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01-12-2008 | Magnetic Resonance

Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function

Authors: Audrey E. T. Jacques, Anju Sahdev, Madrika Sandrasagara, Rick Goldstein, Daniel Berney, Andrea G. Rockall, Shern Chew, Rodney H. Reznek

Published in: European Radiology | Issue 12/2008

Abstract

The purpose of this study was to describe the range of appearances of adrenal phaeochromocytomas on T2-weighted MRI, correlate appearances with histopathology, and quantify the incidence of the previously described hyperintense appearance. The appearance and MR characteristics of 44 phaeochromocytomas were reviewed retrospectively. T2-weighted appearances were grouped: (1) ‘classical’, homogeneous, high signal intensity, isointense to CSF; (2) homogeneous, isointense or minimally hyperintense to spleen, hypointense to CSF; (3) heterogeneous, marbled appearance; (4) heterogeneous, multiple high signal intensity pockets. All 44 adrenal phaeochromocytomas were well circumscribed, 1.2–15 cm in maximum diameter, with no visual or quantitative signal loss on chemical shift imaging. On T2-weighted MRI 5/44 (11%) had group 1 appearance; 15/44 (34%) group 2, 7/44 (16%) group 3; and 17/44 (39%) group 4. Homogeneous group 1 and 2 lesions were smaller (mean 4.5 cm) than heterogeneous group 3 and 4 lesions (mean 6.3 cm). Increasing MRI heterogeneity correlated pathologically with increasing amounts of haemorrhage, necrosis and fibrosis. No MRI features were predictive of malignancy. Non-functioning phaeochromocytomas were larger than functioning lesions. No size difference was seen between syndrome and sporadic lesions. In this large series we report a wide range of appearances of adrenal phaeochromocytomas on T2-weighted MRI. The previously described classical hyperintense phaeochromocytoma is relatively uncommon.

Minno AM, Bennett WA, Kvale WF (1955) Pheochromocytoma — study of 15 cases diagnosed at autopsy. Proc Staff Meet. Mayo Clinic 30:394–396

Baguet J-P, Hammer L, Longo Mazzuco T et al (2004) Circumstances of discovery of phaeochromocytoma: a retrospective study of 41 consecutive patients. E J Endocrinol 150:681–686CrossRef

Lucon AM, Pereira MAA, Mendonca BB, Halpern A, Wajchenbeg BL, Sami A (1997) Pheochromocytoma: study of 50 cases. J Urol 157:1208–1212PubMedCrossRef

Francis IR, Korobkin M (1996) Pheochromocytoma. Radiol Clin North Am 34:1101–1112PubMed

Neumann HPH, Bausch B, McWhinney SR et al (2002) Germ-line mutations in nonsyndromic phaeochromocytoma. N Engl J Med 346:1459–1466PubMedCrossRef

Heinz-Peer G, Hönigschnabl S, Schneider B, Niederle B, Kaserer K, Lechner G (1999) Characterization of adrenal masses using MR imaging with histopathologic correlation. AJR Am J Roentgenol 173:15–22PubMed

Hussain HK, Korobkin M (2004) MR Imaging of the adrenal glands. Magn Reson Imaging Clin N Am 12:515–544PubMedCrossRef

Fink IJ, Reinig JW, Dwyer AJ, Doppman JL, Linehan WM, Keiser HR (1985) MR imaging of pheochromocytomas. J Comput Assist Tomogr 9:454–458PubMedCrossRef

Reinig JW, Doppman JL, Dwyer AJ, Johnson AR, Knop RH (1986) Adrenal masses differentiated by MR. Radiology 158:81–84PubMed

10.

Reinig JW, Doppman JL, Dwyer AJ, Frank J (1986) MRI of indeterminate adrenal masses. AJR Am J Roentgenol 147:493–496PubMed

11.

Glazer GM, Woolsey EJ, Borrello J et al (1986) Adrenal tissue characterization using MR imaging. Radiology 158:73–79PubMed

12.

Quint LE, Glazer GM, Francis IR, Shapiro B, Chenevert TL (1987) Pheochromocytoma and paragangliomas: comparison of MR imaging with CT and I-131 MIBG scintigraphy. Radiology 165:89–93PubMed

13.

Varghese JC, Hahn PF, Papanicolaou N, Mayo-Smith WW, Gaa JA, Lee MJ (1997) MR differentiation of phaeochromocytoma from other adrenal lesions based on qualitative analysis of T2 relaxation times. Clin Radiol 52:603–606PubMedCrossRef

14.

Blake MA, Krishnamoorthy SK, Boland GW, Sweeney AT (2003) Low-density pheochromocytoma on CT: a mimicker of adrenal adenoma. AJR Am J Roentgenol 181:1663–1668PubMed

15.

