Инциденталома надпочечника. Часть 1. Компьютерная томография инциденталом надпочечника: возможности и сложности дифференциальной диагностики - Журнал Терапевтический архив №12 Vario 2020

Инциденталома надпочечника. Часть 1. Компьютерная томография инциденталом надпочечника: возможности и сложности дифференциальной диагностики

Бурякина С.А., Тарбаева Н.В., Волеводз Н.Н. и др. Инциденталома надпочечника. Часть 1. Компьютерная томография инциденталом надпочечника: возможности и сложности дифференциальной диагностики. Терапевтический архив. 2020; 92 (12): 84–93. DOI: 10.26442/00403660.2020.12.200451

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Buryakina S.A., Tarbaeva N.V., Volevodz N.N., et al. Adrenal incidentaloma. Part 1. Computed tomography
of adrenal incidentaloma: the possibilities and difficulties of differential diagnosis. Therapeutic Archive. 2020; 92 (12): 84–93.
DOI: 10.26442/00403660.2020.12.200451

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Аннотация

Инциденталома надпочечника – это объемное образование различной природы, являющееся случайной находкой у пациентов, которым проводилось исследование не по поводу болезни данного органа. Образования могут быть как гормонально неактивными, так и гормонально активными, могут исходить из различных зон надпочечника или иметь неспецифическую органную принадлежность, могут быть доброкачественными или злокачественными. Рентгенологическая характеристика этих образований, особенно при дифференциальной диагностике доброкачественных и злокачественных, крайне важна для установки верного диагноза с целью адекватного дальнейшего ведения пациента. В статье представлены ключевые КТ-критерии, позволяющие наиболее точно охарактеризовать и установить верный диагноз с помощью метода компьютерной томографии.

Ключевые слова: инциденталома, надпочечник, компьютерная томография, дифференциальная диагностика.

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The adrenal incidentaloma is a lesion of a different etiology and found incidentally in patients who underwent a diagnostic study not about the disease of this organ. Lesions can be both hormonally inactive and hormonally active, can arise from different zones of the adrenal gland or have non-specific organ affiliation, can be benign or malignant. Computed tomography characterization of these lesions, especially the differential diagnosis of benign and malignant, is extremely important for the correct diagnosis in order to provide adequate management of the patient. The article presents the key computed tomography criteria that allow radiologist to characterize the lesion most accurately and consider appropriate diagnosis.

Keywords: incidentaloma, adrenal gland, computed tomography, differential diagnosis

