Magnetic resonance imanging of adrenal tumors

Trinh Van Ky, Nguyen Xuan Hien, Nguyen Minh Tuan, Nguyen Thi Bich Ngoc

Main Article Content

Abstract

Purpose: to evaluate the role of MRI in diagnosis adrenal tumors.
Subject and methods: our cross–sectional descriptive study included 25 patients who were diagnosed as adenoma hyperplasia in pathology. All patients underwent MRI examination in Bach Mai hospital from June, 2020 to July, 2021.
Results: mean age of all patient was 49,2±11,8. Male/female ratio was 1.5/1. 25 adrenal tumor on MRI and identified on the diagnosed as adenoma hyperplasia in pathology. These adenomas consisted 12 adrenal cortical adenoma (ACA) and 13 non – adrenal cortical adenoma (NACA): 09 pheochromocytomas, 01 adrenocortical carcinoma, 01 ganglioneuroma and 02 myelolipoma. Mean size of all adrenal tumors was 38,8 ± 23,5mm, therein, mean size of ACA group and NACA group was 23,2 ± 7,6 mm and 52,2 ± 25,7 mm respectively. Chemical Shift Imaging (CSI) allowed differential diagnose between ACA and NACA. Qualitative analysis based on signal reduction on out – phase compared to in – phase allows 11/12 ACA, but 2/13 NACA have been misdiagnosed as ACA. Quantitative analysis based on SII index (SII threshold > 16,1%) allowed correctly diagnose 11/12 ACA and 01 NACA. ASR index (ASR threshold <0,71) allowed correctly diagnose 11/12 ACA and 01 NACA. There are 02 adrenal tumors that invaded to the surrounding area in imaging and was demonstrated by surgery and pathology reports.
Conclusion: MRI has an important role in adrenal mass diagnosis with sensitivity and specificity were 100% and 96,1% respectively. CSI enable to distinguish ACA and NACA with sensitivity and specificity were 91,7% and 92,3% respectively by using SII and ASR index. MRI also help to assess invasive and metastatic properties with high accuracy.

Article Details

References

1. Blake M.A and Boland G.W.L (2009). Adrenal Imaging, Humana Press, Totowa.
2. Comparison of Quantitative MRI and CT Washout Analysis for Differentiation of Adrenal Pheochromocytoma From Adrenal Adenoma : American Journal of Roentgenology : Vol. 206, No. 6 (AJR). https://www.ajronline.org/doi/full/10.2214/AJR.15.15318. Accessed October 20, 2021.
3. Halefoglu AM, Yasar A, Bas N, Ozel A, Erturk SM, Basak M. Comparison of computed tomography histogram analysis and chemical-shift magnetic resonance imaging for adrenal mass characterization. Acta Radiol Stockh Swed 1987. 2009;50(9):1071-1079. doi:10.3109/02841850903207170
4. Nguyễn Minh Châu. Nghiên cứu đặc điểm hình ảnh và giá trị của chụp cắt lớp vi tính 64 dãy trong chẩn đoán u tuyến thượng thận. Luận Văn Thạc Sĩ Học Trường Đại Học Hà Nội. 2014.
5. Nguyễn Đình Minh (2003). Nghiên cứu giá trị của chụp cắt lớp vi tính trong chẩn đoán u tuyến thượng thận, Luận văn thạc sĩ y học, Trường Đại học Y Hà Nội.
6. Park SH, Kim MJ, Kim JH, Lim JS, Kim KW. Differentiation of adrenal adenoma and nonadenoma in unenhanced CT: new optimal threshold value and the usefulness of size criteria for differentiation. Korean J Radiol. 2007;8(4):328-335. doi:10.3348/kjr.2007.8.4.328
7. Seo JM, Park BK, Park SY, Kim CK. Characterization of Lipid-Poor Adrenal Adenoma: Chemical-Shift MRI and Washout CT. Am J Roentgenol. 2014;202(5):1043-1050. doi:10.2214/AJR.13.11389
8. Wajchenberg BL, Albergaria Pereira MA, Medonca BB, et al. Adrenocortical carcinoma: clinical and laboratory observations. Cancer. 2000;88(4):711-736.
9. Adam SZ, Nikolaidis P, Horowitz JM, et al. Chemical Shift MR Imaging of the Adrenal Gland: Principles, Pitfalls, and Applications. RadioGraphics. 2016;36(2):414-432. doi:10.1148/rg.2016150139
10. Heinz-Peer G, Hönigschnabl S, Schneider B, Niederle B, Kaserer K, Lechner G. Characterization of adrenal masses using MR imaging with histopathologic correlation. AJR Am J Roentgenol. 1999;173(1):15-22. doi:10.2214/ajr.173.1.10397092
11. Israel GM, Korobkin M, Wang C, Hecht EN, Krinsky GA. Comparison of Unenhanced CT and Chemical Shift MRI in Evaluating Lipid-Rich Adrenal Adenomas. Am J Roentgenol. 2004;183(1):215-219. doi:10.2214/ajr.183.1.1830215