Diagnostic ultrasound ( PDFDrive )

CHAPTER 11 The Adrenal Glands 429
glands, Jhala et al. reported that adequate cellularity was obtained
from all patients, with no signiicant complications. 74 Similarly,
Puri et al. performed endoscopic ultrasound-guided ine-needle
aspiration in 21 consecutive patients and found no signiicant
adverse events in cases where conventional imaging modalities
were deemed unsuccessful. 75
A
Intraoperative Ultrasound
Intraoperative ultrasound can be performed in cases of partial
adrenalectomy to ensure clear resection margins or for improved
localization of an underlying lesion. his is especially valuable
in cases of adrenal sparing surgery, where a laparoscopic ultrasound
probe can be used to identify multiple lesions within the
adrenal gland, as well as to decipher the plane between the lesion
and the native gland. 76
Acknowledgments
he authors thank Lisa Napolitano, Dr. Trevor Morrison,
and Dr. Tyler Berzin for their assistance in image collection
he authors also acknowledge authors of this chapter in the
fourth edition of this text, Drs. AR Ahuja, W hurston, and
SR Wilson, since their text formed the backbone of this revised
chapter.
B
FIG. 11.16 Percutaneous Adrenal Biopsy. (A) Transverse sonogram
shows transhepatic placement of a needle (echogenic line) into a small
right adrenal metastasis in a patient with lung cancer. (Courtesy of Dr.
J. William Charboneau.) (B) Sagittal sonogram in a different patient
demonstrates percutaneous biopsy of an adrenal lesion.
FIG. 11.17 Endoscopic Ultrasound Image of the Adrenal Glands.
Endoscopic ultrasound evaluation demonstrates diffuse nodular thickening
of the adrenal gland compatible with nodular adrenal hyperplasia. (Courtesy
of Dr. Tyler Berzin.)
come into view with a clockwise rotation of the probe. Martinez
et al. performed endoscopic ine-needle aspiration of the adrenal
glands in 94 patients with sensitivity, speciicity, accuracy, positive
predictive value, and negative predictive value at 86%, 97%, 92%,
96%, and 89% for malignant lesions, and 97%, 86%, 92%, 89%,
96% for benign lesions, respectively. 73 In 24 patients with endoscopic
ultrasound-guided ine-needle aspiration of the adrenal
REFERENCES
1. Wan Y-L. Ultrasonography of the adrenal gland. J Med Ultrasound.
2007;15(4):213-227.
2. Ma G, Liu SW, Zhao ZM, et al. Sectional anatomy of the adrenal gland in
the coronal plane. Surg Radiol Anat. 2008;30(3):271-280.
3. Lurie S, Neelon F. Physiology of the adrenal gland. In: Pollack HM, editor.
Clinical urography: an atlas and textbook of urological imaging. Philadelphia:
Saunders; 1990. p. 2306-2312.
4. Lockhart ME, Smith JK, Kenney PJ. Imaging of adrenal masses. Eur J Radiol.
2002;41(2):95-112.
5. Marchal G, Verbeken E, Oyen R, et al. Ultrasound of the normal kidney:
a sonographic, anatomic and histologic correlation. Ultrasound Med Biol.
1986;12(12):999-1009.
6. Günther RW, Kelbel C, Lenner V. Real-time ultrasound of normal adrenal
glands and small tumors. J Clin Ultrasound. 1984;12(4):211-217.
7. Oppenheimer DA, Carroll BA, Yousem S. Sonography of the normal neonatal
adrenal gland. Radiology. 1983;146(1):157-160.
8. Fan J, Tang J, Fang J, et al. Ultrasound imaging in the diagnosis of
benign and suspicious adrenal lesions. Med Sci Monit. 2014;20:
2132-2141.
9. Kim KW, Kim JK, Choi HJ, et al. Sonography of the adrenal glands in the
adult. J Clin Ultrasound. 2012;40(6):357-363.
10. Dunnick NR, Korobkin M, Francis I. Adrenal radiology: distinguishing
benign from malignant adrenal masses. AJR Am J Roentgenol. 1996;
167(4):861-867.
11. Mayo-Smith WW, Boland GW, Noto RB, Lee MJ. State-of-the-art adrenal
imaging. Radiographics. 2001;21(4):995-1012.
12. Herr K, Muglia VF, Kof WJ, Westphalen AC. Imaging of the adrenal gland
lesions. Radiol Bras. 2014;47(4):228-239.
13. Remer EM, Casalino DD, Bishof JT, et al. Expert panel on urologic imaging.
ACR Appropriateness Criteria®: incidentally discovered adrenal mass. 2012.
Available from: https://acsearch.acr.org/docs/69366/Narrative/.
14. McDermott S, O’Connor OJ, Cronin CG, Blake MA. Radiological evaluation
of adrenal incidentalomas—current methods and future prospects. Best
Pract Res Clin Endocrinol Metab. 2012;26(1):21-33.
15. Boland GW, Blake MA, Holalkere NS, Hahn PF. PET/CT for the characterization
of adrenal masses in patients with cancer: qualitative versus quantitative
accuracy in 150 consecutive patients. AJR. 2009;192:956-
962.