|Hough size remains an important criterion for differentiating benign and malignant adrenocortical neoplasms, size alone is insufficient for differentiating relatively large accs from small accs. The medical literature contains scant information regarding the ct characteristics of acc . Studies of the washout profiles of adrenal masses have shown that such profiles can aid in successful differentiation of adenoma from malignant lesions [13, 14, 17, 22]. Pena et al.  compared the decrease in attenuation values on dynamic ct scans with the values on scans obtained with a 10-minute delay (range, 5-15 minutes) and found that adenomas have a relative percentage washout greater than 50%, regardless of the fat content of the mass. natural alternative viagra viagra Malignant tumors have a relative percentage washout less than 50%. viagra canada Using this technique, pena et al. viagra online without prescription Calculated a sensitivity of 98% and a specificity of 100% in the diagnosis of adrenal adenoma. In a similar study caoili and coworkers  compared enhancement washout values at 15 minutes with portal venous enhanced attenuation values. Acc has been included in the nonadenoma population in some studies of washout characteristics of adrenal lesions. Two studies by szolar and kammerhuber [12, 23] described three and six accs. Although specific details regarding the washout characteristics of those tumors were not reported, one can infer that the washout characteristics of the lesions were similar to those of other nonadenoma lesions. generic viagra In two studies by caoili et al. [16, 22], one acc was included in the nonadenoma population, but specific washout analysis for acc was reported in only the more recent publication . buy cheap viagra The lesion was a 3-cm highly differentiated acc with a relative percentage washout of 53% on scans obtained with a 15-minute delay. cheap generic viagra Although these enhancement washout figures are similar to those of an adenoma, the authors conceded that this tumor may have been an atypical example of acc. Although to our knowledge no specific results on the washout characteristics of large adrenal adenomas have been reported, studies addressing the relative percentage washout of adrenal adenomas have shown lipid-rich adenomas measuring 6. 0 cm and lipid-poor adenomas measuring 4. viagra safe teenagers 2 cm that have relative percentage washout characteristics similar to those of smaller adenomas . lowest viagra viagra viagra A critical factor in such lesions, however, is that applying the size criterion alone may result in a presumptive diagnosis of malignancy. The results of our study showed that acc has relative contrast washout characteristics similar to those previously determined for adrenal metastatic lesions and that acc can be differentiated from adrenal adenoma on this basis. In our series, the mean relative percentage washout was 21% (range, 14. 4-32. buy generic viagra 1%). viagra made bayer This result compares favorably with the 2-43% range of relative percentage washout of nonadenomas previously report. bayer generic viagra
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