{"id":4136062,"date":"2022-05-17T23:09:00","date_gmt":"2022-05-18T03:09:00","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/?p=4136062"},"modified":"2024-12-30T20:07:55","modified_gmt":"2024-12-31T02:07:55","slug":"adrenal-washout-calculator","status":"publish","type":"post","link":"https:\/\/myendoconsult.com\/learn\/adrenal-washout-calculator\/","title":{"rendered":"Adrenal Washout Calculator"},"content":{"rendered":"For <a href=\"https:\/\/myendoconsult.com\/learn\/adrenal-disorders\/\">adrenal adenomas<\/a> with concerning computed tomographic features, adrenal washout characteristics can be used to characterize these lesions further. By administering intravenous contrast, the contrast uptake phase can be compared to the washout phase in order to differentiate between benign and malignant adrenal lesions. For non-contrast CT of the adrenal glands, an attenuation value less than 10 <a href=\"https:\/\/myendoconsult.com\/learn\/hounsfield-unit-chart\/\">Hounsfield Units (HU)<\/a> has a high specificity for lipid-rich adrenal adenomas.\n\n<div class='fluentform ff-default fluentform_wrapper_40 ffs_default_wrap'><form data-form_id=\"40\" id=\"fluentform_40\" class=\"frm-fluent-form fluent_form_40 ff-el-form-top ff_form_instance_40_1 ff-form-loading ff_calc_form ff_calc_form ffs_default\" data-form_instance=\"ff_form_instance_40_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">adrenal gland washout calculator<\/legend>        <div\n                style=\"display: none!important; position: absolute!important; transform: translateX(1000%)!important;\"\n                class=\"ff-el-group ff-hpsf-container\"\n        >\n            <div class=\"ff-el-input--label asterisk-right\">\n                <label for=\"ff_40_item_sf\" aria-label=\"Contact\">\n                    Contact                <\/label>\n            <\/div>\n            <div class=\"ff-el-input--content\">\n                <input type=\"text\"\n                       name=\"item_40__fluent_sf\"\n                       class=\"ff-el-form-control\"\n                       id=\"ff_40_item_sf\"\n                \/>\n            <\/div>\n        <\/div>\n        <input type='hidden' name='__fluent_form_embded_post_id' value='4136062' \/><input type=\"hidden\" id=\"_fluentform_40_fluentformnonce\" name=\"_fluentform_40_fluentformnonce\" value=\"069b27fa41\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/learn\/wp-json\/wp\/v2\/posts\/4136062\" \/><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_40_HU__portal_venous_phase__' id='label_ff_40_HU__portal_venous_phase__' aria-label=\"HU (portal venous phase)\">HU (portal venous phase)<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"HU__portal_venous_phase__\" id=\"ff_40_HU__portal_venous_phase__\" class=\"ff-el-form-control\" placeholder=\"HU estimation during the portal venous phase after contrast administration\" data-name=\"HU__portal_venous_phase__\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_40_HU__delayed_phase_' id='label_ff_40_HU__delayed_phase_' aria-label=\"HU (delayed phase)\">HU (delayed phase) <\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"HU__delayed_phase_\" id=\"ff_40_HU__delayed_phase_\" class=\"ff-el-form-control\" placeholder=\"HU estimation of the adrenal adenoma, approximately 15 minutes after contrast administration (delayed) \" data-name=\"HU__delayed_phase_\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_40_HU__pre_contrast_phase_' id='label_ff_40_HU__pre_contrast_phase_' aria-label=\"HU (pre-contrast phase)\">HU (pre-contrast phase)<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"HU__pre_contrast_phase_\" id=\"ff_40_HU__pre_contrast_phase_\" class=\"ff-el-form-control\" placeholder=\"HU estimation of the adrenal adenoma, before administration of IV contrast\" data-name=\"HU__pre_contrast_phase_\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_40_ABS_WASHOUT' id='label_ff_40_ABS_WASHOUT' aria-label=\"Absolute washout of the adrenal nodule\">Absolute washout of the adrenal nodule<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"ABS_WASHOUT\" id=\"ff_40_ABS_WASHOUT\" class=\"ff-el-form-control  ff_has_formula ff_numeric\" data-name=\"ABS_WASHOUT\" data-calculation_formula=\"(({input.HU__portal_venous_phase__}-{input.HU__delayed_phase_}) \/ ({input.HU__portal_venous_phase__}-{input.HU__pre_contrast_phase_})) * 100\" readonly=\"1\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_40_numeric-field' id='label_ff_40_numeric-field' aria-label=\"Relative washout of the adrenal nodule\">Relative washout of the adrenal nodule<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"numeric-field\" id=\"ff_40_numeric-field\" class=\"ff-el-form-control  ff_has_formula ff_numeric\" data-name=\"numeric-field\" data-calculation_formula=\"(({input.HU__portal_venous_phase__}-{input.HU__delayed_phase_}) \/ {input.HU__portal_venous_phase__}) * 100\" readonly=\"1\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Disclaimer: This endocrinology calculator is for educational purposes only and is not a substitute for sound clinical judgment. The author(s) from MyEndoConsult makes no claims about the accuracy of the information generated by this medical calculator.' class='ff-el-form-check-label ff_tc_label' for=terms-n-condition_a810869ae4f9361066e6c93a89582b85> <div class='ff_t_c'><p>Disclaimer: This endocrinology calculator is for educational purposes only and is not a substitute for sound clinical judgment. The author(s) from <strong>MyEndoConsult<\/strong> makes no claims about the accuracy of the information generated by this medical calculator.