Emre Altınmakas

Adrenal Kortikal Karsinom’da Bilgisayarlı Tomografi Görüntüleme Bulguları

Amaç: Adrenal kortikal karsinomun (AKK) Bilgisayarlı Tomografi (BT) görüntüleme özelliklerini araştırmak. Gereç ve yöntem: Patolojik olarak AKK tanısı almış 15 hastanın (K/E: 8/7, ortanca [aralık]: 53 yıl [31-74 yıl]) kalitatif ve kantitatif BT bulguları retrospektif olarak değerlendirildi. Lezyonların fonksiyonel durumlarına klinik notlardan ulaşıldı. Bulgular: Hastaların patolojik tanısı cerrahi (n=12) veya cerrahi eşliğinde biyopsi (n=3) ile konulmuştu. 9 lezyon (%60) fonksiyonel, 6 lezyon (%40) non-fonksiyoneldi. Fonksiyonel lezyonların 5’i androjen, 4’ü kortizon üretmekteydi. Kalitatif değerlendirmede 13 lezyon (%93) nekroz, 3 lezyon (%20) kalsifikasyon ve 1 lezyon (%7) makroskobik yağ içeriyordu. Lezyonların tamamı iyi sınırlı olup heterojen kontrastlanmaktaydı. Lezyonların ortanca (aralık) boyutu 9,7 cm (6.3-18 cm) idi. Prekontrast, arteriyel faz, portal faz ve geç faz ortanca (aralık) dansite değerleri sırasıyla şöyleydi: 34 HU (22-41 HU), 46 HU (27-65 HU), 60 HU (29-90 HU), 48 HU (28-64 HU). 9 hastada 15. dakika geç faz elde olunmuştu. Ortanca (aralık) mutlak (MKYY) ve bağıl (BKYY) kontrast yıkanma yüzdeleri sırasıyla şöyleydi: %48,8 (%-3.8-62.5) ve %21 (%-1.5-30.8). Sadece bir lezyonun MKYY değeri %60’in üzerindeydi. Sonuç: AKK’lar BT’de genellikle büyük (>6cm), iyi sınırlı, heterojen kontrastlanan, nekrotik kitleler şeklinde görülür. Makroskobik yağ ve kalsifikasyon içerebilir ve geç faz imajlarda sınırlı kontrast yıkanması gösterirler.

Anahtar Kelimeler:

adrenal kortikal karsinom, bilgisayarli tomografi, kontrast yıkanma yüzdesi

Computed Tomography Findings in Adrenocortical Carcinoma

Objective: To evaluate computed tomography (CT) imaging manifestations of adrenocortical carcinomas (ACC). Materials and Methods: Qualitative, and quantitative CT findings of 15 patients (Eight women, seven men; median age [range], 53 years [31-74 years]) with 15 pathologically proven ACCs were retrospectively analyzed. Lesions' functional status were captured through clinical notes. Results: Pathologic diagnosis was based on either surgery (n=12) or surgical biopsy (n=3). Nine lesions were functioning (60%, androgen [n=5] or cortisol [n=4]) and 6 lesions were non-functioning (40%). In qualitative CT analysis, 13 (93%), 3 (20%), and 1 (7%) lesion had necrosis, calcification and macroscopic fat, respectively. All lesions showed well-defined borders and heterogeneous enhancement. Median [range] density on precontrast, arterial phase, portal phase, and 15-minute delay phase were 34 HU (22-41 HU), 46 HU (27-65 HU), 60 HU (29-90 HU), and 48 HU (28-64 HU), respectively. Nine patients had 15-minute delay phase available. Median (range) absolute and relative percentage of enhancement wash-out (APEW and RPEW) values were 48.8% (-3.8-62.5%) and 21% (-1.5-30.8%). Only one lesion had an APEW above %60. Conclusion: ACCs usually manifest as, large (>6cm), well-defined, heterogeneously enhancing, necrotic masses on CT. These lesions may include calcification or macroscopic fat and tend to show limited wash-out on delay phase CT.

Keywords:

adrenocortical carcinoma, computed tomography, percentage of enhancement wash-out,

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