In ∼70% of AIs, attenuation values are ≤10 HU. Berends AMA, Buitenwerf E, de Krijger RR, Veeger NJGM, van der Horst-Schrivers ANA, Links TP, Kerstens MN. In addition, many cases were excluded because of the availability of postcontrast CT scans only. Purpose: Small pheochromocytomas are usually homogeneous, with soft tissue density (40-50 HU) and with uniform contrast-enhancement [8]. Type of CT examination and field of view, number and location of lesions, tumor size, unenhanced HU, APW and RPW were considered. Pheochromocytoma is a neoplasm composed of cells similar to the chromaffin cells ... An adrenal incidentaloma is an adrenal tumor found by coincidence without clinical symptoms or suspicion. Pro]. Washout data for AI should therefore not be used to determine whether biochemical testing should be done. Unenhanced HU values were available for 376 of 548 histologically confirmed PCCs, two of which (0.5%) exhibited an attenuation of exactly 10 HU, consistent with an ACA-like attenuation according to recent ESE/ENSAT guidelines. Four hundred seven cases were excluded, mainly because of the performance of postcontrast CT only (n = 305). In addition, Jun et al. [Preoperative α-receptor block in patients with pheochromocytoma? Jun JH, Ahn HJ, Lee SM, Kim JA, Park BK, Kim JS, Kim JH. Ionic Iodinated contrast is a risk for Hypertensive Emergency, but nonionic contrast is safe. Unlike in situations when substantial adrenal hormone secretion or malignancy are suspected, no treatment is indicated for benign, nonfunctioning ACA. While pheochromocytomas most commonly occur in the 3rd to 5thdecade of life, they can occur at any age. Only 1 PCC of 222 demonstrated an attenuation value of <10 HU. Hence, in this international multicenter study, we retrospectively evaluated the quantitative CT characteristics of PCCs, as indicated in the radiological reports, to assess the proportion and associated characteristics of PCCs with an ACA-like attenuation on CT, taking into account both unenhanced attenuation and contrast washout measurements. NA, not available. The prevalence of AI on thoracic, abdominal, and pelvic CT ranges between 1.0% and 8.7% depending on age (9–14). 2019 Nov;59(11):975-981. doi: 10.1007/s00117-019-0569-7. Biochemical phenotypes were categorized as “adrenergic,” “noradrenergic,” or “normal.” The phenotype was classified as “adrenergic” when the increment of metanephrines, relative to the upper limits of normal, exceeded 5% of the combined metanephrine and normetanephrine increments. Conversely, a high washout does not rule out PCC. Nuclear medicine scan (MIBG). Bethesda, MD 20894, Copyright Journal of Vascular Surgery® is dedicated to the science and art of vascular surgery and aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. Adrenal venography: A procedure to look at the adrenal veins and the flow of blood near the adrenal glands. As the contrast dye moves … 8600 Rockville Pike However, with the widespread use of CT and MRI, approximately 50% of all pheochromocytomas are initially detected as adrenal incidentalomas in patients without spells and, frequently, without hypertension.” Dr Grant continues: “It is important to Typical symptoms and signs include headache, tremors, palpitations, sweating, and anxiety. Statistical analysis was performed with SPSS software, version 17.0 for Windows (IBM Inc., Armonk, NY). The reasons for this, however, could not be verified because washout data were unavailable; in the two cases where unenhanced attenuation was mentioned, it was >10 HU. Kunz WG, Auernhammer CJ, Nölting S, Pfluger T, Ricke J, Cyran CC. 3T not available: SPECT bone scan. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. Patients provided informed consent, under ENSAT or local institutional protocol, when required. However, the guideline also mentioned that it would be reasonable to avoid biochemical testing for PCC in patients who have AI with an unenhanced attenuation of ≤10 HU. Prevention and treatment information (HHS). CT without contrast for screening. diagnosed pheochromocytomas were prospectively evaluated with 1311 metaiodobenzyl. In the given example of 2000 low-attenuation AIs, based on $50 cost of metanephrine measurement, omitting biochemical testing would result in an immediate cost reduction of $100,000. Chirurg. I work at the hospital where I had my CT's and the tech told me that history of pheochromocytoma is on the list of things they have