Blake / Boland Adrenal Imaging

1. Auflage 2009
ISBN: 978-1-59745-560-2
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 224 Seiten

Reihe: Contemporary Medical Imaging

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.

Autoren/Hrsg.

Blake, Michael A.

Boland, Giles

Inhaltsverzeichnis

1;Preface;6
2;Contents;8
3;Contributors;10
4;Adrenal Embryology and Pathology;12
4.1;Introduction;12
4.2;Embryology and Developmental Disorders of the Adrenal Glands;12
4.3;Gross and Microscopic Anatomy of the Adrenal Glands;14
4.4;Hyperplastic Disorders;16
4.4.1;Cortical Hyperplasia;16
4.4.1.1;Pituitary/Hypothalamic-based Hyperplasia (Cushing’s Disease);17
4.4.1.2;Cortical Hyperplasia Associated with Ectopic Production of Adrenocorticotropic Hormone or Corticotropin-releasing Hormone;17
4.4.1.3;Cortical Hyperplasia Associated with Hyperaldosteronism;18
4.4.2;Macronodular Hyperplasia (Massive Macronodular Adrenal Cortical Disease);18
4.4.3;Primary Pigmented Nodular Adrenocortical Disease-Microadenomatous Hyperplasia of the Adrenal;18
4.4.4;Other Types of Adrenal Hyperplasia;19
4.5;Adrenal Neoplasms;19
4.5.1;Cortical Adenomas;20
4.5.1.1;Nonfunctional Cortical Adenomas and Cortical Nodules;20
4.5.1.2;Cushing’s Syndrome;20
4.5.1.3;Conn’s Syndrome;21
4.5.1.4;Adrenogenital Syndromes (Sex Steroid Overproduction);22
4.5.1.5;Oncocytic Adenoma (Oncocytoma);22
4.5.2;Cortical Carcinoma;23
4.5.3;Neuroblastic Tumors;26
4.5.4;Pheochromocytoma;30
4.6;Other Adrenal Mass Lesions;34
4.6.1;Metastatic Malignancies and Malignant Lymphoma;34
4.6.2;Cysts and Pseudocysts;35
4.6.3;Myelolipoma;36
4.6.4;Connective Tissue Tumors;37
4.6.5;Other Tumors;37
4.6.6;Needle Biopsy of Adrenal Masses;37
4.7;Metabolic Disorders;39
4.7.1;Storage Diseases;39
4.7.2;Congenital Adrenal Hyperplasia;39
4.8;Hypofunctional States;40
4.8.1;Primary Hypofunction;40
4.8.1.1;Autoimmune Adrenalitis;40
4.8.1.2;Infectious Disorders;40
4.8.1.3;Amyloidosis;41
4.8.1.4;Adrenal Hemorrhage;41
4.8.2;Secondary Hypofunction;41
4.9;References;41
5;Adrenocortical Dysfunction;45
5.1;Normal Physiology and Regulation of Adrenocortical Function;46
5.2;Biosynthesis of Adrenal Steroids;46
5.3;Steroid Transport;47
5.4;Steroid Metabolism and Excretion;47
5.4.1;Glucocorticoids;47
5.4.2;Mineralocorticoids;47
5.4.3;Adrenal Androgen;47
5.5;Regulation of Hypothalamic-Pituitary-Adrenal Axis;47
5.5.1;Factors Controlling the Release of ACTH;47
5.5.2;Physiologic Actions of Glucocorticoids (GC);48
5.5.3;Molecular Mechanisms of Cortisol Action;49
5.6;Regulation of Renin-Angiotensin-Aldosterone Axis;49
5.6.1;Physiology of Renin-Angiotensin;49
5.6.2;Regulation of Renin Secretion;49
5.6.3;Physiological Actions of Aldosterone;50
5.6.4;Regulation of Aldosterone Secretion;51
5.7;Adrenal Androgen Physiology;51
5.8;Laboratory Evaluation of Adrenocortical Function;51
5.9;Cushing’s Syndrome;51
5.10;ACTH-Dependent Causes;51
5.10.1;Cushing’s Disease;51
5.10.2;Ectopic ACTH Syndrome;52
5.10.3;Other Causes;53
5.11;ACTH-Independent Causes;53
5.11.1;Other Etiologies;53
5.12;Clinical Features of Cushing’s Syndrome;54
5.13;Diagnosis;54
5.14;Investigations to Determine the Etiology of Cushing’s Syndrome;54
