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. 2014 Nov-Dec;47(6):333-41.
doi: 10.1590/0100-3984.2013.1812.

Application of a protocol for magnetic resonance spectroscopy of adrenal glands: an experiment with over 100 cases

Homero José de Farias E Melo  1 , Suzan M Goldman  2 , Jacob Szejnfeld  3 , Juliano F Faria  4 , Martha K P Huayllas  5 , Cássio Andreoni  6 , Cláudio E Kater  7
Affiliations

Application of a protocol for magnetic resonance spectroscopy of adrenal glands: an experiment with over 100 cases

Homero José de Farias E Melo et al. Radiol Bras. 2014 Nov-Dec.

Abstract
in English, Portuguese

Objective: To evaluate a protocol for two-dimensional (2D) hydrogen proton (1H) magnetic resonance spectroscopy (MRS) (Siemens Medical Systems; Erlangen, Germany) in the detection of adrenal nodules and differentiation between benign and malignant masses (adenomas, pheochromocytomas, carcinomas and metastases).

Materials and methods: A total of 118 patients (36 men; 82 women) (mean age: 57.3 ± 13.3 years) presenting with 138 adrenal nodules/masses were prospectively assessed. A multivoxel system was utilized with a 2D point-resolved spectroscopy/chemical shift imaging sequence. The following ratios were calculated: choline (Cho)/creatine (Cr), 4.0-4.3/Cr, lipid (Lip)/Cr, Cho/Lip and lactate (Lac)/Cr.

Results: 2D-1H-MRS was successful in 123 (89.13%) lesions. Sensitivity and specificity values observed for the ratios and cutoff points were the following: Cho/Cr ≥ 1.2, 100% sensitivity, 98.2% specificity (differences between adenomas/pheochromocytomas and carcinomas/ metastases); 4.0-4.3 ppm/Cr ≥ 1.5, 92.3% sensitivity, 96.9% specificity (differences between carcinomas/pheochromocytomas and adenomas/metastases); Lac/Cr ≤ -7.449, 90.9% sensitivity and 77.8% specificity (differences between pheochromocytomas and carcinomas/adenomas).

Conclusion: Information provided by 2D-1H-MRS were effective and allowed for the differentiation between adrenal masses and nodules in most cases of lesions with > 1.0 cm in diameter.

Objetivo: Avaliar um protocolo de espectroscopia por ressonância magnética (ERM) do próton de hidrogênio (1H) bidimensional (2D) disponível comercialmente (Siemens Medical Systems; Erlangen, Alemanha), aplicado para nódulos adrenais e diferenciação das massas (adenomas, feocromocitomas, carcinomas e metástases).

Materiais e métodos: Um total de 118 pacientes (36 homens e 82 mulheres), apresentando-se com 138 nódulos/massas adrenais, foi avaliado prospectivamente (média de idade: 57,3 ± 13,3 anos). Uma sequência de ERM-1H-PRESS-CSI (espectroscopia por resolução de ponto-imagem por desvio químico) multivoxel foi utilizada. Análise espectroscópica foi realizada da esquerda-direita, sentido crânio-caudal, usando três sequências sagitais, além de sequências axiais e coronais T2-HASTE. Os seguintes índices foram calculados: colina (Cho)/creatina (Cr), 4,0–4,3 ppm/Cr, lipídio (Lip)/Cr, Cho/Lip e lactato (Lac)/Cr.

Resultados: ERM-1H-2D foi bem sucedida em 123 (89,13%) lesões. Os valores de sensibilidade e especificidade encontrados para as proporções e pontos de corte avaliados foram: Cho/Cr ≥ 1,2, sensibilidade de 100% e especificidade de 98,2% (diferenciação de adenomas e carcinomas de feocromocitomas e metástases); 4,0–4,3 ppm/Cr ≥ 1,5, 92,3% de sensibilidade, especificidade de 96,9% (diferenciação de carcinomas e feocromocitomas de adenomas e metástases); Lac/Cr ≤ –7,449, sensibilidade de 90,9% e especificidade de 77,8% (diferenciação de feocromocitomas contra carcinomas e adenomas).

Conclusão: Os dados da ERM-1H-2D foram eficazes e permitiram a diferenciação entre massas adrenais e nódulos na maioria das lesões com diâmetro > 1,0 cm.

Keywords: Adrenal gland; Espectroscopia; Glândula adrenal; Magnetic resonance imaging; Ressonância magnética; Spectroscopy.

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Figures

Figure 1
Figure 1
Adjustment of the positioning and size of the field of view and shimming area.
Figure 2
Figure 2
Final programming of adrenal gland 1H-MRS.
Figure 3
Figure 3
Spectroscopic charts of the adrenal gland in four different masses: adenoma (A), pheochromocytoma (B), carcinoma (C), metastasis (D). The respective Cho, Cr, Lip and H2O peaks are identified on their respective curves.
Figure 4
Figure 4
ROC curve of the Lac/Cr ratio between adenoma (A) and carcinoma (B) groups with pheochromocytoma. A: Lac/Cr ≤ –4.79 (adenoma). B: Lac/Cr ≤ –7.449 (carcinoma).
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References

    1. Krebs TL, Wagner B. MR imaging of the adrenal gland: radiologicpathologic correlation. Radiographics. 1998;18:1425–1440. - PubMed
    1. Lockhart ME, Smith JK, Kenney PJ. Imaging of adrenal masses. Eur J Radiol. 2002;41:95–112. - PubMed
    1. Mansmann G, Lau J, Balk E, et al. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev. 2004;25:309–340. - PubMed
    1. Boland GWL, Blake MA, Hahn PF, et al. Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology. 2008;249:756–775. - PubMed
    1. Mitchell DG, Crovello M, Matteucci T, et al. Benign adrenocortical masses: diagnosis with chemical shift MR imaging. Radiology. 1992;185:345–351. - PubMed

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