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X-Ray Tests for Adrenal Gland Tumors
There are 4 primary x-ray tests to examine the adrenal glands
(and the rest of the abdomen) for the presence of a tumor
(the word "tumor" simply means "mass".
Tumors can be benign or malignant). Some of these tests
are better than others and are therefore used routinely,
while one or two are used infrequently yet can yield important
information when positive.
Ultrasound. This is the fastest, cheapest, and most readily
available test to look at the kidneys and adrenals. But,
it is the least accurate, so it is usually not used as much
as the CT scan. Can be used to examine any type of adrenal
tumor.
CT Scan. The CT scan (also called CAT scan) is very accurate
at examining the adrenal glands and other abdominal structures
and can be used on any type of adrenal tumor.
Like the other 3 tests in this group, the CT scan is painless.
It will take about 30 minutes to complete. The pictures
which result are very good at finding tumors throughout
the body, and very accurate measurements can be taken which
help the planning of subsequent therapies. This scan shows
a left adrenal gland (yellow) lying on top of the left kidney
(red) and behind the pancreas (green).
The spleen is outlined in blue. This is the normal location
for an adrenal, its just a lot bigger than it should be.
The right adrenal gland is its normal small size and cannot
be seen on this CT scan (as expected). Tumors of this size
( less than 6cm, or 2.5 inches) are rarely cancerous and
lend themselves very nicely to laparoscopic adrenalectomy.
This CT scan, on the other hand, shows
a much larger adrenal gland. This right adrenal (outlined
in yellow) measures18 cm (8 inches) which is much more worrisome
for cancer. Also worrisome (although not so apparent with
the yellow line on the picture) is that the edges of this
tumor are not well defined, suggesting it is malignant and
growing into surrounding structures. The liver (normal)
is outlined in red, and the left kidney (normal) is outlined
in blue. Large tumors and those with ill-defined borders
are not suited for laparoscopic adrenalectomy.
MRI Scan. The MRI (also called an MR scan
or NMR scan) is very similar to the CT scan in the type
of information and pictures it provides. The scan takes
about an hour and uses magnetic fields to generate pictures
of body structures rather than x-rays like the CT scan or
sound waves like the ultrasound.
Often pheochromocytomas enhance (light up brightly) on an
MRI scan which is so characteristic that it is almost as
accurate as a biopsy, yet this test can be used for any
type of adrenal tumor. The MRI shown here is different from
the other pictures on this page in that the patient is not
"cut in half" across their body, but rather they
are "cut in half" down the length of their body
as if the front half was removed and we can see inside them.
This MRI shows a much enlarged left adrenal (outlined in
yellow) on top of the left kidney (outlined in red). This
tumor was benign as was suggested by its moderate size and
nice smooth edges.
This scan also shows very nicely the relationship the left
adrenal has to the spleen (outlined in pink). The left adrenal
normally lives on top of the left kidney and below and behind
the spleen. The liver is normal sized and is outlined in
blue. The spinal column can be seen as a series of discs
lying on top of one another down the center of the picture.
MIBG Scan. The MIBG scan is used only
to detect the presence and location of adrenal pheochromocytomas.
This test does NOT detect any other type of adrenal tumor.
MIBG is another nuclear medicine scan which takes advantage
of the fact that endocrine cells make hormones. Just like
the sestamibi scan which makes hyperactive parathyroids
radioactive so they can be seen on special x-ray film, the
MIBG scan shows pheos.
A special radioactive dye is given to a patient which is
a precursor for adrenaline (the hormone made by the adrenal
medulla). This dye is concentrated in the hyperactive endocrine
tissue which comprises the pheo and it can be seen on x-ray
film. The picture on the right shows a bright pheo in the
patient's left adrenal gland. To make the picture easier
to interpret, the radiologist gave the patient a second
radioactive dye which is absorbed by the kidney. The computer
interprets the dye in both kidneys as black areas, which
accounts for the two "empty" areas on the scan.
The pheo, therefore is the bright spot (the adrenal) on
the top side of the left (empty) kidney.
This test takes about an hour a day for 3 or 4 days. Note:
X-rays are typically read as if we were looking at the patient,
therefore, the patients left side will be on the right side
of the picture we are viewing.
Introduction to the Adrenal Gland
Overview of the different Surgical Options
for removing an adrenal tumor
More about Pheochromocytoma
More about Diseases of the Adrenal Cortex
More about Laparoscopic Adrenalectomy
as the best new way to remove adrenal tumors
Introduction
to the different Endocrine Glands
http://www.endocrineweb.com/
adrtest.html
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