<\/p><\/div><\/label><\/div><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\"  aria-label=\"Calculate Washout with Interpretation\">Calculate Washout with Interpretation<\/button><\/div><\/fieldset><\/form><div id='fluentform_40_errors' class='ff-errors-in-stack ff_form_instance_40_1 ff-form-loading_errors ff_form_instance_40_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_40_1 = {\"id\":\"40\",\"ajaxUrl\":\"https:\\\/\\\/myendoconsult.com\\\/learn\\\/wp-admin\\\/admin-ajax.php\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_40_1\",\"form_id_selector\":\"fluentform_40\",\"rules\":{\"HU__portal_venous_phase__\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \"},\"digits\":{\"value\":\"\",\"message\":\"The number of digits has to be \"}},\"HU__delayed_phase_\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \"},\"digits\":{\"value\":\"\",\"message\":\"The number of digits has to be \"}},\"HU__pre_contrast_phase_\":{\"required\":{\"value\":true,\"message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \"},\"digits\":{\"value\":\"\",\"message\":\"The number of digits has to be \"}},\"ABS_WASHOUT\":{\"required\":{\"value\":false,\"message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \"},\"digits\":{\"value\":\"\",\"message\":\"The number of digits has to be \"}},\"numeric-field\":{\"required\":{\"value\":false,\"message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \"},\"digits\":{\"value\":\"\",\"message\":\"The number of digits has to be \"}},\"terms-n-condition\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}}},\"debounce_time\":300};\n                            <\/script>\n            \n\nYou will need the following parameters in order to calculate the washout characteristics of an adrenal nodule.\n<ul>\n \t<li>HU (portal venous phase) = HU estimation during the portal venous phase after contrast administration<\/li>\n \t<li>HU (delayed phase) = HU estimation of the adrenal adenoma, approximately 15 minutes after contrast administration (delayed)<\/li>\n \t<li>HU (pre-contrast phase) = HU estimation of the adrenal adenoma before administration of IV contrast<\/li>\n<\/ul>\n<blockquote><strong>Absolute washout:<\/strong>\n\n[(HU<sub>portal venous phase<\/sub>) \u2013\u00a0(HU<sub>delayed phase<\/sub>)]\u00a0\/ [(HU<sub>portal venous phase<\/sub>)\u00a0\u2013 (HU<sub>pre-contrast phase<\/sub>)]\u00a0x 100<\/blockquote>\n<blockquote><strong>Relative washout:<\/strong>\n\n[(HU<sub>portal venous phase<\/sub>) \u2013\u00a0(HU<sub>delayed phase<\/sub>)]\u00a0\/ (HU<sub>portal venous phase<\/sub>) x 100<\/blockquote>\n<h2><\/h2>\n<h2>Interpretation of adrenal washout<\/h2>\n<ul>\n \t<li>An absolute washout &gt;60% is suggestive of an adrenal adenoma<\/li>\n \t<li>A relative washout &gt;40% is suggestive of an adrenal adenoma<\/li>\n \t<li>Limited washout on the other hand may be due to either <a href=\"https:\/\/myendoconsult.com\/learn\/hereditary-paraganglioma-pheochromocytoma-syndromes\/\">pheochromocytomas<\/a> or adrenocortical carcinoma<\/li>\n<\/ul>\n<h2>Origin of Computed Tomography<\/h2>\nGodfrey Hounsfield was the first to recognize that x-ray measurements taken from different directions could lead to a reasonably accurate reconstruction of internal tissues. Hounsfield showed that a computation of the x-ray attenuation coefficient in each CT slice area could be used to image tissues of varying densities in the human body. Hounsfield won the 1979 <a href=\"https:\/\/myendoconsult.com\/learn\/endocrine-history\/\">Nobel Prize in Physiology and Medicine<\/a> for his pioneering work in computed tomography.\n<h2>Estimating Hounsfield Units on CT<\/h2>\nUse the region of interest tool to measure the HU (see the illustration below).\n\n<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/ROI-hounsfield-units.jpg\" sizes=\"auto, (max-width: 330px) 100vw, 330px\" srcset=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/ROI-hounsfield-units.jpg 330w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/ROI-hounsfield-units-300x234.jpg 300w\" alt=\"ROI-hounsfield-units.\" width=\"330\" height=\"257\" \/>\n<h2>References<\/h2>\n<ul>\n \t<li>Hounsfield GN. Computerized transverse axial scanning (tomography): part 1. Description of system.<a href=\"https:\/\/doi.org\/10.1259\/0007-1285-46-552-1016\"> Brit J Radiol. 1973;46:1016\u201322.<\/a><\/li>\n \t<li>Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. <a href=\"https:\/\/doi.org\/10.2214\/ajr.07.2799\">AJR Am J Roentgenol. 2008;190(5):1163\u20138.<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>For adrenal adenomas with concerning computed tomographic features, adrenal washout characteristics can be used to characterize these lesions further. By administering intravenous contrast, the contrast uptake phase can be compared to the washout phase in order to differentiate between benign and malignant adrenal lesions. For non-contrast CT of the adrenal glands, an attenuation value less [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[100],"tags":[],"class_list":["post-4136062","post","type-post","status-publish","format-standard","hentry","category-endocalculator","post-wrapper","thrv_wrapper"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/4136062","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/comments?post=4136062"}],"version-history":[{"count":23,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/4136062\/revisions"}],"predecessor-version":[{"id":4422017,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/4136062\/revisions\/4422017"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4136062"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/categories?post=4136062"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/tags?post=4136062"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}