Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2016 Vol. 24 No 1

GENERAL & SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2016.1.40   |  

О.N. SADRIEV 1, А.D. GAIBOV 1,2 S.S. ANVAROVA2

POTENTIAL OF COMPUTED TOMOGRAPHY IN DIFFERENTIAL DIAGNOSIS OF ADRENAL TUMORS

Republican Scientific Center of Cardiovascular Surgery 1,
Avicenna Tajik State Medical University2,
Dushanbe
The Republic of Tajikistan

Objectives. To assess the possibilities of computed tomography at differential diagnostics of adrenal tumors.
Methods. Correlation analysis between the results of computed tomography (CT) and morphologiocal structure of the adrenal tumors in patients (n=54) with pheochromocytoma (PCHC) (n=23; 42,6%), aldosteroma (AS) (n=18; 33,3%) and corticosteroma (CS) (13; 24,1%) has been analyzed. At 3-phase CT such parameters as the tumor size, structure and contours, the presence of the capsule, native and maximum density at contrasting, washout time of contrast medium by more than 60% have been assessed.
Results. While comparing the size of PCHC, CS and AS the reliable difference between them has been registered. Round and oval tumors are more typical for CS and AS; PCHC tumors are of irregular shape. Uneven contours, heterogeneity of the structure and the presence of inclusions in the structure of the tumor turned out to be typical mainly for PCHC, while at CS and AS those signs were practically absent. At comparative assessment of PCHC density (+22 (20-25) UH, CS(+14 (11-16) UH; and AS(+6 (4,25-8,5) UH) in the native regimen and at contrasting, PCHC – +41 (40-45) UH; CS – +20 (16-20,5) UH; AS – +11 (9,25-13) UH), their reliable difference has also been established (р<0,001). While comparing washout time of contrast PCHC (+14 (11-15) min.) and adrenocortical tumors (+8 (6-12,75) min. and +4,9 (3,5-6,625) min. for CS and AS, statistically reliable diference has been registered.
Conclusion. The analysis of tumor size, structure, density in different phases of contrasting and washout time of contrast medium, revealed at CT permits to differentiate the different nosological forms of adrenal tumors and to be clinically significant in the choice of further treatment tactics.

Keywords: computed tomography, comparative assessment, adrenal tumors, diagnostics, pheochromocytoma, aldosteroma, corticosteroma
p. 40-46 of the original issue
References
  1. Willatt JM, Francis IR. Radiologic evaluation of incidentally discovered adrenal masses. Am Fam Physician. 2010 Jun 1;81(11):1361-66.
  2. Kapoor A, Morris T, Rebello R. Guidelines for the management of the incidentally discovered adrenal mass. Can Urol Assoc J. 2011 Aug;5(4):241-7. doi: 10.5489/cuaj.11135.
  3. Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol. 1998 Jul;171(1):201-4.
  4. Ilias I, Sahdev A, Reznek RH, Grossman AB, Pacak K. The optimal imaging of adrenal tumours: a comparison of different methods. Endocr Relat Cancer. 2007 Sep;14(3):587-99.
  5. Gopan T, Remer E, Hamrahian AH. Evaluating and managing adrenal incidentalomas. Cleve Clin J Med. 2006 Jun;73(6):561-68.
  6. Song JH, Mayo-Smith WW. Current status of imaging for adrenal gland tumors. Surg Oncol Clin N Am. 2014 Oct;23(4):847-61. doi: 10.1016/j.soc.2014.06.002.
  7. Hamrahian AH, Ioachimescu AG, Remer EM, Motta-Ramirez G, Bogabathina H, Levin HS, et al. Clinical utility of noncontrast computed tomography attenuation value (hounsfield units) to differentiate adrenal adenomas/hyperplasias from nonadenomas: Cleveland Clinic experience. J Clin Endocrinol Metab. 2005 Feb;90(2):871-77.
  8. Bel'tsevich DG, Soldatova TV, Kuznetsov NS, Remizov OV, Vorontsov A V, Rogal' EIu, i dr. Differentsial'naia diagnostika intsidentalom nadpochechnikov [Differential diagnosis of adrenal incidentalomas]. Problemy Endokrinologii. 2011;57(6):3-8.
  9. Terzolo M, Stigliano A, Chiodini I, Loli P, Furlani L, Arnaldi G, et al. AME position statement on adrenal incidentaloma. Eur J Endocrinol. 2011 Jun;164(6):851-70. doi: 10.1530/EJE-10-1147.
  10. Blake MA, Krishnamoorthy SK, Boland GW, Sweeney AT, Pitman MB, Harisinghani M, et al. Low-density pheochromocytoma on CT: a mimicker of adrenal adenoma. AJR Am J Roentgenol. 2003 Dec;181(6):1663-8.
  11. Young WF Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007 Feb 8;356(6):601-10.
  12. Degenhart C. Adrenal tumors: principles of imaging and differential diagnostics. Radiologe. 2014 Oct;54(10):998-1006. doi: 10.1007/s00117-014-2690-y. [Article in German]
  13. Goldman SM, Coelho RD, Freire Filho Ede O, Abdala N, Szejnfeld D, Faria J, et al. Imaging procedures in adrenal pathology. Arq Bras Endocrinol Metabol. 2004 Oct;48(5):592-611.
Address for correspondence:
734003, Republic of Tadzhikistan,
Dushanbe, prospekt Rudaki, d. 139,
Tadzhikskiy gosudarstvennyiy
meditsinskiy universitet imeni Abuali ibni Sino,
kafedra khirurgicheskih bolezney №2.
tel.: 992 915 25 00 55;
e-mail: sadriev_o_n@mail.ru,
Sadriev Okildzhon Nemadzhonovich
Information about the authors:
Sadriev O.N. A leading researcher of the Republican Scientific Center of Cardiovascular Surgery.
Gaibov A.D. Corresponding member of the academy of Medical Sciences of the Ministry of Health and Social Protection of the Population of the republic of Tajikistan, MD, professor of the surgical diseases chair №2 of Avicenna Tajik State Medical University, professor and tutor of the vascular surgery department of the Republican Scientific Center of Cardiovascular Surgery.
Anvarova S.S. MD, a head of the endocrinology chair of Avicenna Tajik State Medical University.
Contacts | ©Vitebsk State Medical University, 2007