[The informative value of various diagnostic methods in Itsenko-Cushing's disease]

The authors studied the informative value of various diagnostic methods: ultrasonic examination (USE), computed tomography (CT), magneto-resonance tomography (MRT), phlebography with separate collection of blood from the inferior vena cava and its hormonal investigation in Itsenko-Cushing's disease (52 cases). All patient underwent operation, and because of this the changes detected in the adrenals by various diagnostic methods of examination were compared with the morphological findings. Three patients were subjected to bilateral adrenalectomy. Morphological study of the adrenals revealed diffuse hyperplasia of the cortex in 17 cases, macro- and microadenomas in hyperplasia of the adrenals in 23, and diffuse-nodular hyperplasia in 15 cases. In macroadenomatosis identification, the informative value of MRT was 77.8%, CT 66.6%, and USE 22.2%. MRT was most informative in detection of microedenomatosis and diffuse-nodular hyperplasia--82.3% of cases; the respective values for CT and USE were 71.4% and 56.5%. The quantitative parameters of the adrenal tissue were studied in MRT: relaxation time (T-2) and the value of relative signal intensity (E). The value of relative signal intensity was lower in micro-macroadenomatosis than in diffuse and diffuse-nodular hyperplasia. The use of the quantitative parameters (T-2 and E) increases the diagnostic possibilities of MRT and provides for a more authentic idea of the character of the pathological changes in the adrenal tissue. Precise verification of the pathological process in the adrenal cortex allows the optimal treatment to be chosen, adrenalectomy to be considered in time, and the side of the operation to be correctly determined.