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Adrenal: Imaging Techniques Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Adrenal ❯ Imaging Techniques

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  • OBJECTIVES: To compare robot-assisted laparoscopic adrenalectomy (RALA) and open adrenalectomy (OA) with regard to intra-operative complications, peri-operative outcome and cost effectiveness.
    
CONCLUSIONS: The study showed that RALA was safe and cost-effective compared with OA. Increasing experience leads to similar operating times, putting high-volume centres at an advantage.
Robot-assisted vs open adrenalectomy: evaluation of cost-effectiveness and peri-operative outcome.


    Probst KA et al.
BJU Int. 2016 Dec;118(6):952-957
  • RESULTS: As a result of the matching process, patient groups did not differ in their main characteristics. Length of hospital stay was shorter for RALA than for OA (11.1 ± 4.8 vs 6.8 ± 1.2 days; P < 0.01) as was IMC treatment (2.3 ± 1.7 vs 1.2 ± 0.4 days; P < 0.01). The mean operating time was longer for RALA (128.5 ± 46.5 vs 102.2 ± 44.5 min; P = 0.03), but the last 10 RALA procedures (mean: 97.1 ± 35.2 min) were similar to OA. The rate of complications was similar in the two groups. Estimated costs were €8 627.5 for OA and €7 334 for RALA.
Robot-assisted vs open adrenalectomy: evaluation of cost-effectiveness and peri-operative outcome.


    Probst KA et al.
BJU Int. 2016 Dec;118(6):952-957
  • PURPOSE: To evaluate the surgical feasibility of retroperitoneal laparoscopic adrenalectomy for tumors exceeding 5 cm.
    RESULTS: The estimated blood loss (271.75 ± 232.98 mL vs. 367.24 ± 275.11 mL; p = 0.037), time to ambulation (1.60 ± 0.49 days vs. 1.89 ± 0.31 days; p = 0.001), and postoperative hospitalization (7.88 ± 3.08 days vs. 9.264 ± 3.10 days; p = 0.012) were significantly higher in group II. The operation time and hemoglobin level change were not statistically different between groups. Blood transfusions were performed in 3 patients from group I and 6 patients from group II (5.3 vs. 7.9 %; p = 0.449). No patients experienced conversion to open surgery.

    CONCLUSIONS: Retroperitoneal laparoscopic adrenalectomy can be used in patients with tumors larger than 5 cm.
Is larger tumor size a contraindication to retroperitoneal laparoscopic adrenalectomy?

