Marco Moschetta MD, Presenter: Nothing to Disclose

michele telegrafo, Abstract Co-Author: Nothing to Disclose

Armando Pignatelli, Abstract Co-Author: Nothing to Disclose

Davide Antonio Carluccio, Abstract Co-Author: Nothing to Disclose

Amato Antonio Stabile Ianora, Abstract Co-Author: Nothing to Disclose

Giuseppe Angelelli, Abstract Co-Author: Nothing to Disclose

Acute adrenal ischemia represents a rare clinical event which should be promptly diagnosed in order to preserve the adrenal vitality and function. This study aims to evaluate the diagnostic accuracy of a new CT sign in order to define or exclude an initial phase of adrenal ischemia.  

69 patients suspected of having adrenal ischemia underwent 320-row CT examination. CT multi-planar images were evaluated searching for the patency of adrenal arterial and venous vessels, adrenal gland volume and the presence of the “capsular sign” represented by the evidence of a peripheral subtle hyper-dense line around an hypo-dense enlarged adrenal gland. All CT findings were then compared with the surgical findings (n=5), follow-up examinations (n=20) or autopsy (n=4). Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV) and negative (NPV) were calculated for the “capsular sign” and represented by ROC analysis. 

Acute adrenal ischemia occurred in 29/69 patients (42%), unilateral in 20 and bilateral in 9. Venous thrombosis was found in 20/29 (69%) and arterial hypo-perfusion in 9/29 (31%). The sign was found in 24/29 patients (83%). Sensitivity, specificity, DA, PPV and NPV values of 83%, 100%, 93%, 100% and 89%, respectively, were obtained. 

The “capsular sign” represents a CT finding to be searched when an acute adrenal pathological condition is suspected. Its evidence correlates to acute ischemia with a 100% probability and when it is not found, the probability of a non-ischemic condition is 89%.  

The proposed CT “capsular sign” could represent a specific finding of acute adrenal ischemia providing a prompt diagnosis in the early phase of the disease.

Moschetta, M, telegrafo, m, Pignatelli, A, Carluccio, D, Stabile Ianora, A, Angelelli, G, Value of the CT “Capsular Sign” in Acute Adrenal Ischemia.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012742.html