5.15;Radiological Evaluation of Cushing’s Syndrome;55
5.16;Differential Diagnosis;55
5.16.1;Pseudo-Cushing’s Syndrome;55
5.17;Management;55
5.17.1;ACTH Dependent Causes;55
5.17.2;Ectopic ACTH Syndrome;55
5.17.3;Adrenal Etiologies;56
5.18;Medical Therapies for Cushing’s Syndrome;56
5.19;Mineralocorticoid Excess;57
5.19.1;Hyperaldosteronism;57
5.20;Primary Hyperaldosteronism;57
5.20.1;Etiology;57
5.20.2;Clinical Features;58
5.20.3;Aldosterone and Cardiovascular Damage;58
5.20.4;Diagnosis;58
5.20.5;Differential Diagnosis;59
5.20.6;Management;59
5.20.7;Glucocorticoid-Remediable Aldosteronism;59
5.21;Secondary Hyperaldosteronism;60
5.22;Other Causes of Increased Mineralocorticoid Action;60
5.22.1;Hypoaldosteronism with Low Plasma Renin Activity;60
5.22.2;Apparent Mineralocorticoid Excess;60
5.23;Liddle’s Syndrome;60
5.24;Hyperaldosteronism with High Plasma Renin Activity;60
5.24.1;Bartter’s Syndrome;60
5.24.2;Gitelman’s Syndrome;60
5.25;Primary Adrenal Insufficiency;60
5.25.1;Etiology;61
5.25.2;Clinical Features;61
5.25.3;Diagnosis;61
5.25.4;Differential Diagnosis;62
5.25.5;Management;62
5.26;Secondary Adrenocortical Insufficiency;63
5.27;Hypoaldosteronism;63
5.28;Congenital Adrenal Hyperplasia;63
5.29;Adrenal ‘‘Incidentalomas’’;64
5.30;Radiographic Evaluation;64
5.31;Follow Up;65
5.32;Summary Points;65
5.33;References;65
6;Adrenal Medullary Dysfunction;67
6.1;Introduction;67
6.2;Syndromic Pheochromocytoma;68
6.3;Diagnostic Investigation;68
6.3.1;Case Finding;68
6.3.2;Localization;69
6.4;Treatment;70
6.4.1;Preoperative Management;70
6.4.1.1;alpha-Adrenergic Blockade;70
6.4.1.2;beta-Adrenergic Blockade;70
6.4.1.3;Catecholamine Synthesis Inhibitor;71
6.4.1.4;Calcium Channel Blockers;71
6.4.2;Acute Hypertensive Crises;71
6.4.3;Anesthesia and Surgery;71
6.4.4;Long-Term Postoperative Follow-up;72
6.5;Malignant Pheochromocytoma;72
6.6;Summary;73
6.7;References;73
7;The Adrenals in Oncology;75
7.1;Adrenal Anatomy for Oncology;75
7.2;Adrenal Physiology for Oncology;76
7.3;Adrenals and Cancer - Overview;76
7.4;Adrenal Cortical Carcinomas;77
7.4.1;Epidemiology;77
7.4.2;Natural History;77
7.4.3;Clinical Presentation;77
7.4.4;Diagnostic Workup and Staging;78
7.4.5;Endocrinology;78
7.4.6;Imaging Characteristics of ACC;78
7.4.7;Pathologic Classification;78
7.4.8;General Management;79
7.4.9;Surgery;79
7.4.10;Chemotherapy;79
7.4.11;Radiation Therapy Techniques;80
7.5;Adrenal Medulla Tumors;81
7.5.1;Epidemiology;81
7.5.2;Natural History;81
7.5.3;Clinical Presentation;82
7.5.4;Diagnostic Work-up and Staging;82
7.5.4.1;Endocrinology;82
7.5.4.2;Imaging;82
7.5.5;Pathological Classification;82
7.5.6;General Management;83
7.5.6.1;Surgery;83
7.6;Conclusion and Summary;83
7.7;References;84
8;Adrenal Surgery;87
8.1;Introduction;87
8.2;The History of Adrenal Anatomy and Surgery;87
8.2.1;History of the Adrenal Glands - Form and Function;87
8.2.2;Early Adrenal Surgery;88
8.3;Review of Adrenal Anatomy and Histology;88
8.3.1;General Adrenal Anatomy;88
8.3.2;Anatomy of Right Adrenal Gland;89
8.3.3;Anatomy of Left Adrenal Gland;89
8.3.4;Adrenal Gland Histology;90
8.3.5;Adrenal Hormonal Function;91
8.4;Diagnosis of Adrenal Pathology;91
8.4.1;Differential Diagnosis of an Adrenal Mass;91