Список литературы

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19. Waguespack SG, Rich T, Grubbs E, et al. A current review of the etiology, diagnosis, and treatment of pediatric pheochromocytoma and paraganglioma. J Clin Endocrinol Metab. 2010;95(5):2023-37. doi: 10.1210/jc.2009-2830
20. Bharwani N, Rockall AG, Sahdev A, et al. Adrenocortical carcinoma: the range of appearances on CT and MRI. Am J Roentgenol. 2011;196(6):706-14. doi: 10.2214/AJR.10.5540
21. Fishman EK, Deutch BM, Hartman DS, et al. Primary adrenocortical carcinoma: CT evaluation with clinical correlation. Am J Roentgenol. 1987;148(3):531-5. doi: 10.2214/ajr.148.3.531
22. Krebs TL, Wagner BJ. MR imaging of the adrenal gland: radiologic-pathologic correlation. Radiographics. 1998;18(6):1425-40. doi: 10.1148/radiographics.18.6.9821192
23. Abrams HL, Spiros R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950;3(1):74-85.
24. Lenert JT, Barnett CC Jr, Kudelka AP, et al. Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy. Surgery. 2001;130(6):1060-7. doi: 10.1067/msy.2001.118369
25. Park JR, Eggert A, Caron H. Neuroblastoma: biology, prognosis, and treatment. Hematol Oncol Clin North Am. 2010;24(1):65-86. doi: 10.1016/j.hoc.2009.11.011
26. Sasaki S, Yasuda T, Kaneto H, et al. Large adrenal ganglioneuroma.
Inter Med. 2012;51(17):2365-70.
27. Linos D, Tsirlis T, Kapralou A, et al. Adrenal ganglioneuromas: incidentalomas with misleading clinical and imaging features. Surgery. 2011;149(1):99-105. doi: 10.1016/j.surg.2010.03.016
28. Guo YK, Yang ZG, Li Y, et al. Uncommon adrenal masses: CT and MRI features with histopathologic correlation. Eur J Radiol. 2007;62(3):359-70. doi: 10.1016/j.ejrad.2006.12.011
29. Garcia G, Anfossi E, Prost J, et al. Benign retroperitoneal schwannoma: report of three cases. Prog Urol. 2002;12(3):450-3.
30. Hori T, Yamagiwa K, Yagi S, et al. Noradrenalin-secreting retroperitoneal schwannoma resected by hand-assisted laparoscopic surgery: report of a case. Surg Today. 2006;36(12):1108–13. doi: 10.1007/s00595-006-3304-8
31. Liu QY, Gao M, Li HG, et al. Juxta-adrenal schwannoma: dynamic multi-slice CT and MRI findings. Eur J Radiol. 2012;81(4):794-9. doi: 10.1016/j.ejrad.2011.01.082
32. Rosenfeld DL, Girgis WS, Underberg-Davis SJ. Bilateral smoothmuscle tumors of the adrenals in a child with AIDS. Pediatr Radiol. 1999;29(5):376-8. doi: 10.1007/s002470050611
33. Lerttumnongtum P, Muttarak M, Visrutaratna P, Ya-In C. Imaging features of unusual adrenal masses. Australias Radiol. 2004;48(2):107-13. doi: 10.1111/j.1440-1673.2004.01268.x
34. Otal P, Escourrou G, Mazerolles C, et al. Imaging features of uncommon adrenal masses with histopathologic correlation. Radiographics. 1999;19(3):569-81. doi: 10.1148/radiographics.19.3.g99ma07569
35. Michalopoulos N, Laskou S, Karayannopoulou G, et al. Adrenal Gland Lymphangiomas. Indian J Surg. 2015;77(3):1334-42. doi: 10.1007/s12262-015-1206-y
36. Vargas AD. Adrenal hemangioma. Urology. 1980;16(4):389-90.
37. Li Y, Sun H, Gao S, Bai R. Primary bilateral adrenal lymphoma: two case reports. J Comput Assist Tomogr. 2006;30(5):791-3. doi: 10.1097/01.rct.0000216112.15564.0c
38. Guo YK, Yang ZG, Li Y, et al. Uncommon adrenal masses: CT and MRI features with histopathologic correlation. Eur J Radiol. 2007;62(3):359-70. doi: 10.1016/j.ejrad.2006.12.011
39. Hussain HK, Korobkin M. MR imaging of the adrenal glands. Magn Reson Imaging Clin N Am. 2004;12(3):515-44. doi: 10.1016/j.mric.2004.03.008
40. Aziz SA, Laway BA, Rangreze I, et al. Primary adrenal lymphoma: differential involvement with varying adrenal function. Indian J Endocrinol Metab. 2011;15(3):220-3. doi: 10.4103/2230-8210.83414
41. Kato H, Itami J, Shiina T, et al. MR imaging of primary adrenal lymphoma. Clin Imaging. 1996;20(2):126–8.
42. Kawashima A, Alleman WG, Takahashi N, et al. Imaging evaluation of amyloidosis of the urinary tract and retroperitoneum. Radiographics. 2011;31(6):1569-82. doi: 10.1148/rg.316115519

