Adrenal Bez Tümörlerinde Görüntüleme
Özet
Adrenal bezler, perirenal boşlukta yer alan, dışta korteks ve içte medulla bölümlerinden oluşan bir çift endokrin organdır ve bu bezlerin kitleleri arasında en sık %80 oranla benign karakterdeki adrenal adenomlar izlenmektedir. Bilgisayarlı Tomografi (BT) ve Manyetik Rezonans (MR) görüntüleme, lezyonların tespiti ile benign-malign ayrımında temel radyolojik araçlar olup; kontrastsız BT'de 10 Hounsfield Unit (HU) ve altındaki dansite değerleri ile kimyasal şift MR incelemedeki belirgin sinyal kaybı, lipid zengini benign adenomların tanısında %98'e varan spesifite sağlamaktadır. Lipidden fakir adenomlar ile diğer kitlelerin ayırıcı tanısında ise kontrastlı BT protokollerinde mutlak yıkanma oranının (APW) %60'ın üzerinde olması tanısal kabul edilirken, bu oranın altındaki değerler ile 4 cm'den büyük veya heterojen yapılı kitleler malignite açısından cerrahi değerlendirme gerektirir. Adrenal bezlerin diğer önemli kitleleri arasında makroskopik yağ içeriğiyle ayırt edilen benign miyelolipomlar, en sık görülen malign lezyonlar olan sekonder metastazlar, yaşamı tehdit eden hipertansif krizlere yol açabilen feokromasitomalar, agresif karakterli adrenokortikal karsinomlar, çocukluk çağında sık izlenen nöroblastomlar ve nadir görülen adrenal lenfomalar yer almakta olup, kitlelerin yönetiminde American College of Radiology (ACR) kriterlerine dayalı boyut ve stabilite odaklı algoritmalar kullanılmaktadır.
The adrenal glands are a pair of endocrine organs located in the perirenal space, consisting of an outer cortex and an inner medulla, and among their masses, benign adrenal adenomas are most commonly observed with a rate of 80%. Computed Tomography (CT) and Magnetic Resonance (MR) imaging are the primary radiological tools for the detection and differentiation of benign from malignant lesions; attenuation values of 10 Hounsfield Units (HU) or less on unenhanced CT and significant signal loss on chemical shift MR imaging provide a specificity of up to 98% in diagnosing lipid-rich benign adenomas. In the differential diagnosis of lipid-poor adenomas and other masses, an absolute percentage washout (APW) of over 60% in contrast-enhanced CT protocols is considered diagnostic, whereas values below this threshold or masses larger than 4 cm with a heterogeneous structure require surgical evaluation for malignancy. Other significant masses of the adrenal gland include benign myelolipomas distinguished by macroscopic fat, secondary metastases which are the most common malignant lesions, pheochromocytomas capable of causing life-threatening hypertensive crises, aggressive adrenocortical carcinomas, neuroblastomas frequently seen in childhood, and rare adrenal lymphomas, with mass management utilizing size- and stability-focused algorithms based on the American College of Radiology (ACR) criteria.
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