8.4.2;Adrenal Incidentaloma;91
8.4.3;Syndromes of Hormonal Excess;92
8.4.3.1;Aldosterenoma (Conn’s Syndrome);92
8.4.3.2;Cortisol-producing Adenoma;92
8.4.3.3;Pheochromocytoma;92
8.4.3.4;Sex Hormone Secreting Tumors;93
8.4.4;Hormonal Work-up for Adrenal Incidentaloma;93
8.5;Surgical Approaches to Adrenalectomy;94
8.5.1;Retroperitoneal Adrenalectomy;94
8.5.2;Open Adrenalectomy;95
8.5.3;Lateral Laparoscopic Adrenalectomy;95
8.6;Preoperative Preparation;98
8.7;Conclusions and Summary;99
8.8;References;99
9;Imaging Adrenal Dysfunction;100
9.1;Introduction;100
9.2;Adrenal Cortical Hyperfunction;100
9.2.1;Cushing’s Syndrome;100
9.2.1.1;ACTH-Dependent Cushing’s Syndrome;101
9.2.1.1.1;Identifying an Ectopic ACTH Source;101
9.2.1.1.2;Pituitary Dependent Cushing’s Disease;102
9.2.1.2;ACTH-Independent Cushing’s Syndrome;102
9.2.1.2.1;Adrenal Adenomas;102
9.2.1.2.2;Adrenal Carcinoma;103
9.2.1.2.3;Primary Pigmented Nodular Adrenocortical Disease (PPNAD);104
9.2.1.2.4;ACTH-independent Macronodular Adrenal Hyperplasia (AIMAH);105
9.2.2;Primary Hyperaldosteronism (Conn’s Syndrome);106
9.2.2.1;Virilization;108
9.2.2.1.1;Congenital Adrenal Hyperplasia (CAH);108
9.2.2.1.2;Adrenal Virilizing Tumours;108
9.3;Functioning Adrenal Medullary Disorders;109
9.3.1;Adrenal Medullary Hyperplasia (AMH);109
9.3.2;Pheochromocytomas;110
9.3.3;Neuroblastoma and Ganglioneuroblastoma;110
9.4;Adrenal Hypofunction (Addison’s Disease);111
9.4.1;Primary Adrenal Hypofunction;111
9.4.2;Secondary Adrenal Hypofunction;114
9.5;Summary;115
9.6;Key Points;115
9.7;References;115
10;Imaging of Pheochromocytomas;118
10.1;Clinical Features;118
10.2;Laboratory Tests;123
10.3;Pathology;123
10.4;Imaging Examinations;123
10.4.1;Computed Tomography;124
10.4.2;Magnetic Resonance Imaging;128
10.4.3;Ultrasound;130
10.4.4;Nuclear Scintigraphy;130
10.5;Summary Points;133
10.6;References;133
11;Adrenal Imaging Using Computed Tomography: Differentiation of Adenomas and Metastasis;136
11.1;Introduction;136
11.2;CT;137
11.2.1;Nodule/mass Size;138
11.2.2;Nodule/mass Homogeneity;138
11.2.3;Nodule/mass Density;139
11.2.4;CT Histogram Analysis;144
11.2.5;CT Density Measurement Accuracy;146
11.3;Summary;147
11.4;References;147
12;MRI of the Adrenal Glands;149
12.1;Introduction;149
12.2;Technique for MRI of the Adrenals;150
12.3;Normal Anatomy;150
12.4;MRI of Pheochromocytoma;150
12.5;MRI of Adrenocortical Carcinoma;151
12.6;MRI of Adrenal Functional Disorders;153
12.7;MRI of Adrenal Adenoma vs Nonadenoma;155
12.7.1;Incidentalomas;155
12.7.2;Adenoma Characteristics on MRI;156
12.7.2.1;Chemical Shift Principle;157
12.7.3;Metastasis Characteristics;158
12.7.4;MRI: Benign vs Malignant;158
12.7.5;Role of MRI for Incidentalomas;160
12.8;MRI of Miscellaneous Pathology;160
12.8.1;MRI of Myelolipoma;160
12.8.2;MRI of Adrenal Hematomas;160
12.8.3;MRI of Adrenal Cysts;160
12.8.4;MRI of Rare Adrenal Tumors;160
12.8.5;MRI of Inflammatory Adrenal Disease;161
12.9;Summary and Future Directions;163
12.10;References;163
13;Single Photon Imaging of the Adrenal Gland;165
13.1;Introduction;165
13.2;Imaging of the Adrenal Cortex;166
13.3;Imaging of the Adrenal Medulla;166
13.3.1;MIBG;166
