caa a22 4500 606171924 CHVBK 20210128100725.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s10140-015-1327-4 doi (NATIONALLICENCE)springer-10.1007/s10140-015-1327-4 Value of the CT "capsular sign” as a potential indicator of acute adrenal ischemia [Elektronische Daten] [Marco Moschetta, Michele Telegrafo, Armando Pignatelli, Amato Stabile Ianora, Giuseppe Angelelli] Acute adrenal ischemia represents a rare cause of adrenal insufficiency which should be promptly diagnosed in order to preserve adrenal vitality and function. Our study aims to retrospectively evaluate the diagnostic accuracy of the CT capsular sign as an indicator of adrenal ischemia and its association with vascular involvement. Between January 2013 and January 2014, 69 consecutive patients (47 men, 22 women; mean age 46; range 22-67) with suspected adrenal insufficiency based on clinical and biochemical data underwent 320-row CT examination in our Emergency Department. Written informed consent was obtained for the CT examinations, and the institutional review board approval was obtained for our retrospective study. CT multi-planar images were retrospectively and independently analyzed by two radiologists searching for the patency of adrenal vessels, enlarged adrenals, the presence of the "capsular sign” represented by a peripheral subtle hyperdense line around a hypodense enlarged adrenal, and the presence of any periadrenal inflammatory changes. 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 predictive value (NPV) were calculated for the "capsular sign” and were further evaluated by ROC analysis. Acute adrenal ischemia occurred in 29/69 patients (42%), unilateral in 20, and bilateral in 9. Forty of sixty-nine patients (58%) had no evidence of adrenal disease on CT. Thrombosis of the main adrenal vein was found in 20/29 (69%) and non-venous ischemia in 9/29 (31%). The capsular 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 indicator of acute adrenal ischemia, with a specificity of 100% and leading to a prompt diagnosis in the early phase of the disease. American Society of Emergency Radiology, 2015 Adrenal nationallicence Ischemia nationallicence CT nationallicence Capsular sign nationallicence Moschetta Marco DIM—Interdisciplinary Department of Medicine—Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy aut Telegrafo Michele DIM—Interdisciplinary Department of Medicine—Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy aut Pignatelli Armando DIM—Interdisciplinary Department of Medicine—Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy aut Stabile Ianora Amato DIM—Interdisciplinary Department of Medicine—Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy aut Angelelli Giuseppe DIM—Interdisciplinary Department of Medicine—Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy aut Emergency Radiology Springer Berlin Heidelberg 22/5(2015-10-01), 533-538 1070-3004 22:5<533 2015 22 10140 https://doi.org/10.1007/s10140-015-1327-4 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10140-015-1327-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Moschetta Marco DIM—Interdisciplinary Department of Medicine—Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy aut NATIONALLICENCE 700 1- Telegrafo Michele DIM—Interdisciplinary Department of Medicine—Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy aut NATIONALLICENCE 700 1- Pignatelli Armando DIM—Interdisciplinary Department of Medicine—Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy aut NATIONALLICENCE 700 1- Stabile Ianora Amato DIM—Interdisciplinary Department of Medicine—Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy aut NATIONALLICENCE 700 1- Angelelli Giuseppe DIM—Interdisciplinary Department of Medicine—Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy aut NATIONALLICENCE 773 0- Emergency Radiology Springer Berlin Heidelberg 22/5(2015-10-01), 533-538 1070-3004 22:5<533 2015 22 10140