Clinical impact of hyperattenuation of adrenal glands on contrast-enhanced computed tomography of polytraumatised patients

Abstract

Objective: To evaluate the prognostic value of hyperattenuating adrenal glands on contrast-enhanced CT of polytraumatised patients.

Methods: Two hundred ninety-two patients (195 men and 97 women, mean age 45.3 ± 23.3 years) were included in this retrospective study. CT examinations were performed 60 s after intravenous injection of contrast material. Image analysis was performed by two radiologists. Patients were assigned to one of two groups according to the attenuation of the adrenal gland [group 1: adrenal glands ≥ inferior vena cava (IVC); group 2: adrenal glands < IVC].

Results: Eighteen patients (42.2 years ± 24.2) were assigned to group 1 and 274 patients (48.4 years ± 22.4) to group 2. The average adrenal density was 150.8 ± 36.1 HU in group 1 and 83.7 ± 23.6 HU in group 2 (P < 0.0001). Eight of the 18 patients in group 1 (44.4%) and 33 of the 274 patients in group 2 (12.4%) died during hospitalisation (P < 0.05). Mean adrenal enhancement was significantly higher in patients who died (101.9 ± 40.6 HU) compared with survivors (86.1 ± 27.0 HU; P < 0.001).

Conclusion: Hyperattenuation of adrenal glands is associated with a higher mortality rate in polytraumatised patients and may serve as a predictor of poor clinical outcome.

Key points: • Hyperattenuating adrenal glands can be observed in 6.2% of polytraumatised patients. • Hyperattenuating adrenal glands indicate poor clinical outcome in polytraumatised patients. • In polytraumatised patients, hyperattenuating adrenal glands are associated with a high mortality rate. • Adrenal enhancement is higher amongst patients who died than amongst survivors.