________________________________________________

1. Korobkin M, Brodeur FJ, Francis IR, et al. CT time attenuation washout curves of adrenal adenomas and nonadenomas. Am J Roentgenol. 1998;170(3):747-52. doi: 10.2214/ajr.170.3.9490968
2. Pena CS, Boland GW, Hahn PF, et al. Characterization of indeterminate (lipid-poor) adrenal masses: use of washout characteristics at contrastenhanced CT. Radiology. 2000;217(3):798-802. doi: 10.1148/radiology.217.3.r00dc29798
3. [Dedov II, Melnichenko GA. Clinical recommendations of the adrenal incidentaloma (diagnosis and differential diagnosis). Guidelines for primary care physicians. Moscow, 2015; р. 1-16 (In Russ.)].
4. Boland GW, Blake MA, Hahn PF, Mayo-Smith WW. Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology. 2008;249(3):756-75. doi: 10.1148/radiol.2493070976
5. [Kuznetsov NS, Beltsevich DG, Vanushko VE, et al. Differential diagnostics of adrenal incedentaloma. Endocrine surgery. 2011;1:5-16 (In Russ.)]. doi: 10.14341/2306-3513-2011-1-5-16
6. Johnson PT, Horton KM, Fishman EK. Adrenal imaging with multidetector CT: evidence-based protocol optimization and interpretative practice. Radiographics. 2009;29(5):1319-31. doi: 10.1148/rg.295095026
7. Caoili EM, Korobkin M, Francis IR, et al. Delayed enhanced CT of lipid-poor adrenal adenomas. Am J Roentgenol. 2000;175(5):1411-5. doi: 10.2214/ajr.175.5.1751411
8. Caoili EM, Korobkin M, Francis IR, et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology. 2002;222(3):629-33. doi: 10.1148/radiol.2223010766
9. Sangwaiya MJ, Boland GWL, Cronin CG, et al. Incidental adrenal lesions: accuracy of characterization with contrast-enhanced washout multidetector CT-10-minute delayed imaging protocol revisited in a large patient cohort. Radiology. 2010;256(2):504–10. doi: 10.1148/radiol.10091386
10. [Arablinsky AV, Sidorova YuV. Computer and magnetic resonance tomography in the diagnosis of adrenal diseases. Siberian Journal of Oncology. 2011;2:8-9 (In Russ.)]
11. Low G, Dhliwayo H, Lomas DJ. Adrenal neoplasms. Clinical radiology. 2012;67(10):988-1000. doi: 10.1016/j.crad.2012.02.005
12. Taffel M, Haji-Momenian S, Nikolaidis P, Miller FH. Adrenal imaging: a comprehensive review. Radiol Clin North Am. 2012;50(2):219-43. doi: 10.1016/j.rcl.2012.02.009
13. [Dubova EA, Shchegolev AI, Karmazanovsky GG, et al. Mielolipoma adrenal gland. Medical Visualization. 2006;1:22-8 (In Russ.)]
14. Cyran KM, Kenney PJ, Memel DS, Yacoub I. Adrenal myelolipoma. Am J Roentgenol. 1996;166(2):395-400. doi: 10.2214/ajr.166.2.8553954
15. Johnson PT, Horton KM, Fishman EK. Adrenal mass imaging with multidector CT: pathologic conditions, pearls and pitfalls. Radiographics. 2009;29(5):1333-51. doi: 10.1148/rg.295095027
16. Blake MA, Kalra MK, Maher MM, et al. Pheochromocytoma: an imaging chameleon. Radiographics. 2004;24(1):87-99. doi: 10.1148/rg.24si045506
17. Chorney E, Rosen A, Lewis S, et al. Radiologic Differentiation of Adrenal Lesions and Its Impact on Patient Management. Contemp Diagnost Radiol. 2016;39(3):1-5.
18. Lenders JW, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet. 2005;366(9486):665-75. doi: 10.1016/S0140-6736(05)67139-5
19. Waguespack SG, Rich T, Grubbs E, et al. A current review of the etiology, diagnosis, and treatment of pediatric pheochromocytoma and paraganglioma. J Clin Endocrinol Metab. 2010;95(5):2023-37. doi: 10.1210/jc.2009-2830
20. Bharwani N, Rockall AG, Sahdev A, et al. Adrenocortical carcinoma: the range of appearances on CT and MRI. Am J Roentgenol. 2011;196(6):706-14. doi: 10.2214/AJR.10.5540
21. Fishman EK, Deutch BM, Hartman DS, et al. Primary adrenocortical carcinoma: CT evaluation with clinical correlation. Am J Roentgenol. 1987;148(3):531-5. doi: 10.2214/ajr.148.3.531
22. Krebs TL, Wagner BJ. MR imaging of the adrenal gland: radiologic-pathologic correlation. Radiographics. 1998;18(6):1425-40. doi: 10.1148/radiographics.18.6.9821192
