGROUND: The incidence of abdominal tuberculous lymphadenopathy never appears low. In addition to infecting the abdominal lymph nodes through the digestive tract, the tuberculosis bacteria can also infect the abdominal lymph nodes and extra-nodal organs through hematogenous dissemination. This study investigated contrast-enhanced CT features and anatomic locations of hematogenous disseminated tuberculosis involving abdominal organs. METHODS: Thirteen patients with documented hematogenous disseminated tuberculosis involving abdominal organs were recruited. Contrast-enhanced CT scanning was carried out in the abdomen of all patients. CT images were retrospectively analyzed for the size, attenuation, enhancement patterns, and anatomic distribution of the foci in infected lymph node, liver, spleen, and kidney. RESULTS: Hematogenous disseminated tuberculosis dominantly affected lymph nodes in the hepatoduodenal ligament (84.6%), the portacaval space (84.6%), the root of the mesentery (84.6%), the peripancreatic region (84.6%), the periceliac region (76.9%), the hepatogastric ligament (69.2%), and the upper and lower paraaortic region (both were 69.2%). Out of the 13 cases studied, 12 (92.3%) had lymphadenopathy with peripheral enhancement accompanied by multilocular appearance; 10 (76.9%) had homogeneous hepatomegaly; 13 (100%) had inhomogeneous splenomegaly accompanied by scattered low-density lesions with peripheral enhancement; and 8 (61.5%) had low-density lesions in the kidney with peripheral enhancement. CONCLUSION: Anatomically, peritoneal and retroperitoneal lymph nodes are most susceptible to hematogenous disseminated tuberculosis. The hepatomegaly manifested to be homogeneous in most cases while the splenomegaly is of frequently inhomogeneous attenuation. All these characteristics are closely related to the infection routes and pathologic features of abdominal hematogenous disseminated tuberculosis.

Addison's disease due to adrenal tuberculosis: contrast-enhanced CT features and clinical duration correlation.

PURPOSE: To describe CT morphology of untreated adrenal tuberculosis during the different stages of the natural history of the disease and to evaluate the diagnostic implications of CT features. MATERIALS AND METHODS: We retrospectively evaluated CT features in 42 patients with documented adrenal tuberculosis for the location, size, morphology, and enhancement patterns shown on CT images. The clinical duration were correlated with the CT features. RESULTS: Of the 42 patients with untreated adrenal tuberculosis, bilaterally enlarged adrenal glands were revealed in 38 cases (91%), unilaterally enlarged in 3 cases (7%), and normal size in 1 case (2%). Of the 41 cases (98%) with enlargement, mass-like enlargement was seen in 20 cases (49%) and enlargement with preserved contours in 21 cases (51%). Peripheral rim enhancement presented in 22 cases (52%) on contrast-enhanced CT. Non-enhanced CT scan revealed calcification in 21 cases (50%). As the duration of Addison's disease increased, the presence of calcification and contour preservation increased concomitantly (p<0.001), whereas peripheral rim enhancement and mass-like enlargement decreased concomitantly on CT images (p<0.001). CONCLUSION: CT may be helpful in diagnosing adrenal tuberculosis when clinically suspected, and CT features are correlated to the clinical duration of Addison's disease.

Differentiation between tuberculosis and primary tumors in the adrenal gland: evaluation with contrast-enhanced CT.

The aim of the present study is to determine imaging criteria for differentiating tuberculosis from primary tumors in the adrenal gland on contrast-enhanced CT. Non-contrast and contrast-enhanced CT features in 108 patients with adrenal tuberculosis (n = 34) and primary tumor (n = 74) were retrospectively assessed for the location, size, calcification and enhancement patterns. The primary tumors included 41 adenomas, 11 pheochromocytomas, 4 carcinomas, 3 lymphomas, 6 myelolipomas, 6 ganglioneuromas, 2 neurilemmomas and 1 ganglioneuroblastoma. Biochemical investigation was performed for all patients. Of the tuberculosis cases, 31 (91%) invaded with bilateral involvement, while 7 (9%) of the primary tumors invaded with bilateral involvement (P < 0.001). Tuberculosis often showed calcification (20 of 34; 59%), whereas primary tumors infrequently showed calcification (6 of 74; 8%; P < 0.001). Low attenuation in the center with peripheral rim enhancement was more commonly seen in tuberculosis (16 of 34; 47%) than in primary tumors (7 of 74; 9%; P < 0.001). In the determination of tuberculosis, the highest sensitivity (91%) and accuracy (91%) were obtained with bilateral involvement, and the highest specificity (99%) was obtained with the contour preserved. In the determination of primary tumors using a combination of having unilateral involvement and being mass-like, the outcome was a sensitivity of 91%, specificity of 94% and accuracy of 92%. CT findings can differentiate tuberculosis from a primary tumor of the adrenal glands with high sensitivity and an acceptable specificity when combined with the endocrinological examination.