title: Contrast-enhanced ultrasound for imaging of adrenal masses.
abstract: OBJECTIVE
  The number of incidentally discovered adrenal masses is growing due to the increased use of modern high-resolution imaging techniques. However, the characterization and differentiation of benign and malignant adrenal lesions is challenging. This study aimed to evaluate contrast-enhanced ultrasound for the characterization of adrenal masses.
  
  
  METHODS
  We studied 58 patients with adrenal masses detected with computed tomography, magnetic resonance imaging, or ultrasound. 7 patients had bilateral adrenal lesions. Contrast-enhanced ultrasound was performed using high-resolution ultrasound (3.5 - 7 MHz) and intravenous injection of 2.4 ml SonoVue. The contrast enhancement pattern of all adrenal lesions was documented.
  
  
  RESULTS
  The 18 malignant adrenal tumors were significantly larger at the time of diagnosis compared to the 40 benign lesions (p < 0.03). The majority of benign adrenal lesions (37 / 40) had a nonspecific type of contrast enhancement (24 / 40) or a peripheral to central contrast filling (13 / 40) described as the iris phenomenon. Similar findings were observed in malignant adrenal tumors: most malignant lesions also showed nonspecific (6 / 18) or peripheral to central contrast filling (9 / 18). Peripheral to central contrast filling had 50 % sensitivity (26 - 74 %) and 68 % specificity (51 - 81 %) for indicating malignancy.
  
  
  CONCLUSIONS
  Contrast-enhanced ultrasound facilitates the visualization of vascularization even in small adrenal masses, but it does not help to distinguish malignant and benign lesions.
authors.affiliation: Innere Medizin 2, Caritas-Krankenhaus, Bad MergentheimGermany. Christoph.Dietrich@ckbm.de
authors.forename: C F
authors.initials: CF
authors.lastname: Dietrich
authors.forename: A
authors.initials: A
authors.lastname: Ignee
authors.forename: A P
authors.initials: AP
authors.lastname: Barreiros
authors.forename: D
authors.initials: D
authors.lastname: Schreiber-Dietrich
authors.forename: M
authors.initials: M
authors.lastname: Sienz
authors.forename: J
authors.initials: J
authors.lastname: Bojunga
authors.forename: B
authors.initials: B
authors.lastname: Braden
mesh_terms: D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging; D000310:Adrenal Gland Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000556:secondary; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage*; D003480:Cushing Syndrome / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement; D033162:Incidental Findings; D008067:Lipoma / Q000098:blood supply / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018813:Multiple Endocrine Neoplasia Type 2a / Q000098:blood supply / Q000000981:diagnostic imaging; D009378:Neoplasms, Multiple Primary / Q000098:blood supply / Q000000981:diagnostic imaging; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D010673:Pheochromocytoma / Q000098:blood supply / Q000000981:diagnostic imaging; D010743:Phospholipids; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride