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Chung R, Garratt J, Remer EM, Navin P, Blake MA, Taffel MT, Hackett CE, Sharbidre KG, Tu W, Low G, Bara M, Carney BW, Corwin MT, Campbell MJ, Lee JT, Lee CY, Dueber JC, Shehata MA, Caoili EM, Schieda N, Elsayes KM. Adrenal Neoplasms: Lessons from Adrenal Multidisciplinary Tumor Boards. Radiographics 2023; 43:e220191. [PMID: 37347698 DOI: 10.1148/rg.220191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
The radiologic diagnosis of adrenal disease can be challenging in settings of atypical presentations, mimics of benign and malignant adrenal masses, and rare adrenal anomalies. Misdiagnosis may lead to suboptimal management and adverse outcomes. Adrenal adenoma is the most common benign adrenal tumor that arises from the cortex, whereas adrenocortical carcinoma (ACC) is a rare malignant tumor of the cortex. Adrenal cyst and myelolipoma are other benign adrenal lesions and are characterized by their fluid and fat content, respectively. Pheochromocytoma is a rare neuroendocrine tumor of the adrenal medulla. Metastases to the adrenal glands are the most common malignant adrenal tumors. While many of these masses have classic imaging appearances, considerable overlap exists between benign and malignant lesions and can pose a diagnostic challenge. Atypical adrenal adenomas include those that are lipid poor; contain macroscopic fat, hemorrhage, and/or iron; are heterogeneous and/or large; and demonstrate growth. Heterogeneous adrenal adenomas may mimic ACC, metastasis, or pheochromocytoma, particularly when they are 4 cm or larger, whereas smaller versions of ACC, metastasis, and pheochromocytoma and those with washout greater than 60% may mimic adenoma. Because of its nonenhanced CT attenuation of less than or equal to 10 HU, a lipid-rich adrenal adenoma may be mimicked by a benign adrenal cyst, or it may be mimicked by a tumor with central cystic and/or necrotic change such as ACC, pheochromocytoma, or metastasis. Rare adrenal tumors such as hemangioma, ganglioneuroma, and oncocytoma also may mimic adrenal adenoma, ACC, metastasis, and pheochromocytoma. The authors describe cases of adrenal neoplasms that they have encountered in clinical practice and presented to adrenal multidisciplinary tumor boards. Key lessons to aid in diagnosis and further guide appropriate management are provided. © RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Ryan Chung
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Joanie Garratt
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Erick M Remer
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Patrick Navin
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Michael A Blake
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Myles T Taffel
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Caitlin E Hackett
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Kedar G Sharbidre
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Wendy Tu
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Gavin Low
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Meredith Bara
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Benjamin W Carney
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Michael T Corwin
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Michael J Campbell
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - James T Lee
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Cortney Y Lee
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Julie C Dueber
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Mostafa A Shehata
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Elaine M Caoili
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Nicola Schieda
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
| | - Khaled M Elsayes
- From the Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA (R.C., M.A.B.); Department of Radiology, Abdominal Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA (J.G.); Department of Radiology, Imaging Institute and Glickman Urological Institute, Cleveland Clinic, Cleveland, OH (E.M.R.); Department of Radiology, Mayo Clinic, Rochester, MN (P.N.); Department of Radiology, Center for Biomedical Imaging, NYU Grossman School of Medicine, NYU Langone Health, New York, NY (M.T.T.); Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH (C.E.H.); Department of Radiology, University of Alabama, Birmingham, AL (K.G.S.); Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada (W.T., G.L., M.B.); Departments of Radiology (B.W.C., M.T.C.) and Surgery (M.J.C.), UC Davis Medical Center, Sacramento, CA; Department of Radiology (J.T.L.), Department of General Surgery (C.Y.L.), and Department of Pathology and Laboratory Medicine (J.C.D.), University of Kentucky, Lexington, KY; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (M.A.S., K.M.E.); Department of Radiology, University of Michigan, Ann Arbor, MI (E.M.C.); and Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (N.S.)
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Naeem M, Zulfiqar M, Siddiqui MA, Shetty AS, Haq A, Varela C, Siegel C, Menias CO. Imaging Manifestations of Genitourinary Tuberculosis. Radiographics 2021; 41:1123-1143. [PMID: 34048278 DOI: 10.1148/rg.2021200154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The genitourinary region is one of the most common sites of extrapulmonary tuberculosis (TB) involvement. The imaging features of genitourinary TB are protean and can mimic other entities, including malignancy, and pose a diagnostic dilemma. Hematogenous seeding and lymphatic spread of mycobacteria from pulmonary, tonsillar, and nodal TB are implicated in the pathogenesis of genitourinary TB. In addition, contiguous extension from the urinary tract and sexual transmission are described as sources of genital TB. Genitourinary TB can be indolent and results in nonspecific signs and symptoms; thus, imaging has a vital role in the working diagnosis for these cases. Classic uroradiologic signs of genitourinary TB are primarily described from the era of intravenous urography and conventional radiography. Now, CT, CT urography, MRI, and US are used in the diagnosis and management. Familiarity with the imaging features of genitourinary TB may help guide the diagnosis and, in turn, lead to timely management. US has a vital role in the evaluation of scrotal and female genital TB. MRI offers superior soft-tissue contrast resolution and excellent depiction of anatomic detail. The various imaging manifestations of genitourinary TB are highlighted. ©RSNA, 2021.
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Affiliation(s)
- Muhammad Naeem
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Mohammed Azfar Siddiqui
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Anup S Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Adeel Haq
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Cristian Varela
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Cary Siegel
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
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