title: Contrast-Enhanced Computed Tomography in Intensive Care Unit Patients With Acute Clinical Deterioration: Impact of Hyperattenuating Adrenal Glands.
abstract: OBJECTIVE
  The study sought to assess the frequency and prognostic value of hyperattenuating adrenal glands on contrast-enhanced computed tomography (CT) scans of surgical intensive care unit (ICU) patients with acute clinical deterioration.
  
  
  METHODS
  Eighty-eight consecutive ICU patients (63.2 ± 14.5 years of age) were included in this retrospective analysis. All patients underwent biphasic contrast-enhanced CT due to an acute clinical deterioration. Hyperattenuation of the adrenal glands was assessed subjectively and objectively. Subjective presence or absence of hyperattenuating adrenal glands was assessed by 2 blinded radiologists (J.B. and R.S.L.) in consensus. Hounsfield units (HU) were measured in the adrenal glands and in the inferior vena cava. Objective hyperattenuation was defined as HU (adrenal glands) > HU (inferior vena cava) with a 15-HU threshold. Death within 14 days following CT was set as endpoint and acquired from electronic patient data.
  
  
  RESULTS
  Thirty-eight patients (43.2%, Group Asubj) exhibited hyperattenuation of the adrenal glands, whereas 50 patients (56.8%, Group Bsubj) did not. Concerning the objective analysis, 31 patients (35.2%, Group Aobj) exhibited hyperdense adrenal glands, whereas 53 patients (64.8%, Group Bobj) did not. Overall 27 of 88 patients (30.6%) died within 14 days following the CT examination. Lethal outcome was significantly more frequent among patients in Group Asubjand Aobj(19 of 38 patients [50.0%] and 15 of 31 patients [48.4%]) as compared with patients in Group Bsubj(8 of 50 patients [16.0%]) and Group Bobj(12 of 57 patients [21.1%]; P < .05). Subjective and objective analysis correlated significantly (P < .05).
  
  
  CONCLUSIONS
  Hyperattenuation of adrenal glands on contrast-enhanced CT of ICU patients with acute clinical deterioration is associated with a high mortality and might serve as a prognostic marker for patients' outcome.
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany. Electronic address: johannes.boos@med.uni-duesseldorf.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Boos
authors.affiliation: Radiologie, MVZ am RKK, Bremen, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Schek
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
authors.forename: Patric
authors.initials: P
authors.lastname: Kröpil
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Heusch
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
authors.forename: Niklas
authors.initials: N
authors.lastname: Heinzler
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
authors.forename: Rotem Shlomo
authors.initials: RS
authors.lastname: Lanzman
mesh_terms: D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging*; D000311:Adrenal Glands / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media
keywords: Adrenal gland; Contrast-enhanced computed tomography; Hyperattenuation; Intensive care unit