Adrenal Imaging (eBook)

Michael A. Blake, Giles Boland (Herausgeber)

eBook Download: PDF

2009 | 2009
X, 224 Seiten
Humana Press (Verlag)
978-1-59745-560-2 (ISBN)

Infos

Imaging of the adrenal gland has made tremendous progress in the last decade as new technologies continue to evolve. Adrenal Imaging highlights the pertinent clinical and pathological information that underpins the accurate interpretation and use of adrenal imaging. Written by a prestigious group of international contributors, individual chapters in Adrenal Imaging serve as a relevant and up-to-date reference of adrenal imaging findings, algorithms and techniques in CT, MR nuclear medicine, intervention and trauma. Summary sections at the end of each chapter illuminate key teaching points to enhance retention.

Inhalt

Preface 6
Contents 8
Contributors 10
Adrenal Embryology and Pathology 12
Introduction 12
Embryology and Developmental Disorders of the Adrenal Glands 12
Gross and Microscopic Anatomy of the Adrenal Glands 14
Hyperplastic Disorders 16
Cortical Hyperplasia 16
Pituitary/Hypothalamic-based Hyperplasia (Cushing’s Disease) 17
Cortical Hyperplasia Associated with Ectopic Production of Adrenocorticotropic Hormone or Corticotropin-releasing Hormone 17
Cortical Hyperplasia Associated with Hyperaldosteronism 18
Macronodular Hyperplasia (Massive Macronodular Adrenal Cortical Disease) 18
Primary Pigmented Nodular Adrenocortical Disease-Microadenomatous Hyperplasia of the Adrenal 18
Other Types of Adrenal Hyperplasia 19
Adrenal Neoplasms 19
Cortical Adenomas 20
Nonfunctional Cortical Adenomas and Cortical Nodules 20
Cushing’s Syndrome 20
Conn’s Syndrome 21
Adrenogenital Syndromes (Sex Steroid Overproduction) 22
Oncocytic Adenoma (Oncocytoma) 22
Cortical Carcinoma 23
Neuroblastic Tumors 26
Pheochromocytoma 30
Other Adrenal Mass Lesions 34
Metastatic Malignancies and Malignant Lymphoma 34
Cysts and Pseudocysts 35
Myelolipoma 36
Connective Tissue Tumors 37
Other Tumors 37
Needle Biopsy of Adrenal Masses 37
Metabolic Disorders 39
Storage Diseases 39
Congenital Adrenal Hyperplasia 39
Hypofunctional States 40
Primary Hypofunction 40
Autoimmune Adrenalitis 40
Infectious Disorders 40
Amyloidosis 41
Adrenal Hemorrhage 41
Secondary Hypofunction 41
References 41
Adrenocortical Dysfunction 45
Normal Physiology and Regulation of Adrenocortical Function 46
Biosynthesis of Adrenal Steroids 46
Steroid Transport 47
Steroid Metabolism and Excretion 47
Glucocorticoids 47
Mineralocorticoids 47
Adrenal Androgen 47
Regulation of Hypothalamic-Pituitary-Adrenal Axis 47
Factors Controlling the Release of ACTH 47
Physiologic Actions of Glucocorticoids (GC) 48
Molecular Mechanisms of Cortisol Action 49
Regulation of Renin-Angiotensin-Aldosterone Axis 49
Physiology of Renin-Angiotensin 49
Regulation of Renin Secretion 49
Physiological Actions of Aldosterone 50
Regulation of Aldosterone Secretion 51
Adrenal Androgen Physiology 51
Laboratory Evaluation of Adrenocortical Function 51
Cushing’s Syndrome 51
ACTH-Dependent Causes 51
Cushing’s Disease 51
Ectopic ACTH Syndrome 52
Other Causes 53
ACTH-Independent Causes 53
Other Etiologies 53
Clinical Features of Cushing’s Syndrome 54
Diagnosis 54
Investigations to Determine the Etiology of Cushing’s Syndrome 54
Radiological Evaluation of Cushing’s Syndrome 55
Differential Diagnosis 55
Pseudo-Cushing’s Syndrome 55
Management 55
ACTH Dependent Causes 55
Ectopic ACTH Syndrome 55
Adrenal Etiologies 56
Medical Therapies for Cushing’s Syndrome 56
Mineralocorticoid Excess 57
Hyperaldosteronism 57
Primary Hyperaldosteronism 57
Etiology 57
Clinical Features 58
Aldosterone and Cardiovascular Damage 58
Diagnosis 58
Differential Diagnosis 59
Management 59
Glucocorticoid-Remediable Aldosteronism 59
Secondary Hyperaldosteronism 60
Other Causes of Increased Mineralocorticoid Action 60
Hypoaldosteronism with Low Plasma Renin Activity 60
Apparent Mineralocorticoid Excess 60
Liddle’s Syndrome 60
Hyperaldosteronism with High Plasma Renin Activity 60