13.3.2;Somatostatin Receptor Imaging;167
13.4;Summary and Key Points;176
13.5;References;179
14;PET and PET-CT Imaging of Adrenal Lesions;180
14.1;Differentiation of Adrenal Lesions: The Need for Molecular Imaging;180
14.2;Principles of PET Imaging;181
14.3;The Additional Value of PET-CT Over PET Alone;181
14.4;The Normal Adrenal Glands in FDG PET and PET-CT;182
14.5;Differentiation of Adrenal Lesions - Benign vs Malignant;183
14.6;Differentiation of Adrenal Lesions with FDG PET - Results from Clinical Studies;183
14.7;Differentiation of Adrenal Lesions with FDG PET-CT - Results from Clinical Studies;184
14.8;Adrenal Uptake Relative to Liver or Background Activity?;184
14.9;Lipid-poor Adenomas in FDG PET-CT;184
14.10;Discordant Findings Between the PET and the CT Component in a PET-CT Exam;187
14.11;Absolute or Relative SUV Measurements of Adrenal Lesions?;187
14.12;The Additional Value of PET-CT Over PET Alone in Adrenal Gland Imaging;187
14.13;False Negatives in FDG PET and PET-CT;188
14.14;False Positives in FDG PET and PET-CT;188
14.15;Why PET/PET-CT When There is Already CT, MRI and Biopsy?;189
14.16;Suggested Diagnostic and Therapeutic Approach for Adrenal Lesions;190
14.17;Identification of Adrenocortical Lesions;192
14.17.1;Primary Adrenocortical Tumors;192
14.17.2;FDG PET Imaging for Adrenocortical Carcinoma;193
14.17.3;Principals of METO PET Imaging;193
14.17.4;METO PET Imaging: Results from Clinical Studies;193
14.17.5;First Experiences with FETO PET;193
14.17.6;Imaging of Adrenocortical Tumors: Conclusions;194
14.18;Identification of Medullary Lesions (Pheochromocytomas);194
14.18.1;PET for Pheochromocytoma Imaging;194
14.18.2;Conclusions for Pheochromocytoma Imaging: PET Compared to MIBG;195
14.19;Key Points;195
14.20;References;196
15;Adrenal Trauma and Intervention;199
15.1;Introduction;199
15.2;Percutaneous Adrenal Biopsy;199
15.2.1;Indications;199
15.2.2;Patient Preparation and Care;200
15.2.3;Biopsy Technique;200
15.2.4;Results;202
15.2.5;Complications;202
15.3;Percutaneous Adrenal Radiofrequency Ablation;202
15.3.1;Patient Preparation and Care;202
15.3.2;RFA Technique;202
15.3.3;Results;203
15.3.4;Complications;203
15.4;Miscellaneous Adrenal Procedures;203
15.5;Adrenal Vein Sampling;204
15.5.1;Indications;204
15.5.2;Patient Preparation and Care;204
15.5.3;Technique;204
15.5.4;Results;205
15.5.5;Complications;205
15.5.6;Conclusions;206
15.6;Adrenal Trauma;206
15.6.1;Introduction;206
15.6.2;Imaging Characteristics;206
15.7;Conclusion;208
15.8;References;208
16;Evolving Functional and Advanced Image Analysis Techniques for Adrenal Lesion Characterization;210
16.1;Introduction;210
16.2;Advanced Image Analysis Techniques;211
16.2.1;Dual Energy CT;211
16.2.1.1;Basic Principle;211
16.2.2;Histogram Analysis;212
16.2.2.1;Basic Principle;212
16.3;Functional Imaging Techniques;213
16.3.1;Nuclear Medicine;213
16.3.2;Diffusion-weighted MR Imaging (DWI);214
16.3.2.1;Basic Principle;214
16.3.2.2;Technique;214
16.3.3;MR Spectroscopy (MRS);217
16.3.3.1;Basic Principle;218
16.3.3.2;Technique;218
16.3.4;Perfusion Imaging;219
16.3.4.1;Basic Principle;219
16.4;Conclusion and Summary;221
16.5;References;221
17;Index;224