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Computed tomography of the adrenal glands
Last reviewed: 23.04.2024
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The maximum length of the adrenal gland is 2.1 - 2.7 cm, the right one is often longer than the left one. The thickness of the branches should not exceed 5 - 8 mm in cross section. Spindle-shaped or nodal thickening of the adrenal and inferior vena cava.
On computed tomography, the adrenal glands are usually distinctly differentiated from the surrounding fatty tissue, diaphragm, kidney, liver.
Depending on what hormones are produced in excess, the following conditions can be diagnosed: hyperplasia of the adrenal cortex (androgens), Kona syndrome (aldosterone) and Cushing's syndrome (cortisone). Differential diagnosis is performed with a cyst of the upper pole and angiomyolipoma of the kidney. The density of the contents of benign cysts is close to the density of water. In case of heterogeneous increase or infiltration into neighboring organs, one can think of metastatic damage or adrenal cancer. Because lung cancer often metastasizes to the liver and adrenal glands, the KT of the chest in these patients must be continued caudal to fully visualize the liver and adrenal glands. Also paravertebrally it is possible to reveal tumors of the sympathetic trunk, which are located next to the adrenal glands, but are quite rare.
Whenever there are doubts as to the goodness of the process when the adrenal gland is enlarged, it is necessary to measure the density of the formation in the process of contrast enhancement. Benign adrenal adrenal gland tends to flush out the contrast drug faster than malignant tumors, such as metastases and cancer. This technique requires additional scanning at the adrenal level after 3, K) and 30 minutes after the injection of the contrast drug.
Malignant neoplasms of the adrenal gland tend to prolong contrast enhancement. This feature can be applied in practice for differential diagnosis. The dynamics of adrenal strengthening has been studied in a large number of studies. There is a difference in the absolute and relative peaks of elution of contrast enhancement. However, leaching completely coincides with different types of tumors. Therefore, only the following parameters are clearly proved and useful for evaluation:
Measurement of Adrenal Density for Differential Diagnosis of Volume Formations
Unexplained <11HU => Adenoma
10 min after CS injection: <45 HU => Adenoma
30 min after CS injection: <35 HU => Adenoma
From these three density measurements, it is clear how different the indices of both types of tumor lesions are. If the density is below these values, you can accurately speak of the presence of a benign adrenal adrenal gland.
In all other cases, the benign adenoma can not be determined with sufficient sensitivity and specificity, therefore additional studies are required.
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