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ENDOCRINE SURGERY - PART 6

Hình 5 trục T2 FSE (A) và duy nhất-shot (B) hình ảnh của bệnh nhân Sami. Trong hình ảnh IS A-chất béo bị đàn áp, nào Tăng conspicuity của tổn thương thượng thận (mũi tên). Các hemangioma gan IS sáng trên cả hai chuỗi (đầu mũi tên). | MRI of Endocrine Adrenal Tumors 347 Figure 5 Axial T2 FSE A and single-shot B images of the same patient. In A the image is fat-suppressed which increases the conspicuity of the adrenal lesion arrow . The hepatic hemangioma is bright on both sequences arrowheads . Figure 6 Axial T1 in-phase A and single-shot T2 B MR images of a left adrenal adenoma arrow seen in Figures 4 and 5 which is iso-intense on both sequences when compared to the liver L . Copyright Marcel Dekker Inc. All rights reserved. 348 Berning and Goldman Figure 7 Axial T1 in-phase A and single-shot T2 B MR images of a left adrenal mass arrow in a different patient which is also relatively iso-intense on both sequences when compared to the liver L . In A the intensity of the adrenal is similar to that of the spleen S . On the out-of-phase image C the adenoma loses signal in relation to the spleen indicating the presence of intracellular lipid and therefore in keeping with an adenoma. Axial T1 with fat suppresion immediate postgadolinium image D shows minimal enhancement. wide variation in histological characteristics of both benign and malignant lesions 60-62 which contributes to a wide range of T1 and T2 values as well as varying appearances on chemical shift techniques. In particular larger adenomas which may contain foci of calcification cystic change degeneration and hemorrhage may be impossible to differentiate from carcinomas 63 . Two other entities complicate the differentiation collision tumors where benign and malignant tumors coexist and a zonal phenomenon where adjacent lipid-rich and lipid-poor regions abut one another 60 62 . 5 SPECIFIC SYNDROMES 5.1 Cushing s Syndrome Most patients with Cushing s syndrome do not have a primary neoplasm of the adrenal cortex but have increased corticotrophin production by the pituitary Copyright Marcel Dekker Inc. All rights reserved. Marcel Dekker Inc. 270 Madison Avenue New York New York 10016 MRI of Endocrine Adrenal Tumors 349 Figure 8 Axial T1 MR .