    
Hwang I et al.
World J Urol. 2014 Jun;32(3):723-8
  • “The following dimensions were measured: the maximum width perpendicular to the long axis of the body of the gland, and maximum width of the medial and lateral limbs. The average measurements for the right adrenal gland were: maximum width 0.61 cm (S.D. 0.2), width of the medial limb 0.28 cm (S.D. 0.08), and width of the lateral limb 0.28 cm (S.D. 0.06). The average measurements for the left adrenal gland were: maximum width 0.79 cm (S.D. 0.21), width of the medial limb 0.33 cm (S.D. 0.09), and width of the lateral limb 0.30 cm (S.D. 0.10)”
    The size of normal adrenal glands on computed tomography.
    Vincent JM1 et al.
    Clin Radiol. 1994 Jul;49(7):453-5.
  • “The adrenal glands are small organs, weighing approximately 5.0 g each, on average, and measuring approximately 30.0 mm in width, 50.0 mm in length, and up to 10.0 mm in thickness. They have a linear "V’ or "Y’ shape and are located anterosuperiorly to the kidneys.”
    CT and MRI of Adrenal Masses
    Antonio CA et al.
    Appl Radiol. 2006;35(8)10-26
  • “ The length, width, thickness of right adrenal body, thickness of medial limb and lateral limb were, respectively, 34.02 +/- 2.12 mm, 10.91 +/- 0.89 mm, 5.82 +/- 0.26 mm, 2.78 +/- 0.08 mm, 2.62 +/- 0.06 mm, whereas the measurements of left adrenal gland were 28.31 +/- 2.46 mm, 18.40 +/- 1.06 mm, 6.84 +/- 0.24 mm, 3.02 +/- 0.08 mm, 2.86 +/- 0.07 mm, respectively. The coronal plane has superior advantage in showing the bilateral adrenal glands. The shapes of adrenal glands are various, whereas the range of adrenal thickness is quite narrow. The thickness of adrenal medial and lateral limbs, especially the thickness of lateral limb are useful for the diagnosis of the bilateral adrenocortical disease.”
    “ The length, width, thickness of right adrenal body, thickness of medial limb and lateral limb were, respectively, 34.02 +/- 2.12 mm, 10.91 +/- 0.89 mm, 5.82 +/- 0.26 mm, 2.78 +/- 0.08 mm, 2.62 +/- 0.06 mm, whereas the measurements of left adrenal gland were 28.31 +/- 2.46 mm, 18.40 +/- 1.06 mm, 6.84 +/- 0.24 mm, 3.02 +/- 0.08 mm, 2.86 +/- 0.07 mm, respectively.”
    Sectional anatomy of the adrenal gland in the coronal plane.
    Ma G et al.
    Surg Radiol Anat. 2008 May;30(3):271-80.
  • “The coronal plane has superior advantage in showing the bilateral adrenal glands. The shapes of adrenal glands are various, whereas the range of adrenal thickness is quite narrow. The thickness of adrenal medial and lateral limbs, especially the thickness of lateral limb are useful for the diagnosis of the bilateral adrenocortical disease.”
    Sectional anatomy of the adrenal gland in the coronal plane.
    Ma G et al.
    Surg Radiol Anat. 2008 May;30(3):271-80.
  • “ CT body scans of 60 random patients without evidence of adrenal disease were reviewed to determine the location, size, and shape of both normal adrenal glands. Both glands were clearly delineated in 78% of the patients evaluated. The length, width, and thickness of adrenal glands as measured by computed tomography were similar to comparable measurements from surgical and autopsy studies.”
    Computed tomography of the normal adrenal glands.
    Montagne JP et al.
    AJR 1978 May; 130(5):963-6
  • Washout Characteristics
    -Adenomas washout more rapidly than metastases
    -Pheochromocytoma can exhibit high washout levels when hypervascular
  • Relative Percentage Washout

    100 x (Venous HU – Delayed HU)
    Venous HU

    > 40% ~ adenoma
  • Absolute Percentage Washout

    100 x (Venous HU – Delayed HU)
    Venous HU-Precontrast HU

    > 60% ~ adenoma
  • ASIR: Potential Limitations
    - Takes longer than standard algorithms to reconstruct CT data by a factor of up to 30%
    - Image smoothing may lead to lack of lesion recognition. It is not clear whether this means missed lesions.
  • "The ASIR reconstruction algorithm is a promising technique for providing diagnostic quality CT images at significantly reduced radiation doses."

    Innovations in CT Dose Reduction Strategy: Application of the Adaptive Statistical Iterative Reconstruction Algorithm
    Silva AC et al.
    AJR 2010;194: 191-199

  • "Currently, increased noise limits the evaluation of thin reconstructed images (<2.5 mm) in abdominal imaging."

    Iterative Reconstruction Technique for Reducing Body Radiation Dose at CT: Feasibility Study
    Hara AK et al.
    AJR 2009; 193:764-771

  • "Low dose CT with adaptive statistical iterative reconstruction and routine dose CT had identical results for low contrast resolution and nearly identical results for overall image quality. Spatial resolution was better with routine dose CT."

    Iterative Reconstruction Technique for Reducing Body Radiation Dose at CT: Feasibility Study
    Hara AK et al.
    AJR 2009; 193:764-771

  • "These preliminary results support body CT dose index reductions of 32-65% when adaptive statistical iterative reconstruction is used. Studies with larger statistical samples are needed to confirm these findings."

    Iterative Reconstruction Technique for Reducing Body Radiation Dose at CT: Feasibility Study
    Hara AK et al.
    AJR 2009; 193:764-771

  • Three dimensional volume rendered CT successfully displayed the relationship of adrenal masses to adjacent structures and organs before laparoscopic adrenalectomy. Three Dimensional Volume Rendered Helical CT before Laparoscopic Adrenalectomy Hurley ME et al. Radiology 2003; 229:581-586

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