to check for before doing a CT. We included patients with a histologically proven PCC (single or multiple) who had undergone preoperative CT [i.e., unenhanced CT (with or without contrast-enhanced CT) or contrast washout CT]. This study had several limitations. Here is an overview of the indications for contrasted CT: Chest – Mass, cancer/metastatic workup, lymphoma, sarcoid. Venkatanarasimha N, Olubaniyi B, Freeman SJ, Suresh P. Emerg Radiol. AJR Am J Roentgenol. With isotonic contrast media, no adrenoceptor blockade is necessary. Pheochromocytoma is a rare neuroendocrine tumor of the adrenal gland that classically causes paroxysms of hypertension, headaches, palpitations, and sweating. administration of nonionic contrast material. 2). All 10 patients intravenously received the specific alpha-adrenergic blocker phenoxybenzamine hydrochloride (0.5 mg/kg in 250 mL of 5% dextrose infused over 2 hours) 24 hours before iohexol-enhanced computed tomography. However, recent studies suggest that biochemical exclusion of PCC not be performed for lesions with CT characteristics of an adrenocortical adenoma (ACA). The analysis was based on locally generated radiological reports. For lipid-poor lesions, the contrast washout rate can be calculated using CT adrenals. Pheochromocytoma - - + (as a part of the hypertension paroxysm) - - CT is the preferred imaging modality for the diagnosis of pheochromocytoma. In the latter study, a central re-evaluation of CT images was performed to calculate unenhanced attenuation, whereas in the current study, both unenhanced attenuation and contrast washout were analyzed based on locally generated CT reports. Would you like email updates of new search results? In the evaluation of AI, it is generally recommended that PCC be excluded by measurement of plasma-free or 24-hour urinary fractionated metanephrines. In the current study, we found a similarly low proportion (0.5%) of PCCs with an unenhanced attenuation of ≤10 HU. Questionnaires for examinations using iodinated contrast media and their grades of recommendation: Japan Radiological Society/Japanese College of Radiology Joint Committee on Contrast Media Safety. Less prevalent causes are myelolipomas, cysts, adrenocortical carcinoma, and metastases from other malignancies. FOIA Epub 2012 Jan 24. The clinical characteristics and information regarding HU and maximum diameter of PCCs are given in Table 1. Characteristics of Patients (n = 368) and Lesions (n = 382) for Whom Quantitative CT Characteristics Were Available. This dye can be injected into a patient’s vein or given as a … The second lesion was a 48-mm left adrenal PCC that contained areas of prominent nodular adrenocortical hyperplasia besides PCC. Abstract. Objective: When pheochromocytoma or paraganglioma is suspected, many institutions perform only unenhanced CT because of a perceived risk of inducing a hypertensive crisis with i.v. Dahia PL, Hao K, Rogus J, Colin C, Pujana MA, Ross K, Magoffin D, Aronin N, Cascon A, Hayashida CY, Li C, Toledo SP, Stiles CD; Familial Pheochromocytoma Consortium. In addition, the guideline recommended that an endocrine work-up for AI be performed, including the measurement of plasma-free or 24-hour urinary fractionated metanephrines. Cystic changes, hemorrhage, necrosis, and calcifications are common. Unenhanced attenuation was available for 115 tumors. Occasionally, tests may be falsely elevated in patients without a pheochromocytoma. 2012 May;30(4):310-6. doi: 10.1007/s11604-012-0051-1. Canu L, Van Hemert JAW., Kerstens M, Hartman RP, Khanna A., Kraljevic I, Kastelan D, Badiu C, Ambroziak U, Tabarin A, Haissaguerre M, Buitenwerf E, Visser A, Mannelli M, Arlt W, Chortis V, Bourdeau I, Gagnon N, Buchy M, Borson-Chazot F, Deutschbein T, Fassnacht M, Hubalewska Dydejczy H. A, Motyka M, Rzepka E, Casey R T, Challis B G, Quinkler M, Vroonen L, Spyroglou A, Beuschlein F, Lamas C, Young W F, Bancos I, Timmers H J L M. Canu_SupdataTab1.pdf. Unable to load your collection due to an error, Unable to load your delegates due to an error. Usual and unusual causes of splaying of the carotid artery bifurcation: the Lyre sign--a pictorial review. Rather than taking AI as a starting point, in the current study and in one previous report, primarily patients with PCC were selected. The purpose of this study was to review our experience with the use of nonionic i.v. However, the guidelines stated that an exception could be made