Abstract

BINDA, M.C et al. Optimización del uso de las imágenes en la patología suprarrenal (parte 2)^q. Rev. argent. radiol. [online]. 2013, vol.77, n.4. ISSN 1852-9992.

Training Objectives: The aim of this study is to propose an algorithm for the evaluation of adrenal lesions in order to arrive at the correct diagnosis in the shortest possible time. This method would be suitable for the most appropriate therapeutic procedures for each pathology, and may substantially modify a given treatment. In spite of the fact that the structural features of lesions are generally non-specifi c, with imaging techniques, it is possible to establish features which could help us differentiate benign from malignant lesions and with the contribution of the endocrinologist and the laboratory, to distinguish functional from non-functional ones. Topic review: A retrospective evaluation from May 2009 to December 2011 has been carried out on 157 patients with adrenal diseases, including 95 females and 61 males, from 33 to 78 years of age (mean age 55). The study protocol consisted in non-contrasted intravenous computed tomography, with lesion density measurement, followed by contrasted intravenous computed tomography and wash out time with lesion density determination in portal time and delayed after 15 minutes wash out. Measurements and calculations were: adrenal lesion size, medium density and absolute and relative wash-out percentiles. Magnetic resonance and 18F-fl uorodeoxyglucose positron emission tomography was only performed on those patients that required these techniques. A comparison of the present results with those in the literature is included. Imaging fi ndings: Fifty-nine patients with a non-functional adenoma were identifi ed (49 unilateral and 10 bilateral), 29 functional adenomas, 9 with bilateral hyperplasia, 4 myelolipomas (2 in a female patient with simple virilizing congenital adrenal hyperplasia), 2 cysts, 2 hematomas, 3 lymphomas (2 secondary and 1 primary bilateral), 30 metastases, 5 adrenocortical carcinomas, 12 pheochromocytoma,1 malignant pheochromocytoma and 1 ganglioneuroma. Conclusion: The use of an appropriate study algorithm, with proper diagnostic tools, enables adrenal lesions to be correctly differentiated. Moreover, this approach prevents loss of time, a wrong diagnosis, excessive irradiation of the patient, and incorrect use of resources.

Keywords : Glándulas suprarrenales; Tomografía computada; Resonancia magnética; Tomografía por emisión de positrones con 18F-fl uorodesoxiglucosa.

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