Bartter’s Syndrome 60
Gitelman’s Syndrome 60
Primary Adrenal Insufficiency 60
Etiology 61
Clinical Features 61
Diagnosis 61
Differential Diagnosis 62
Management 62
Secondary Adrenocortical Insufficiency 63
Hypoaldosteronism 63
Congenital Adrenal Hyperplasia 63
Adrenal ‘‘Incidentalomas’’ 64
Radiographic Evaluation 64
Follow Up 65
Summary Points 65
References 65
Adrenal Medullary Dysfunction 67
Introduction 67
Syndromic Pheochromocytoma 68
Diagnostic Investigation 68
Case Finding 68
Localization 69
Treatment 70
Preoperative Management 70
alpha-Adrenergic Blockade 70
beta-Adrenergic Blockade 70
Catecholamine Synthesis Inhibitor 71
Calcium Channel Blockers 71
Acute Hypertensive Crises 71
Anesthesia and Surgery 71
Long-Term Postoperative Follow-up 72
Malignant Pheochromocytoma 72
Summary 73
References 73
The Adrenals in Oncology 75
Adrenal Anatomy for Oncology 75
Adrenal Physiology for Oncology 76
Adrenals and Cancer - Overview 76
Adrenal Cortical Carcinomas 77
Epidemiology 77
Natural History 77
Clinical Presentation 77
Diagnostic Workup and Staging 78
Endocrinology 78
Imaging Characteristics of ACC 78
Pathologic Classification 78
General Management 79
Surgery 79
Chemotherapy 79
Radiation Therapy Techniques 80
Adrenal Medulla Tumors 81
Epidemiology 81
Natural History 81
Clinical Presentation 82
Diagnostic Work-up and Staging 82
Endocrinology 82
Imaging 82
Pathological Classification 82
General Management 83
Surgery 83
Conclusion and Summary 83
References 84
Adrenal Surgery 87
Introduction 87
The History of Adrenal Anatomy and Surgery 87
History of the Adrenal Glands - Form and Function 87
Early Adrenal Surgery 88
Review of Adrenal Anatomy and Histology 88
General Adrenal Anatomy 88
Anatomy of Right Adrenal Gland 89
Anatomy of Left Adrenal Gland 89
Adrenal Gland Histology 90
Adrenal Hormonal Function 91
Diagnosis of Adrenal Pathology 91
Differential Diagnosis of an Adrenal Mass 91
Adrenal Incidentaloma 91
Syndromes of Hormonal Excess 92
Aldosterenoma (Conn’s Syndrome) 92
Cortisol-producing Adenoma 92
Pheochromocytoma 92
Sex Hormone Secreting Tumors 93
Hormonal Work-up for Adrenal Incidentaloma 93
Surgical Approaches to Adrenalectomy 94
Retroperitoneal Adrenalectomy 94
Open Adrenalectomy 95
Lateral Laparoscopic Adrenalectomy 95
Preoperative Preparation 98
Conclusions and Summary 99
References 99
Imaging Adrenal Dysfunction 100
Introduction 100
Adrenal Cortical Hyperfunction 100
Cushing’s Syndrome 100
ACTH-Dependent Cushing’s Syndrome 101
Identifying an Ectopic ACTH Source 101
Pituitary Dependent Cushing’s Disease 102
ACTH-Independent Cushing’s Syndrome 102
Adrenal Adenomas 102
Adrenal Carcinoma 103
Primary Pigmented Nodular Adrenocortical Disease (PPNAD) 104
ACTH-independent Macronodular Adrenal Hyperplasia (AIMAH) 105
Primary Hyperaldosteronism (Conn’s Syndrome) 106
Virilization 108
Congenital Adrenal Hyperplasia (CAH) 108
Adrenal Virilizing Tumours 108
Functioning Adrenal Medullary Disorders 109
Adrenal Medullary Hyperplasia (AMH) 109
Pheochromocytomas 110
Neuroblastoma and Ganglioneuroblastoma 110
Adrenal Hypofunction (Addison’s Disease) 111
Primary Adrenal Hypofunction 111
Secondary Adrenal Hypofunction 114
Summary 115
Key Points 115
References 115
Imaging of Pheochromocytomas 118
Clinical Features 118
Laboratory Tests 123
Pathology 123
Imaging Examinations 123
Computed Tomography 124
Magnetic Resonance Imaging 128
Ultrasound 130
Nuclear Scintigraphy 130
Summary Points 133
References 133
Adrenal Imaging Using Computed Tomography: Differentiation of Adenomas and Metastasis 136
Introduction 136
CT 137
Nodule/mass Size 138
Nodule/mass Homogeneity 138
Nodule/mass Density 139
CT Histogram Analysis 144
CT Density Measurement Accuracy 146
Summary 147
References 147
MRI of the Adrenal Glands 149
Introduction 149
Technique for MRI of the Adrenals 150
Normal Anatomy 150
MRI of Pheochromocytoma 150
MRI of Adrenocortical Carcinoma 151
MRI of Adrenal Functional Disorders 153
MRI of Adrenal Adenoma vs Nonadenoma 155
Incidentalomas 155
