[The usefulness of contrast-enhanced sonography in the differential diagnostic of adrenal tumors].
BACKGROUND
The occurrence of gland tumors causes significant clinical problem. Non hormone-secreting tumors provide the most complicated diagnostic difficulties. The application of contrast-enhanced sonography could improve the vessels visualization and point out characteristic features of benign and malignant changes. The authors believe that this new method make possible the differential adrenal tumor diagnostic process more precise and increase the specificity of ultrasonography in the recognition of benign and malignant tumors. The aim of this study was to define the usefulness of contrasting agent Levovist in differential diagnostics of adrenal tumors and its influence on sensitivity and specificity of ultrasound examination and to establish patients qualification criteria for surgical procedures.


METHODS
Ultrasound examinations were made with the use of digital devise by GE Voluson 740, probe 4-6 mHz with Doppler options and volumetric probe 3D according to the following protocol: 26 patients with recognized adrenal tumor were qualified for the examination. Patients in the first stage of tumor vascularization had Doppler examination with color (CD) and power Doppler (PD). Three-dimensional ultrasonography was used to improve visualization of vascularization. In the final phase of the examination the patients were administrated of Levovist in the recommended by the producer dose: 2.5 g in the concentration of 400 mg/l.


RESULTS
26 cases of adrenal gland tumours were subjected to analysis. In standard ultrasonographic examination focal changes in 25 patients were hipoechogenic focuses and in one case the focus was hyperechogenic. Heterogeneity of focuses was observed in 16 cases. In Doppler examination with color (CD) and power Doppler (PD) vascular blood flow was revealed within 12. After using contrasting agent Levovist vascular blood flow was achieved in 4 additional cases, which constituted 61%.


CONCLUSIONS
1. 3D ultrasound could be useful in cases of big adrenal tumors--over 3 cm diameter after application of ultrasound contrast agents. 2. The use of Levovist in Doppler examination improves the visualization of tumor vascularization. However, it is impossible to differentiate benign from malignant tumors unequivocally.
Słonina
Joanna
J
Department and Institute of Radiology, Medical University, Wrocław. sloninex@post.pl
Nienartowicz
Ewa
E
Agrawal
Anil Kumar
AK
Malczewska
Joanna
J
Moroń
Krzysztof
K
D000310:Adrenal Gland Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D011134:Polysaccharides; D012680:Sensitivity and Specificity; D013959:Thyroid Diseases / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508