Blake MA, Kalra MK, Maher MM et al (2004) Pheochromocytoma: an imaging chameleon. Radiographics Suppl 1:S87–S99CrossRef

16.

Korobkin M, Brodeur FJ, Yutzy GG et al (1996) Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. AJR Am J Roentgenol 166:531–536PubMed

17.

Korobkin M, Brodeur FJ, Francis IR, Quint LE, Dunnick NR, Londy F (1998) CT time-attenuation washout curves of adrenal adenomas and nonadenomas. AJR Am J Roentgenol 170:747–752PubMed

18.

Pena CS, Boland GWL, Hahn PF, Lee MJ, Mueller PR (2000) Characterization of indeterminate (lipid poor) adrenal masses: use of washout characteristics at contrast-enhanced CT. Radiology 217:798–802PubMed

19.

Kudva YC, Young WF, Thompson GB (1999) Adrenal incidentaloma: an important component of the clinical presentation spectrum of benign sporadic adrenal phaeochromocytoma. Endocrinologist 9:77–84CrossRef

20.

Noshiro T, Shimizu K, Watanabe T et al (2000) Changes in clinical features and long-term prognosis in patients with pheochromocytoma. Am J Hyperten 13:35–43CrossRef

21.

Sahdev A, Sohaib A, Monson JP, Chew SL, Reznek RH (2005) CT and MRI imaging of unusual locations of extra-adrenal paragangliomas (pheochromocytomas). Eur Radiol 15:85–92PubMedCrossRef

22.

Melicow MM (1977) One hundred cases of pheochromocytoma (107 tumors) at the Columbia-Presbyterian Medical Center, 1926–1976. Cancer 40:1987–2004PubMedCrossRef

23.

Baker ME, Blinder R, Spritzer C, Leight GS, Herfkens RJ, Dunnick NR (1989) MR evaluation of adrenal masses at 1.5 T. AJR Am J Roentgenol 153:307–312PubMed

24.

Kier R, McCarthy S (1989) MR characterization of adrenal masses: field strength and pulse sequence considerations. Radiology 171:671–674PubMed

25.

Bilbey JH, McLoughlin, Kurkjian PS et al (1995) MR imaging of adrenal masses: value of chemical-shift imaging for distinguishing adenomas from other tumors. AJR Am J Roentgenol 164:637–642PubMed

26.

Mitchell DG, Crovello BS, Matteucci T, Petersen RO, Miettinen MM (1992) Benign adrenocortical masses: diagnosis with chemical shift MR imaging. Radiology 185:345–351PubMed

27.

Tsushima Y, Ishizaka H, Matsumoto M (1993) Adrenal masses: differentiation with chemical shift, fast low-angle shot MR imaging. Radiology 186:705–709PubMed

28.

Korobkin M, Lombardi TJ, Aisen AM et al (1995) Characterization of adrenal masses with chemical shift and gadolinium-enhanced MR imaging. Radiology 197:411–418PubMed

29.

Mayo-Smith WW, Lee MJ, McNicholas MMJ, Hahn PF, Boland GW, Saini S (1995) Characterization of adrenal masses (<5 cm) by use of chemical shift MR imaging: observer performance versus quantitative measures. AJR Am J Roentgenol 165:91–95PubMed

30.

Fujiyoshi F, Nakajo M, Fukukura Y, Tsuchimochi S (2003) Characterisation of adrenal tumours by chemical shift fast low-angle shot MR imaging: comparison of four methods of quantitative evaluation. AJR Am J Roentgenol 180:1649–1657PubMed

31.

Outwater EK, Siegelman ES, Radecki PD, Piccoli CW, Mitchell DG (1995) Distinction between benign and malignant adrenal masses: value of T1-weighted chemical -shift MR imaging. AJR Am J Roentgenol 165:579–583PubMed

32.

Slapa RZ, Jakubowski W, Januszewicz A, Kasperlik-Zaluska AA, Dabrowska E, Fijuth J et al (2000) Discriminatory power of MRI for differentiation of adrenal non-adenomas vs adenomas evaluated by means of ROC analysis: can biopsy be obviated? Eur Radiol 10:95–104PubMedCrossRef

33.

Thompson LDR (2002) Pheochromocytoma of the adrenal gland scaled score (PASS) to separate benign from malignant neoplasms. A clinicopathologic and immunophenotypic study of 100 cases. Am J Surg Pathol 26:551–566PubMedCrossRef

Title: Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function
Authors: Audrey E. T. Jacques
Anju Sahdev
Madrika Sandrasagara
Rick Goldstein
Daniel Berney
Andrea G. Rockall
Shern Chew
Rodney H. Reznek
Publication date: 01-12-2008
Publisher: Springer-Verlag
Published in: European Radiology / Issue 12/2008
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-1073-z

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Springer Medicine

Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function

Abstract

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Abstract

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