23. Abrams HL, Spiros R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950;3(1):74-85.
24. Lenert JT, Barnett CC Jr, Kudelka AP, et al. Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy. Surgery. 2001;130(6):1060-7. doi: 10.1067/msy.2001.118369
25. Park JR, Eggert A, Caron H. Neuroblastoma: biology, prognosis, and treatment. Hematol Oncol Clin North Am. 2010;24(1):65-86. doi: 10.1016/j.hoc.2009.11.011
26. Sasaki S, Yasuda T, Kaneto H, et al. Large adrenal ganglioneuroma.
Inter Med. 2012;51(17):2365-70.
27. Linos D, Tsirlis T, Kapralou A, et al. Adrenal ganglioneuromas: incidentalomas with misleading clinical and imaging features. Surgery. 2011;149(1):99-105. doi: 10.1016/j.surg.2010.03.016
28. Guo YK, Yang ZG, Li Y, et al. Uncommon adrenal masses: CT and MRI features with histopathologic correlation. Eur J Radiol. 2007;62(3):359-70. doi: 10.1016/j.ejrad.2006.12.011
29. Garcia G, Anfossi E, Prost J, et al. Benign retroperitoneal schwannoma: report of three cases. Prog Urol. 2002;12(3):450-3.
30. Hori T, Yamagiwa K, Yagi S, et al. Noradrenalin-secreting retroperitoneal schwannoma resected by hand-assisted laparoscopic surgery: report of a case. Surg Today. 2006;36(12):1108–13. doi: 10.1007/s00595-006-3304-8
31. Liu QY, Gao M, Li HG, et al. Juxta-adrenal schwannoma: dynamic multi-slice CT and MRI findings. Eur J Radiol. 2012;81(4):794-9. doi: 10.1016/j.ejrad.2011.01.082
32. Rosenfeld DL, Girgis WS, Underberg-Davis SJ. Bilateral smoothmuscle tumors of the adrenals in a child with AIDS. Pediatr Radiol. 1999;29(5):376-8. doi: 10.1007/s002470050611
33. Lerttumnongtum P, Muttarak M, Visrutaratna P, Ya-In C. Imaging features of unusual adrenal masses. Australias Radiol. 2004;48(2):107-13. doi: 10.1111/j.1440-1673.2004.01268.x
34. Otal P, Escourrou G, Mazerolles C, et al. Imaging features of uncommon adrenal masses with histopathologic correlation. Radiographics. 1999;19(3):569-81. doi: 10.1148/radiographics.19.3.g99ma07569
35. Michalopoulos N, Laskou S, Karayannopoulou G, et al. Adrenal Gland Lymphangiomas. Indian J Surg. 2015;77(3):1334-42. doi: 10.1007/s12262-015-1206-y
36. Vargas AD. Adrenal hemangioma. Urology. 1980;16(4):389-90.
37. Li Y, Sun H, Gao S, Bai R. Primary bilateral adrenal lymphoma: two case reports. J Comput Assist Tomogr. 2006;30(5):791-3. doi: 10.1097/01.rct.0000216112.15564.0c
38. Guo YK, Yang ZG, Li Y, et al. Uncommon adrenal masses: CT and MRI features with histopathologic correlation. Eur J Radiol. 2007;62(3):359-70. doi: 10.1016/j.ejrad.2006.12.011
39. Hussain HK, Korobkin M. MR imaging of the adrenal glands. Magn Reson Imaging Clin N Am. 2004;12(3):515-44. doi: 10.1016/j.mric.2004.03.008
40. Aziz SA, Laway BA, Rangreze I, et al. Primary adrenal lymphoma: differential involvement with varying adrenal function. Indian J Endocrinol Metab. 2011;15(3):220-3. doi: 10.4103/2230-8210.83414
41. Kato H, Itami J, Shiina T, et al. MR imaging of primary adrenal lymphoma. Clin Imaging. 1996;20(2):126–8.
42. Kawashima A, Alleman WG, Takahashi N, et al. Imaging evaluation of amyloidosis of the urinary tract and retroperitoneum. Radiographics. 2011;31(6):1569-82. doi: 10.1148/rg.316115519

Авторы

С.А. Бурякина 1,2, Н.В. Тарбаева 1,2, Н.Н. Волеводз 1, Г.Г. Кармазановский 2, Л.Д. Ковалевич 1, М.В. Шестакова 1, И.И. Дедов 1

1 ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия;
2 ФГБУ «Национальный медицинский исследовательский центр хирургии им. А.В. Вишневского» Минздрава России, Москва, Россия

________________________________________________

S.A. Buryakina 1,2, N.V. Tarbaeva 1,2, N.N. Volevodz 1, G.G. Karmazanovsky 2, L.D. Kovalevich 1, M.V. Shestakova 1, I.I. Dedov 1

1 Endocrinology Research Centre, Moscow, Russia;
2 Vishnevsky National Medical Research Centre of Surgery, Moscow, Russia

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