for cases in which a non–contrast-enhanced CT attenuation was ≤10 HU. contrast material for CT of patients with pheochromocytoma or paraganglioma. CT scanning with iv contrast is optimal for interpretation [1] because of its sensitivity and specificity in revealing adrenal mass of 98% and 92% respectively [7]. and J.A.W.V.H.) Speak with a Radiologist: 541-284-4016 Kopetschke R, Slisko M, Kilisli A, Tuschy U, Wallaschofski H, Fassnacht M, Ventz M, Beuschlein F, Reincke M, Reisch N, Quinkler M. Zeiger MA, Siegelman SS, Hamrahian AH. guanidine (MIBG) scintigraphy (n=19),computed tomography (CT) … The most accurate diagnostic test for the biochemical diagnosis of these tumors is the measurement of plasma free or 24-hour Gastrointestinal Endoscopy publishes original, peer-reviewed articles on endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. There are different protocols, and some controversy exists as to which protocol is the best. Against]. Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands, Department of Experimental and Clinical Biomedical Sciences University of Florence, Florence, Italy. Characteristics were compared by using an unpaired t test if variables were continuous or a χ2 test if variables were categorical. Nevertheless, the authors acknowledged that only two small studies were published on this topic (16, 17). Tests should include CT and MRI of the chest and abdomen with and without contrast. MRI is similar in sensitivity to CT scans for … MRI with gadolinium contrast media and computed tomography (CT) angiography are equally accurate in visualizing stenosis9 – 11 (Table 4 9, 10, 12 – 18). Jpn J Radiol. In our opinion, this observation justifies omitting biochemical screening in low-attenuation AIs to prevent false-positive test results and unnecessary costs. The assessment of contrast washout, however, is unreliable for ruling out PCC. 2012 Jun;83(6):546-50. doi: 10.1007/s00104-011-2195-4. Participating ENSAT centers were the Mayo Clinic, Rochester, Minnesota (n = 153); Radboud University Medical Center, Nijmegen, Netherlands (n = 46); University Hospital Center Zagreb, Zagreb, Croatia (n = 43); Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (n = 42); Medical University of Warsaw, Warsaw, Poland (n = 33); CHU de Bordeaux, Pessac, France (n = 29); University Medical Center Groningen, Groningen, Netherlands (n = 28); University Hospital of Florence, Florence, Italy (n = 21); University of Birmingham, Birmingham, United Kingdom (n = 20); Center Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (n = 19); Hospices Civils de Lyon, Lyon, France (n = 17); University Hospital of Wuerzburg, Wuerzburg, Germany (n = 17); University Hospital of Krakow, Krakow, Poland (n = 16); Cambridge University Hospitals, Cambridge, United Kingdom (n = 12); Endocrinology in Charlottenburg, Berlin, Germany (n = 12); Center Hospitalier Universitaire de Liege, Liege, Belgium (n = 10); Medizinische Klinik und Poliklinik IV Ludwig-Maximilians-Universität München, Munich, Germany (n = 10); Hospital General Universitario de Albacete, Albacete, Spain (n = 5). Nihon Igaku Hoshasen Gakkai Zasshi. Followup: CT without contrast Mass MRI without and with contrast Infection MRI without and with contrast. Sane et al. Conclusion: While it may be prudent to administer oral alpha- and beta-adrenoceptor antagonists in all patients with a biochemically proved pheochromocytoma to control their symptoms and to prevent a spontaneous adrenergic crisis, specific blockade may not be required before contrast medium-enhanced scanning with iohexol. CT scan with and without contrast with adrenal protocol measures attenuation and time to washout IV iodine contrast. Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline, Incidence of pheochromocytoma and sympathetic paraganglioma in the Netherlands: a nationwide study and systematic review, Novel pheochromocytoma susceptibility loci identified by integrative genomics, Genetics of pheochromocytoma and paraganglioma syndromes: new advances and future treatment options, Paraganglioma and phaeochromocytoma: from genetics to personalized medicine, Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors, Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma, Evaluation and management of the incidental adrenal mass, Medical and surgical evaluation and treatment of adrenal incidentalomas, Clinical practice. Clinical: elevated metabolites of norepinephrine and epinephrine (normetanephrine and metanephrine), no evidence that IV administration of modern (non-ionic) iodinated or gadolinium-based contrast material increases the risk of hypertensive crisis in patients with pheochromocytoma; Cases of Pheochromocytoma Galectin-3 in NAFLD: therapeutic target or non-causal biomarker? If metanephrines were not available, 24-hour urine or plasma catecholamines were used, in order of preference. Drawing of the region of interest for the calculation of radiodensity was done at the discretion of the local radiologist. 