Adenoma Characteristics on MRI 156
Chemical Shift Principle 157
Metastasis Characteristics 158
MRI: Benign vs Malignant 158
Role of MRI for Incidentalomas 160
MRI of Miscellaneous Pathology 160
MRI of Myelolipoma 160
MRI of Adrenal Hematomas 160
MRI of Adrenal Cysts 160
MRI of Rare Adrenal Tumors 160
MRI of Inflammatory Adrenal Disease 161
Summary and Future Directions 163
References 163
Single Photon Imaging of the Adrenal Gland 165
Introduction 165
Imaging of the Adrenal Cortex 166
Imaging of the Adrenal Medulla 166
MIBG 166
Somatostatin Receptor Imaging 167
Summary and Key Points 176
References 179
PET and PET-CT Imaging of Adrenal Lesions 180
Differentiation of Adrenal Lesions: The Need for Molecular Imaging 180
Principles of PET Imaging 181
The Additional Value of PET-CT Over PET Alone 181
The Normal Adrenal Glands in FDG PET and PET-CT 182
Differentiation of Adrenal Lesions - Benign vs Malignant 183
Differentiation of Adrenal Lesions with FDG PET - Results from Clinical Studies 183
Differentiation of Adrenal Lesions with FDG PET-CT - Results from Clinical Studies 184
Adrenal Uptake Relative to Liver or Background Activity? 184
Lipid-poor Adenomas in FDG PET-CT 184
Discordant Findings Between the PET and the CT Component in a PET-CT Exam 187
Absolute or Relative SUV Measurements of Adrenal Lesions? 187
The Additional Value of PET-CT Over PET Alone in Adrenal Gland Imaging 187
False Negatives in FDG PET and PET-CT 188
False Positives in FDG PET and PET-CT 188
Why PET/PET-CT When There is Already CT, MRI and Biopsy? 189
Suggested Diagnostic and Therapeutic Approach for Adrenal Lesions 190
Identification of Adrenocortical Lesions 192
Primary Adrenocortical Tumors 192
FDG PET Imaging for Adrenocortical Carcinoma 193
Principals of METO PET Imaging 193
METO PET Imaging: Results from Clinical Studies 193
First Experiences with FETO PET 193
Imaging of Adrenocortical Tumors: Conclusions 194
Identification of Medullary Lesions (Pheochromocytomas) 194
PET for Pheochromocytoma Imaging 194
Conclusions for Pheochromocytoma Imaging: PET Compared to MIBG 195
Key Points 195
References 196
Adrenal Trauma and Intervention 199
Introduction 199
Percutaneous Adrenal Biopsy 199
Indications 199
Patient Preparation and Care 200
Biopsy Technique 200
Results 202
Complications 202
Percutaneous Adrenal Radiofrequency Ablation 202
Patient Preparation and Care 202
RFA Technique 202
Results 203
Complications 203
Miscellaneous Adrenal Procedures 203
Adrenal Vein Sampling 204
Indications 204
Patient Preparation and Care 204
Technique 204
Results 205
Complications 205
Conclusions 206
Adrenal Trauma 206
Introduction 206
Imaging Characteristics 206
Conclusion 208
References 208
Evolving Functional and Advanced Image Analysis Techniques for Adrenal Lesion Characterization 210
Introduction 210
Advanced Image Analysis Techniques 211
Dual Energy CT 211
Basic Principle 211
Histogram Analysis 212
Basic Principle 212
Functional Imaging Techniques 213
Nuclear Medicine 213
Diffusion-weighted MR Imaging (DWI) 214
Basic Principle 214
Technique 214
MR Spectroscopy (MRS) 217
Basic Principle 218
Technique 218
Perfusion Imaging 219
Basic Principle 219
Conclusion and Summary 221
References 221
Index 224

Produkt-Details

• Erscheint lt. Verlag: 28.2.2009
• Reihe/Serie: Contemporary Medical Imaging
• Reihe/Serie: Contemporary Medical Imaging
• Zusatzinfo: X, 224 p.
• Verlagsort: Totowa
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie
• Themenwelt: Medizinische Fachgebiete ► Radiologie / Bildgebende Verfahren ► Radiologie
• Themenwelt: Studium ► 2. Studienabschnitt (Klinik) ► Anamnese / Körperliche Untersuchung
• Schlagworte: Adrenal Dysfunction • Adrenal Embryology and Pathology • Adrenal glands • Adrenal Imaging • Adrenal Nuclear Medicine • Computed tomography (CT) • Denomas and Metastase • Image Analysis • Intervention • Medullary Dysfunction • PET/CT • Pheochromocytoma • Surgery • Trauma
• ISBN-10: 1-59745-560-1 / 1597455601
• ISBN-13: 978-1-59745-560-2 / 9781597455602