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Low yield of chemical shift MRI for characterization of adrenal lesions with high attenuation density on unenhanced CT

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Abstract

Purpose

To investigate the threshold unenhanced CT density of adrenal nodules at which further evaluation with chemical shift MRI is unlikely to be definitive and therefore not helpful in further characterizing some indeterminate adrenal lesions.

Methods

Retrospective evaluation of 44 adrenal lesions imaged with unenhanced CT and chemical shift MRI and followed for at least 1 year. Qualitative and quantitative assessment of signal loss on chemical shift MRI was performed. Adenomas were diagnosed if the lesion measured equal or less than 10 HU on unenhanced CT; on MRI a SI index greater than 16.5% or adrenal:spleen chemical shift ratio less than 0.71 was considered diagnostic of adenoma.

Results

31.8% (14/44), 47.7% (21/44), and 20.5% (9/44) of the adrenal lesions had an unenhanced CT attenuation density ≤10, 10–30, and >30 HU. Adrenal lesions with an unenhanced CT density 10–30 and >30 HU had a 76.2% (16/21) and a 33.3% (3/9) chance of being categorized as an adenoma using MRI SI index, respectively.

Conclusions

Adrenal lesions with unenhanced attenuation CT density >30 HU had a 66.6% of remaining indeterminate even after evaluation with chemical shift MRI.

Advances in knowledge

Chemical shift MRI is reasonable for evaluating adrenal lesions with an unenhanced CT attenuation density less than 30 HU. The likelihood of chemical shift MRI detecting signal loss in lesions CT density greater than 30 HU, however, is low.

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Author information

Authors and Affiliations

  1. Massachusetts General Hospital Imaging, 55 Fruit Street, Boston, MA, 02114, USA

    Ronnie Sebro

  2. Departments of Radiology and Biomedical Imaging and Urology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA

    Rizwan Aslam, Z. Jane Wang & Antonio Carlos Westphalen

  3. Ribeirao Preto School of Medicine, University of São Paulo (USP), Av. Bandeirantes 3900, 6° andar, Ribeirão Preto, SP, 14048-900, Brazil

    Valdair Francisco Muglia

Authors
  1. Ronnie Sebro
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  2. Rizwan Aslam
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  3. Valdair Francisco Muglia
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  4. Z. Jane Wang
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  5. Antonio Carlos Westphalen
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Corresponding author

Correspondence to Antonio Carlos Westphalen.

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Sebro, R., Aslam, R., Muglia, V.F. et al. Low yield of chemical shift MRI for characterization of adrenal lesions with high attenuation density on unenhanced CT. Abdom Imaging 40, 318–326 (2015). https://doi.org/10.1007/s00261-014-0208-8

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  • DOI: https://doi.org/10.1007/s00261-014-0208-8

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