Adrenocortical carcinoma CT
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Adrenocortical carcinoma Microchapters |
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Differentiating Adrenocortical carcinoma from other Diseases |
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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.
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
- Determining the extent of invasion of the tumor into surrounding organs and tissue
- 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 iv contrast.[1]
- Calcifications, which are best detected on CT imaging as high attenuation foci, can be present in approximately30%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 and hence is not a distinguishing feature.[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. {| class="wikitable" ! !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]FDGPET/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.