Adrenocortical carcinoma CT

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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 (ACC) and differentiating it from other diseases, such as adrenocortical adenoma. Signs such as internal hemorrhage, calcifications, CT density > 10 HU or necrosis increase the chances of ACC. 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.[1]CT imaging of the chest, liver, and bone scan are used for staging workup to detect metastasis.

Key CT Findings in adrenocortical carcinoma

CT scan of the abdomen is useful for:

Properities 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]FDG PET/CT Adrenal to liver SUV ratio >1.45 Adrenal to liver SUV ratio <1.45
Non-contrast CT showing ACC with calcifications, source: Case courtesy of Dr Arshdeep Sidhu, Radiopaedia.org, rID: 22048 ct without
CT angiography shows Case courtesy of Radswiki, Radiopaedia.org, rID: 11176 ct with angio

References

  1. 1.0 1.1 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. PMID 21606258. doi:10.2214/AJR.10.5540. 
  2. 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. PMID 21606258. doi:10.2214/AJR.10.5540. 
  3. Krebs TL, Wagner BJ (1998). "MR imaging of the adrenal gland: radiologic-pathologic correlation.". Radiographics. 18 (6): 1425–40. PMID 9821192. doi:10.1148/radiographics.18.6.9821192. 
  4. 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. PMID 3492881. doi:10.2214/ajr.148.3.531. 
  5. Egbert N, Elsayes KM, Azar S, Caoili EM (2010). "Computed tomography of adrenocortical carcinoma containing macroscopic fat.". Cancer Imaging. 10: 198–200. PMC 2999409Freely accessible. PMID 21067996. doi:10.1102/1470-7330.2010.0029. 

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