2001. Two expert radiologists independently re-evaluated the CT scans. Čtvrtlík F, Koranda P, Schovánek J, Škarda J, Hartmann I, Tüdös Z. Exp Ther Med. National Library of Medicine Schalin-Jäntti et al. 2011 Dec;29(10):744-8. doi: 10.1007/s11604-011-0616-4. Anonymized imaging reports of preoperative CT scans, generated by local radiologists as part of routine diagnostic evaluation, were submitted for central analysis. Children diagnosed with pheochromocytoma are more likely to have an underlying syndrome such as VHL. On the basis of the lack of PCCs with an unenhanced attenuation of <10 HU and the low proportion (0.5%) of PCCs with an attenuation of 10 HU, it seems reasonable to abstain from biochemical testing for PCC in AIs with an unenhanced attenuation ≤10 HU. They retrospectively evaluated a cohort of 174 patients with AI. Of the remaining 533 patients with 548 histologically confirmed PCCs, quantitative CT characteristics were available in 368 patients with 382 PCCs (376 unenhanced HU with or without washout and 6 washout only). Data on tumor size, unenhanced Hounsfield units (HU), absolute percentage washout (APW), and relative percentage washout (RPW) were collected in addition to clinical parameters. The CT scan (also called CAT scan) is very accurate at examining the adrenal glands and other abdominal structures and can be used on any type of adrenal tumor. On nonenhanced CT scans, the mean attenuation of pheochromocytomas is 44 HU, and on 10-minute delayed contrast-enhanced CT scans, the mean attenuation of pheochromocytomas is 83 HU. Clipboard, Search History, and several other advanced features are temporarily unavailable. Among the 376 PCCs for which unenhanced attenuation data were available, 374 had an attenuation of >10 HU (99.5%). Diagnosis of pheochromocytoma using [123I]- compared with [131I]-metaiodobenzylguanidine scintigraphy NOZOMU FURUTA, HIROSHI KIYOTA, FUKUO YOSHIGOE, NORIO HASEGAWA AND YUKIHIKO OHISHI Department of Urology, The Jikei University, School of Medicine Abstract Background: Patient with pheochromocytoma (PCT) cannot be cured without operation, therefore, The most accurate diagnostic test for the biochemical diagnosis of these tumors is the measurement of plasma free or 24-hour urinary fractionated metanephrines (6, 7). In 2016, the European Society of Endocrinology (ESE) in collaboration with the European Network for the Study of Adrenal Tumors (ENSAT) published a guideline to provide clinicians with evidence-based recommendations for clinical management of patients with AIs (7). 2018 Apr;15(4):3151-3160. doi: 10.3892/etm.2018.5871. Of 76 PCCs with unenhanced HU > 10 and available washout data, 22 (28.9%) had a high APW and/or RPW, suggestive of ACA. CT Protocols and Availability of Quantitative Data From Radiological Reports for PCCs. Articles report on outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. IV administration of nonionic contrast material for CT is a safe practice for patients with pheochromocytoma and related tumors even without α-blocking medication. Won Young Lee, Su Jin Kwon, Yu-Mi Im, Bo Sang Kwon, Eun Seok Choi, Chun Soo Park, Tae-Jin Yun Chirurg. 1. 2011 Jan;18(1):75-9. doi: 10.1007/s10140-010-0907-6. A contrast dye is injected into an adrenal vein. They concluded that routine measurement of metanephrines is unnecessary in an asymptomatic patient with AI, provided that the lesion is of low attenuation, small, and homogenous. This was a rare case of ACTH-dependent Cushing disease caused by a PCC. An incidentally discovered adrenal mass by CT scan, MRI or ultrasound is called an incidentaloma. [Pheochromocytoma and paraganglioma : Importance of diagnostic imaging]. Gary A. Ulaner MD, PhD, FACNM, in Fundamentals of Oncologic PET/CT, 2019. The Role of HIF1α-PFKFB3 pathway in Diabetic Retinopathy, A Selective Androgen Receptor Modulator (OPK-88004) in Prostate Cancer