[Modern capabilities of contrast-enhanced computed tomography in the diagnosis of adrenal adenomas].
Adrenal incidentalomas are common, with a detection rate of up to 7% in patients over 70 years of age. Of these, up to 25% are functionally active, leading to the development of severe clinical manifestations. Challenges of insufficient diagnosis and a lack of a personalized approach to the management of such patients persist. To overcome these challenges, the use of CT image analysis is proposed to develop criteria for non-invasive diagnosis, which is a pathway towards improving personalized patient management.
Analysis of statistically significant correlations between clinical-laboratory parameters and contrast-enhanced (CE) CT imaging features of adrenal adenomas.
A single-center, non-comparative, cross-sectional retrospective study analyzed preoperative images from four-phase CECT of adrenal adenomas. Hormonal workup included the determination of aldosterone, renin, cortisol levels during an overnight dexamethasone suppression test (DST), adrenocorticotropic hormone (ACTH), 24-hour urinary free cortisol (UFC); potassium and creatinine levels were also assessed. Clinical data included arterial hypertension, impaired carbohydrate metabolism, dyslipidemia, hypokalemia, and renal dysfunction. A comparative and correlation analysis was performed between clinical-laboratory parameters and CECT characteristics.
The study included 254 patients. Hormonal activity was detected in 226 (89.0%) patients; 28 (11.0%) patients had non-functioning adenomas. Hormonally inactive adenomas were characterized by larger size (43.0 mm [32.7; 51.2] vs. 29.0 mm [20; 36], p<0.001), higher native density (41.0 HU [36.0; 47.2] vs. 25.0 HU [12.0; 37.0], p<0.001), and lower venous phase contrast enhancement (141.6% vs. 283.7%, p=0.001). In primary aldosteronism (PA), adenomas were significantly smaller (20.0 mm [16.8; 25.0]) and had lower native density (14.0 HU [4.0; 24.0]) compared to cortisol-producing tumors (34.0 mm [30.0; 38.0], 35.5 HU [30.0; 44.0], p<0.001). The presence of calcifications was more frequently observed in cortisol hypersecretion compared to PA (p=0.011). Correlation analysis revealed negative associations between adenoma size and levels of aldosterone (r=-0.504, p<0.001) and ACTH (r=-0.419, p<0.001), and positive associations with post-DST cortisol levels (r=0.500, p<0.001), renin (r = 0.454, p<0.001), and potassium (r=0.458, p<0.001).
CT characteristics of adrenal adenomas vary depending on hormonal activity, type of secretion, and clinical manifestations.
Analysis of statistically significant correlations between clinical-laboratory parameters and contrast-enhanced (CE) CT imaging features of adrenal adenomas.
A single-center, non-comparative, cross-sectional retrospective study analyzed preoperative images from four-phase CECT of adrenal adenomas. Hormonal workup included the determination of aldosterone, renin, cortisol levels during an overnight dexamethasone suppression test (DST), adrenocorticotropic hormone (ACTH), 24-hour urinary free cortisol (UFC); potassium and creatinine levels were also assessed. Clinical data included arterial hypertension, impaired carbohydrate metabolism, dyslipidemia, hypokalemia, and renal dysfunction. A comparative and correlation analysis was performed between clinical-laboratory parameters and CECT characteristics.
The study included 254 patients. Hormonal activity was detected in 226 (89.0%) patients; 28 (11.0%) patients had non-functioning adenomas. Hormonally inactive adenomas were characterized by larger size (43.0 mm [32.7; 51.2] vs. 29.0 mm [20; 36], p<0.001), higher native density (41.0 HU [36.0; 47.2] vs. 25.0 HU [12.0; 37.0], p<0.001), and lower venous phase contrast enhancement (141.6% vs. 283.7%, p=0.001). In primary aldosteronism (PA), adenomas were significantly smaller (20.0 mm [16.8; 25.0]) and had lower native density (14.0 HU [4.0; 24.0]) compared to cortisol-producing tumors (34.0 mm [30.0; 38.0], 35.5 HU [30.0; 44.0], p<0.001). The presence of calcifications was more frequently observed in cortisol hypersecretion compared to PA (p=0.011). Correlation analysis revealed negative associations between adenoma size and levels of aldosterone (r=-0.504, p<0.001) and ACTH (r=-0.419, p<0.001), and positive associations with post-DST cortisol levels (r=0.500, p<0.001), renin (r = 0.454, p<0.001), and potassium (r=0.458, p<0.001).
CT characteristics of adrenal adenomas vary depending on hormonal activity, type of secretion, and clinical manifestations.
Authors
Tarbaeva Tarbaeva, Chevais Chevais, Manaev Manaev, Beltsevich Beltsevich, Platonova Platonova, Troshina Troshina, Melnichenko Melnichenko, Mokrysheva Mokrysheva
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