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Tumoren der Nebennieren

Prinzipien der Bildgebung und Differenzialdiagnosen

Adrenal tumors

Principles of imaging and differential diagnostics

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Zusammenfassung

Klinisches/methodisches Problem

Raumforderungen der Nebennieren sind häufig und werden überwiegend inzidentell nachgewiesen. Seltener wird bei einer bereits bekannten endokrinologischen Erkrankung eine radiologische Diagnostik zur Lokalisation eines funktionellen Tumors gezielt durchgeführt. Grundlegend ist die Unterscheidung von Adenomen der Nebennieren und nichtadenomatösen Raumforderungen.

Methodische Innovationen

Adenome zeigen im Nativ-CT eine niedrige Dichte sowie ein rasches „wash-out“ in Kontrastmitteluntersuchungen. Im MRT sind Adenome durch ein im Vergleich zur In-phase-Untersuchung niedrigeres Signal in der Opposed-phase-Untersuchung charakterisiert.

Leistungsfähigkeit

Der Literatur zufolge spricht eine native Dichte innerhalb einer adrenalen Raumforderung von höchstens 10 Hounsfield Units (HU) mit 98 % Spezifität und 71 % Sensitivität für das Vorliegen eines Adenoms. Die Sensitivität der MRT zum Nachweis von Adenomen ist im Vergleich zur CT etwas höher. Manche nichtadenomatöse Raumforderungen wie Zysten oder Myelolipome sind anhand pathognomonischer Befunde eindeutig nachweisbar.

Bewertung

In der Regel ist eine sichere Einordnung einer adrenalen Raumforderung, insbesondere hinsichtlich der endokrinen Funktion, nur in Zusammenschau mit klinischen und laborchemischen Parametern möglich.

Empfehlung für die Praxis

Eine CT-Untersuchung zur Beurteilung einer Nebennierenraumforderung sollte mit einer nativen Untersuchung beginnen, ggf. ergänzt durch eine Untersuchung des Kontrastmittel-“wash-out“. Wesentliche Bestandteile eines adrenalen MRT-Untersuchungsprotokolls sind die In- und Opposed-phase-Sequenzen.

Abstract

Clinical/methodical issue

Adrenal masses are very common and are usually detected incidentally. Less frequently, imaging is performed for the localization of the underlying lesion in the case of endocrine disease. The differentiation between adenomas and non-adenomas is fundamental.

Methodical innovations

Adenomas show a low density on unenhanced computed tomography (CT) and a rapid washout of contrast agents. In magnetic resonance imaging (MRI) adenomas are characterized by a low signal in opposed phase imaging as compared to in phase imaging.

Performance

According to the literature a density of less than 10 HU in an adrenal mass has a specificity of 98 % and a sensitivity of 71 % for the presence of an adenoma and MRI is slightly more sensitive. Some adrenal lesions, e.g. cysts or myelolipomas can be diagnosed with high accuracy due to pathognomonic findings.

Achievements

In the majority of cases the synopsis of imaging along with clinical and laboratory findings is necessary for a reliable diagnosis.

Practical recommendations

For the evaluation of an adrenal mass the CT examination should begin with an unenhanced scan, if necessary followed by a washout examination. In the case of MRI in phase and opposed phase imaging are essential components of the examination.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Degenhart gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Institut für klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Innenstadt, Nussbaumstr. 20, 80336, München, Deutschland

    C. Degenhart

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Degenhart, C. Tumoren der Nebennieren. Radiologe 54, 998–1006 (2014). https://doi.org/10.1007/s00117-014-2690-y

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