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When first seen on ct or mr imaging and need no further diagnostic tests. Radiological evaluation if the adrenal mass appears to be functional, no further diagnostic imaging is recommended, as surgery is often necessary. order viagra online from canada If it is non-functional, the first step in the radiologic evaluation for malignancy is to determine whether it has been imaged previously. viagra young men anxiety If there are prior images and the lesion size has been stable for >6 months, it is almost certainly benign. If a non-contrast-enhanced ct scan (figure 1) is available, this is also useful in assessing whether the lesion is likely to be a benign adenoma. generic viagra canada Unlike metastatic malignant masses, adenomas typically have a high  lipid content. over counter pills work like viagra If the attenuation of a uniform mass is <10 hounsfield units (hu), it is highly unlikely to be malignant (table 1). viagra generic Signs of possible malignancy include a ct density of >43 hu, an irregular border, and necrosis.     figure 1. http://milkpaint.com/ibe-buy-cheap-viagra-canada-bz/ Axial ct demonstrating an incidental left adrenal mass in a 55 year old man undergoing unenhanced ct for urinary stone evaluation. The adrenal mass is well defined and uniform in appearance and measures 1. 3 hu in attenuation as indicated by the region of interest tool and thus is most consistent with a benign adrenal adenoma. If no prior imaging is available or there is insufficient information from the available images, the next step (figure 2) is an adrenal protocol ct examination. This consists of three steps: a non-contrast ct (figure 3a), followed (if necessary) by contrast-enhanced ct images taken at 60-75 seconds (figure 3b) and at 10 minutes (figure 3c) after the administration of contrast, using a fine collimation multi-detector ct scanner. compare viagra prices If the adrenal mass is uniform and <10 hu on non-contrast ct, it is not necessary to perform the contrast-enhanced examinations, because these lesions are lipid rich and almost certainly benign. compare viagra prices At 60-75 seconds after the administration of contrast agent, the enhancement is at its peak. viagra canada Contrast agent washes out of malignant tissue more slowly than normal and differences in wash out rate are measured by calculating the relative percentage washout (rpw) and absolute percentage washout (apw) of the contrast agent from data collected from the non-contrast, peak contrast-enhancement, and 10-minute delay contrast-enhanced images. After excluding pheochromocytomas, the sensitivity and specificity of adrenal protocol ct for detecting adrenal adenomas is reported. buy viagra without prescription


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