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. 2014 Nov 3:20:2132-41.
doi: 10.12659/MSM.890800.

Ultrasound imaging in the diagnosis of benign and suspicious adrenal lesions

Jin Fan  1 , Jie Tang  1 , Jiabin Fang  2 , Qiuyang Li  1 , Enhui He  1 , Jia Li  1 , Yanqiu Wang  1
Affiliations

Ultrasound imaging in the diagnosis of benign and suspicious adrenal lesions

Jin Fan et al. Med Sci Monit. .

Abstract

Background: The purpose of this study was to define the ultrasound imaging characteristics of adrenal tumors and to assess the performance of ultrasound in differentiating benign 'leave-alone' lesions from suspicious lesions.

Material and methods: We enrolled 882 patients in this study. The nature of each lesion was determined by histopathology. Ultrasound finding of each lesion was compared with its corresponding histopathologic result. The final study group consisted of 911 adrenal masses in 882 patients. All images were reviewed by 2 experienced investigators in a double blind manner.

Results: There were 553 adenomas identified in the study, which constituted 60.70% of the lesions. There were 161 pheochromocytomas (17.67%), 49 myelolipomas (5.38%), 39 cysts (4.28%), 37 metastasis (4.06%), 35 ganglioneuromas (3.84%), 22 lymphomas (2.41%), and 15 cortical carcinomas (1.65%). The sensitivity, specificity, and accuracy of ultrasound-based diagnosis were 89%, 99%, and 93.9%, respectively. A positive predictive value of 90.9% and a negative predictive value of 94.2% were obtained in this study.

Conclusions: This large-sample study showed that ultrasound was a reliable method in differentiating benign 'leave-alone' lesions from suspicious lesions.

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Figures

Figure 1
Figure 1
Typical ultrasound imaging of adrenal carcinoma. (A) Right adrenal mass with 6.1×3.6 cm size, middle uniform echo, and unclear boundary. (B) No notable vascularization is shown within the mass on color Doppler sonography. (C) Multiple enlarged lymph nodes were found retroperitoneally (D) Histopathology result showed adrenal adenomas.
Figure 2
Figure 2
Typical ultrasound imaging of no necrosis pheochromocytomas. (A) Right adrenal mass with 9.5×5.4 cm size, middle echo, and complete capsule. (B) Visible internal sonolucent area in multiple sections. (C) Blood flow signals were found both inside and around the lesion by color Doppler examination. (D) Histopathology result showed pheochromocytomas.
Figure 3
Figure 3
_Typical ultrasound imaging of pheochromocytomas with necrosis in a 59-year-old female with no history of hypertension. (A) Right adrenal mass with 10.8×8.7 cm size, middle and uneven echo, and visible liquefied area. (B) 1/3 above the tumor volume was a necrotic area in different scanning section. (C) Blood flow signals were found mainly around the lesion but also in the lesion by color Doppler examination. (D) Histopathology result showed pheochromocytomas.
Figure 4
Figure 4
Typical ultrasound imaging of pheochromocytomas with necrosis in a 31-year-old man with a 5-year history of hypertension. (A) Left adrenal mass with 5.5×4.1 cm size, middle and uneven echo, and visible liquefied area. (B) Blood flow signals were found mainly in the lesion but also around the lesion by color Doppler examination. (C) Histopathology result showed pheochromocytomas.
Figure 5
Figure 5
Typical ultrasound imaging of myelolipoma in a 59-year-old man. (A) Right adrenal mass 52×39 mm in size and homogenous hyperechoic. (B) No notable vascularization is shown within the mass (arrows) on color Doppler sonography. (C) Histopathology result showed myelolipoma.
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