Survivors: A Randomized Trial, Rare variants in triglycerides-related genes increase pancreatitis risk in multifactorial chylomicronemia syndrome, The Journal of Clinical Endocrinology & Metabolism, About The Journal of Clinical Endocrinology & Metabolism, Receive exclusive offers and updates from Oxford Academic, Letter to the Editor: "CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma". CT characteristics of PCCs. When the local report did not mention values for APW/RPW, APW and RPW were calculated according to the formulas below, provided that the required parameters were available. Hemorrhage, necrosis, and additional adrenocortical changes (23) may result in intralesional heterogeneity, emphasizing the importance of selecting the proper region of interest for the assessment of attenuation. The detail with which different quantitative parameters were reported varied considerably, leading to missing data. The increasing use of cross-sectional imaging has led to an increase in the incidental discovery of adrenal masses (adrenal incidentalomas). Of 76 PCCs with unenhanced HU > 10 and available washout, 22 (28.9%) had an APW ≥ 60% and/or an RPW ≥ 40%, suggestive of ACA. Abdomen and Pelvis – Pain, colitis, Crohn’s, appendicitis, tumor, cancer, mass. It is one of the more common unexpected findings revealed by computed tomography (CT), magnetic resonance imaging (MRI), or ultrasonography. On CT or MR, pheochromocytomas typically demonstrate marked contrast enhancement. Although most of these lesions are benign, they often present a diagnostic dilemma. The reports were evaluated and scored independently by two observers (L.C. Please enable it to take advantage of the complete set of features! No information on the biochemical phenotype could be retrieved. We found that in almost one third of PCCs with available APW/RPW data, washout was high. 2012 Jun;83(6):551-4. doi: 10.1007/s00104-011-2196-3. 3 Follow-up of a solitary pulmonary nodule also typically does … Careers. Search for other works by this author on: Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands, Department of Radiology, Mayo Clinic, Rochester, Minnesota, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia, National Institute of Endocrinology C. I. 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However, more recent studies have shown a growing role of MIBG scintigraphy and CT in the evaluation of pheochromocytomas . (24). There was no statistically significant increase in epinephrine or norepinephrine levels in the patients or the control subjects. Most AIs are adrenocortical adenoma (ACA) (12). They found that 24-hour urinary metanephrines were normal at baseline as well as during follow-up. PCCs account for up to 7% of AIs (7). Patients in whom these criteria were not fulfilled and in whom normetanephrine levels exceeded the upper limits of normal were classified as “noradrenergic” (21). Nine patients had a PCC, and in none of these tumors was the unenhanced HU < 10. The PCCs with an unenhanced attenuation of >10 HU and high APW and/or RPW (n = 22) did not differ from those with an unenhanced attenuation of >10 HU and low washout (n = 54) with respect to sex, tumor size, and hereditary syndrome (data not shown). (17) performed a 5-year prospective follow-up study of 56 patients with 69 lipid-rich (i.e., low attenuation) AIs. Clinical characteristics were compared between patients with PCC who had and did not have an ACA-like attenuation based on quantitative criteria. (16) examined whether PCC could be ruled out as cause of AIs on the basis of unenhanced attenuation values only. Eisenhofer G, Pacak K, Huynh TT, Qin N, Bratslavsky G, Linehan WM, Mannelli M, Friberg P, Grebe SK, Timmers HJ, Bornstein SR, Lenders JW. In addition, a delay in contrast washout of <50% at 10 minutes is typical of a pheochromocytoma. Favier J, Amar L, Gimenez-Roqueplo AP. When multiple unenhanced HU values were mentioned, the highest value was chosen for analysis. Results: Baid SK, Lai EW, Wesley RA, Ling A, Timmers HJ, Adams KT, Kozupa A, Pacak K. Ann Intern Med. https://radiopaedia.org/articles/phaeochromocytoma-1?lang=gb However, with the availability of nonionic contrast … (20). Adrenal pheochromocytomas (PCCs) and extra-adrenal sympathetic paragangliomas are rare tumors that arise from catecholamine-producing chromaffin cells (1). Nakano S, Tsushima Y, Higuchi T, Taketomi-Takahashi A, Amanuma M. Jpn J Radiol. This