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The hollow adrenal gland sign: a newly described enhancing pattern of the adrenal gland on dual-phase contrast-enhanced CT for predicting the prognosis of patients with septic shock

  • Emergency Radiology
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Abstract

Objective

To investigate the incidence, CT appearance, and implication for prognosis of the hollow adrenal gland sign (HAGS).

Methods

A total of 194 patients with septic shock and 24 patients with hemorrhagic shock (as control group) were retrospectively included in this study and the patients with septic shock were further divided into four subgroups (digestive tract diseases, DTD, n = 49; biliary and pancreatic diseases, BPD, n = 41; postsurgical infection, PI, n = 64; and other diseases, OD, n = 40). All patients underwent a dual-phase contrast-enhanced CT within 1 week after diagnosis. CT findings and clinical records were reviewed. If in the arterial phase the central zone of adrenal gland showed temporally much lower attenuation than the peripheral zone, it was defined as HAGS positive. The incidence of the HAGS in patients with septic shock and hemorrhagic shock, the demographic features, and mortality between HAGS-positive and HAGS-negative patients in each group were respectively compared.

Results

The incidence of the HAGS in the septic shock group was nearly 30%, while it was 0 in the hemorrhagic shock group. There was no significant difference in age or gender between HAGS-positive and HAGS-negative patients in all groups, while the mortality of HAGS-positive patients was significantly higher than that of HAGS-negative patients in each group (p < 0.05). The concordance correlation coefficient value showed excellent reproducibility of the two observers (κ = 0.977).

Conclusion

The HAGS is specific and common on dual-phase contrast-enhanced CT in patients with septic shock and predicts a poor prognosis.

Key Points

• The hollow adrenal gland sign (HAGS) newly described in this study is a special enhancing pattern of adrenal gland on dual-phase contrast-enhanced CT in patients with septic shock.

• The HAGS is characterized by the much lower-attenuated central zone of the adrenal gland in arterial phase and it showed excellent reproducibility between different observers.

• The HAGS is specific and common on dual-phase contrast-enhanced CT in patients with septic shock and predicts a poor prognosis.

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Abbreviations

BPD:

Biliary and pancreatic diseases

CT:

Computed tomography

DTD:

Digestive tract diseases

HAGS:

Hollow adrenal gland sign

HU:

Hounsfield unit

ICU:

Intensive care unit

OD:

Other diseases

OR:

Odds ratio

PI:

Postsurgical infection

RAI:

Relative adrenal insufficiency

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Funding

The authors state that this work was funded by National Natural Science Foundation of China (No.81701747, Huanjun Wang).

Author information

Author notes

  1. Yang Peng and Qiuxia **e contributed equally to this work, and they are co-first authors.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People’s Republic of China

    Yang Peng, Huanjun Wang, Zhi Lin, Fan Zhang & Jian Guan

  2. Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, No.3025 Shennanzhonglu Road, Shenzhen, Guangdong, People’s Republic of China

    Qiuxia **e & Xuhui Zhou

Authors
  1. Yang Peng
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  2. Qiuxia **e
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  3. Huanjun Wang
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  4. Zhi Lin
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  5. Fan Zhang
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  6. Xuhui Zhou
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  7. Jian Guan
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Corresponding authors

Correspondence to Xuhui Zhou or Jian Guan.

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Guarantor

The scientific guarantor of this publication is Dr. Jian Guan.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Peng, Y., **e, Q., Wang, H. et al. The hollow adrenal gland sign: a newly described enhancing pattern of the adrenal gland on dual-phase contrast-enhanced CT for predicting the prognosis of patients with septic shock. Eur Radiol 29, 5378–5385 (2019). https://doi.org/10.1007/s00330-019-06172-1

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  • DOI: https://doi.org/10.1007/s00330-019-06172-1

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