Contrast-Enhanced Computed Tomography in Intensive Care Unit Patients With Acute Clinical Deterioration: Impact of Hyperattenuating Adrenal Glands

Johannes Boos; Julia Schek; Patric Kröpil; Philipp Heusch; Niklas Heinzler; Gerald Antoch; Rotem Shlomo Lanzman

doi:10.1016/j.carj.2016.07.006

Contrast-Enhanced Computed Tomography in Intensive Care Unit Patients With Acute Clinical Deterioration: Impact of Hyperattenuating Adrenal Glands

Can Assoc Radiol J. 2017 Feb;68(1):21-26. doi: 10.1016/j.carj.2016.07.006. Epub 2016 Dec 20.

Authors

Johannes Boos¹, Julia Schek², Patric Kröpil³, Philipp Heusch³, Niklas Heinzler³, Gerald Antoch³, Rotem Shlomo Lanzman³

Affiliations

¹ Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany. Electronic address: [email protected].
² Radiologie, MVZ am RKK, Bremen, Germany.
³ Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.

PMID: 28010910
DOI: 10.1016/j.carj.2016.07.006

Abstract

Purpose: 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 A_subj) exhibited hyperattenuation of the adrenal glands, whereas 50 patients (56.8%, Group B_subj) did not. Concerning the objective analysis, 31 patients (35.2%, Group A_obj) exhibited hyperdense adrenal glands, whereas 53 patients (64.8%, Group B_obj) 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 A_subj and A_obj (19 of 38 patients [50.0%] and 15 of 31 patients [48.4%]) as compared with patients in Group B_subj (8 of 50 patients [16.0%]) and Group B_obj (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.

Keywords: Adrenal gland; Contrast-enhanced computed tomography; Hyperattenuation; Intensive care unit.

MeSH terms

Adrenal Gland Diseases / diagnostic imaging*
Adrenal Glands / diagnostic imaging*
Contrast Media*
Critical Care / methods
Female
Humans
Intensive Care Units*
Male
Middle Aged
Multidetector Computed Tomography / methods*
Radiographic Image Enhancement / methods*
Retrospective Studies

Substances

Contrast Media