guideline adapts a generally accepted approach in the evaluation of AI by taking into account quantitative CT characteristics. A right 6 cm pheochromocytoma seen on a CT scan (arrow) and after removal. On the other hand, the data were extracted directly from clinical practice and thus are representative of "real life.". This illustrates the large number of patients who might benefit from implementing radiological selection to determine in which patients biochemical screening is needed as a second-line test to rule out PCC (15). In one additional PCC, APW/RPW was high as well, but unenhanced attenuation was unavailable. Current diagnostic imaging of pheochromocytomas and implications for therapeutic strategy. Epub 2018 Feb 14. [Significance of CT findings and catecholamine determination in peripheral blood of asymptomatic pheochromocytoma and paraganglioma]. Pheochromocytoma (PHEO or PCC) is a rare tumor of the adrenal medulla composed of chromaffin cells, also known as pheochromocytes. The US Preventive Services Task Force currently recommends low-dose CT without contrast, along with appropriate patient counseling, for patients with a history of smoking and an age range as detailed in the Task Force statement. Precautions. Preoperative urine catecholamine values were reported to be in the normal range; however, metanephrines were not measured. Privacy, Help To determine the proportion of PCCs with ACA-like attenuation or contrast washout on CT. For this multicenter retrospective study, two central investigators independently analyzed the CT reports of 533 patients with 548 histologically confirmed PCCs. In a pheochromocytoma, there is ncreased attenuation on i nonenhanced CT (>20 HU) and elay in contrast medium d washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent). Patients with catecholamine-producing tumors (pheochromocytomas and paragangliomas) do not need any special preparation before they receive non-ionic iodine-based contrast medium or any gadolinium-based contrast medium intravenously. In the two exceptions (0.5%), unenhanced attenuation was exactly 10 HU, which lies just within the range of ≤10 HU that would suggest a diagnosis of ACA. Adrenal Pheochromocytoma. The impact of these potential confounders, however, is probably limited, inducing minimal variations in attenuation, estimated at 1 to 2 HU (20, 25). Contrast- and non-contrast-enhanced ultrasonography (US) findings of hepatic metastasis from malignant pheochromocytoma/paraganglioma. One of 199 lesions [lesion 1 in online repository (22)] with available quantitative data was among the two lesions with 10 HU. RET (n =32), VHL (n = 11), NF1 (n = 11), SDHB (n = 2), SDHD (n=2), MAX (n = 1), and SDHAF2 (n = 1). Outliers (open circle); extreme values (asterisk); median (vertical line); 25% to 75% (box); 95% CI (whiskers). They reported a rate of PCCs with a high washout pattern of 35%. Our main goal was to determine the proportion of PCCs with an ACA-like appearance based on a low unenhanced attenuation or a high contrast washout. Test Sensitivity: 99.6% CT of pheochromocytoma and paraganglioma: risk of adverse events with i.v. The patient is given intravenous contrast, which is an iodine-based dye that enhances the quality of imaging. Letizia Canu, Janna A W Van Hemert, Michiel N Kerstens, Robert P Hartman, Aakanksha Khanna, Ivana Kraljevic, Darko Kastelan, Corin Badiu, Urszula Ambroziak, Antoine Tabarin, Magalie Haissaguerre, Edward Buitenwerf, Anneke Visser, Massimo Mannelli, Wiebke Arlt, Vasileios Chortis, Isabelle Bourdeau, Nadia Gagnon, Marie Buchy, Francoise Borson-Chazot, Timo Deutschbein, Martin Fassnacht, Alicja Hubalewska-Dydejczyk, Marcin Motyka, Ewelina Rzepka, Ruth T Casey, Benjamin G Challis, Marcus Quinkler, Laurent Vroonen, Ariadni Spyroglou, Felix Beuschlein, Cristina Lamas, William F Young, Irina Bancos, Henri J L M Timmers, CT Characteristics of Pheochromocytoma: Relevance for the Evaluation of Adrenal Incidentaloma, The Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 2, February 2019, Pages 312–318, https://doi.org/10.1210/jc.2018-01532. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Hayashi H, Narumi Y, Takagi R, Takehara Y, Arai Y, Kuwatsuru R, Korogi Y, Sugimoto H, Tsushima Y, Hayakawa K, Fukuda K, Tamura S, Kuribayashi S; Japan Radiological Society/Japanese College of Radiology Joint Committee on Contrast Media Safety.
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