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Primary Hyperaldosteronism (Conn Syndrome): MR Imaging Findings¹

¹ From the Departments of Diagnostic Imaging (S.A.S., P.D.P., R.H.R.) and Endocrinology (C.A., J.P.M., A.B.G., G.M.B.), Dominion House, 59 Bartholomew's Close, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK. S.A.S. supported in part by a grant from the Joint Research Board, St Bartholomew's Hospital, London, England. Received January 29, 1999; revision requested March 22; revision received May 28; accepted August 30. Address reprint requests to S.A.S. (e-mail: S.A.Sohaib@mds.qmw.ac.uk).

PURPOSE: To describe the magnetic resonance (MR) imaging features of the adrenal glands in primary hyperaldosteronism and assess MR imaging in the detection and characterization of aldosterone-producing adenoma (APA).

MATERIALS AND METHODS: The authors retrospectively reviewed the cases of 20 patients (13 female and seven male patients; age range, 14–67 years; median age, 46 years) with primary hyperaldosteronism who underwent 1.5-T MR imaging between 1995 and 1998. All patients underwent transverse T1- and T2-weighted imaging, and chemical shift imaging was performed in 17 patients. Imaging results were correlated with findings at biochemical testing, venous sampling, or surgery.

RESULTS: Among the 20 patients, 10 (50%) had APA and 10 (50%) bilateral adrenal hyperplasia (BAH). In the detection of APA, MR imaging had a sensitivity of 70%, specificity of 100%, and accuracy of 85%. APAs (mean size, 20 x 16 mm) were iso- or hypointense relative to the liver on T1-weighted images and slightly hyperintense on T2-weighted images. With chemical shift imaging, the signal intensity decreased on the out-of-phase images in six of seven (86%) patients with APA and in eight of nine (89%) patients with BAH.

CONCLUSION: MR imaging has a high specificity in the detection of APA. As with nonhyperfunctioning adenoma, APA and BAH show evidence of intracellular lipid at chemical shift imaging.

Index terms: Adrenal gland, hyperplasia, 86.5412 • Adrenal gland, MR, 86.121411, 86.121412, 86.121414 • Adrenal gland, neoplasms, 86.317 • Magnetic resonance (MR), chemical shift, 86.121414

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