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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5767_Библиотеки_им_академика_М_И_Перельмана.pdf
160
ab
f
Fig. 8.16 (continued)
Y. N. Patrunov et al.
c
Fig. 8.17 Right adrenal gland cyst. (a) The grayscale US
reveals a roundish anechoic lesion in the place of the right
adrenal gland. (b) PDI detects no vascularity. (c) The
lesion demonstrates no contrast enhancement (perfusion
defect) with CEUS. (d) TIC proves no lesion enhancement (pink ROI), the normal liver parenchyma (yellow
ROI) is supplied for reference
8 Kidneys andAdrenals
d
161
Fig. 8.17 (continued)
162
Y. N. Patrunov et al.
a
b
c
Fig. 8.18 Right adrenal adenoma. (a) The grayscale US
demonstrates a homogeneous isoechoic lesion with regular margins in the place of the right adrenal gland. (b) CDI
detects no vascularity. (c) Early arterial phase CEUS
image demonstrates peripheral rim-like enhancement. (d)
Venous phase CEUS image demonstrates poor homogeneous enhancement, which is well seen on the background
of the enhanced liver parenchyma. (e) Late phase CEUS
image after 4 min demonstrates homogeneous hypoenhancement. (f) TIC reveals general poor enhancement of
the lesion with a peak in the arterial phase (pink ROI), the
normal liver parenchyma (yellow ROI) is supplied for
reference
8 Kidneys andAdrenals
d
163
e
Fig. 8.18 (continued)
164
Y. N. Patrunov et al.
f
Fig. 8.18 (continued)
8 Kidneys andAdrenals
a
b
165
Fig. 8.19 Right adrenal pheochromocytoma. (a) PDI
fails to detect any vascularity in the heterogeneous right
adrenal lesion. Note the hypoechoic area within the lesion.
(b) Arterial phase CEUS image demonstrates nonspecic
moderate irregular enhancement with the nonenhanced
area, which corresponds to the hypoechoic area.
(c) Venous phase CEUS image shows almost the same
enhancement pattern as in the arterial phase with moderate enhancement on the periphery and nonenhanced area
in the central aspect. The enhancement pattern correlates
with the same in CE-CT. (d) Native CT. (e) Venous phase
CE-CT. (f) Delayed phase CE-CT
166
Y. N. Patrunov et al.
c
d
f
Fig. 8.19 (continued)
e
8 Kidneys andAdrenals
a
167
b
Fig. 8.20 Right adrenal sarcoma of large size. (a) The
arterial phase CEUS image demonstrates slow irregular
enhancement with a large nonenhanced area in the central
part of the lesion. (b) Venous phase CEUS image shows
gradual enhancement, which spreads from the periphery.
There remains the central nonenhanced area of irregular
shape. (c) TIC reveals overall poor enhancement of the
lesion with (pink ROI) as compared to the kidney (yellow
ROI) and liver (blue ROI) parenchyma
168
Y. N. Patrunov et al.
c
Fig. 8.20 (continued)
8 Kidneys andAdrenals
a
b
169
Fig. 8.21 Right adrenal metastasis. (a) PDI detects
increased central and peripheral vascularity in the right
adrenal mass. (b) Early arterial phase CEUS image demonstrates fast hyperenhancement of the adrenal lesion. (c)
The arterial phase CEUS image shows signicant hyper-
enhancement. (d) The venous phase CEUS demonstrates
fast washout, which is prominent on the background of
the persisting enhancement of the adjacent kidney and
liver