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[Current developments in the radiologic diagnosis of the adrenal glands].

Cross-sectional imaging techniques have dramatically improved the diagnosis of adrenal disease. In most patients with endocrine-active adrenal disease, CT is the only imaging test needed to establish the correct diagnosis. Adrenal venography with blood sampling may provide important additional information in patients with Conn adenoma. Magnetic resonance imaging and (IMBG) scintigraphy appear to be the best imaging tests for the localization of multiple or extra-adrenal pheochromocytomas. Inactive adrenal tumors detected incidentally are a problem as for as diagnosis is concerned, since inactive adrenal adenomas have to be differentiated from carcinomas and metastases. MRI is rarely helpful in these cases. For patients with a known primary tumor, the authors recommend CT-guided biopsy. In all other cases a follow-up study often reveals that the adrenal tumor detected is benign.

Adrenal Gland Diseases↗

The widened renal fossa sign on liver-spleen scintigraphy and adrenal disease.

A widened renal fossa on the posterior view during liver-spleen scintigraphy using technetium Tc 99m sulfur colloid raises the possibility of renal or extrarenal disease. We encountered four patients with prominent renal fossae on liver-spleen scans. They were subsequently found to have lesions involving the right adrenal gland. Potential adrenal disease should be considered in patients whose liver-spleen scans show widened renal fossae.

Adrenal Gland Diseases↗

Sonography of the adrenal glands: normal glands and small masses.

To evaluate sonographic imaging of the normal adrenal glands, anterior transverse and longitudinal scans were made on 200 patients who had no evidence of adrenal disease. In 78 additional patients who were suspected of having adrenal masses, anterior and posterior transverse and longitudinal scanning and longitudinal oblique scanning were done. Anterior transverse scanning proved to be the best single method of scanning the adrenal gland and small adrenal masses. The normal adrenal gland which is 3-6 mm thick and adrenal masses as small as 1.3 cm can be delineated. Although the frequency of visualizing normal adrenal glands (78.5% on the right and 44% on the left) with sonography is not as high as with CT, masses are more readily detected than the normal glands. The accuracy for detecting adrenal masses is very high, with a false-negative rate of only 3%. Sonography can be a useful screening test for many patients who are suspected of having adrenal masses. However, for obese patients the image is degraded and a higher false-positive rate (3.5%) is obtained. CT provides better resolution for such patients.

Adenoma↗