| Adrenal glands lie on the extraperitoneal perirenal space.There is a great of diseases taken place in adrenal glands and their clinical manifestations are complicated.Therefore,diseases about the adrenal glands are the investigative interesting subjects in clinical investigations,especially in the medical image and surgery.The deep position of the adrenal glands and their complex relations with nearby structures and viscera complicate the clinical analysis of the many diseases affecting the adrenal glands and bring some difficulties to the imaging investigation of the adrenal glands.The widespread laparoscopic adrenalectomy requires better anatomical information is needed to facilitate diagnosis and surgical treatment of adrenal disease,especially the adjacent relationship and the great vessels of the adrenal glands.Previous studies using CT showed the position,size and some common disease of the adrenal glands in the transverse section,but the allocation and presentation of tiny pathological changes in the adrenal glands can not be carried out without comparison with sectional species.Recently,with the development of multislice spiral CT and its image post processing ability as well as modern high-speed scanning sequence of MRI,imaging technologies provides useful images that more clearly demonstrate the complicated anatomical relationships of the adrenal glands and their diseases on the transverse,sagittal, coronal,and slant sectional images.The sectional anatomies researches of the adrenal glands are mostly reported on the transverse planes;however these studies only adopted few cadavers and are short of images of minimal lesions in adrenal glands combining the CT and MRI images.Therefore,this paper provided initial anatomical research regarding the sectional anatomy of the adrenal glands and related structures and viscera in the coronal plane.Data just include the coronal data without the images of normal adrenal glands and images with minimal lesions. So far,there is no coronal sectional data in the adrenal glands which obtains obvious superiority in demonstrating the bilateral adrenal glands.Adrenal glands lie in the extraperitoneal peritoneal space.Because of the complex coherence and stretch of the renal fasciae,the adjacencies of adrenal glands and the communicated structures of the peritoneal spaces,especially for the left one,became more complicated and controversial.So the deep research about the above area is valuable for the understanding of the disease spreading and influence between the adrenal glands and their surrounding structures.What' more, it also can clarify the variance and controversy.Study about the position,shape and adjacent relationship of the adrenal glands and surrounding organs using sectional anatomy can demonstrate the position of the adrenal glands in vivo.That not only facilitates the control study between the imageology and the sectional anatomy,but also conduces to the location of the pathological changes in all kinds of adrenal gland diseases. However,study about this used few cadavers and only limited on sagittal and transversal planes.With the clinical application of MSCT and three-dimensional reconstruction technique,three-dimensional images of the adrenal glands can be reconstructed, and the position of the adrenal glands and their adjacent relationship in vivo can be displayed thoroughly.Recently,with the development of high-speed scanning sequence of MRI and FS,the tiny structure of the adrenal glands and the ones around it can be clearly displayed,thus the tiny pathological changes in adrenal glands can be precisely location.Nevertheless,due to the Partial volume effect and the density resolution,differences still exist between the images and the specimen. We must re-establish the adrenal glands by combining the images of CT/MRI and the sectional specimens.Now,systematic study of normal adrenal glands and their pathological changes using serial transverse,sagittal and coronal sectional specimens and their clinical manifestation is scare.This paper systematically investigates the three dimensions sectional anatomy features of the adrenal glands and their tiny pathological changes,which combine the images of CT/MSCT/3D/MRI and contrast of CT/MRE images about the adrenal glands' pathological changes.That will provide exact and practical data for the imageology diagnose and surgical therapy of the disease take place in adrenal glands.This study consists of five parts.Part 1:SECTIONAL ANATOMY AND CT&MRI OF THE ADRENAL GLAND IN THE TRANSVERSE PLANEObjective The purpose of this study was to provide sectional anatomic data for the transverse imaging diagnosis and surgical treatment of the disease of the adrenal gland.Methods The shape,location,adjacency,and size of the adrenal gland were investigated using 20 sets of serial transverse sections of upper abdomen of Chinese adult cadavers,transverse MR images of 10 upper abdomens of Chinese adult healthy volunteers and transverse reconstructed MSCT images of 10 patients without lesions in the adrenal gland.Results On the serial transverse section,the adrenal glands appeared firstly on the plane of the first hepatic hilum plane and disappeared at the level of the renal vessels.It was the best plane for searching the adrenal glands at the level of upper pole of kidney,On the transverse section through the inferior part of renal hilus, right adrenal gland was located in the right adrenal gland triangle behind the inferior vena,the left adrenal gland lied in the fight adrenal gland triangle constituted by bare area of the stomach,spleen and left crura of diaphragm.On the section of the left or right upper pole of kidney,the left adrenal gland was located at the quadrilateral region formed by cephalic side of upper pole of left kidney, posterior side of the body of pancreas,median side of spleen and left crura of diaphragm,while the right adrenal gland lied in the quadrilateral region constituted by posterior wall of the inferior vena cava,bare area of liver,right crura of diaphragm and the cephalic to upper pole of right kidneyConclusion On the serial transverse planes,the bilateral upper pole of kidney plane is the reliable one to observe the adrenal glands.The posterior wall of the inferior vena is the mark to recognize the anterior of the right adrenal glands;the changes of shape of bilateral adrenal glands on the transverse planes are obvious, the adjacent structures in anterior of the adrenal glands(especially the left adrenal glands) are complicate.Therefore,there are different prevalent pathways for the forward growth of the diseases of the adrenal glands.Part 2:SECTIONAL ANATOMY AND CT&MRI OF THE ADRENAL GLAND IN THE SAGITTAL PLANEObjective The purpose of this study was to provide sectional anatomic data for the saglttal imaging diagnosis and surgical treatment of the disease of the adrenal gland.Methods The shape,location,adjacency,and size of the adrenal gland were investigated using 30 sets of serial sagittal sections of upper abdomen of Chinese adult cadavers,sagittal MR images of 10 upper abdomen of Chinese adult healthy volunteers and sagittal reconstructed MSCT images of 10 patients without lesions in the adrenal gland.Results On the serial sagittal planes,The left adrenal gland locate generally between the left of the abdominal aorta and the left renal hilus,and the right renal gland locate generally between the left of the abdominal aorta and the right renal hilus.The plane that the appearance of upper pole of bilateral kidneys is the permanent appearance plane of the bilateral adrenal glands:Looking for the plane which the kidney first appear from the sagittal section is an easy way to search adrenal gland.This area appearing in this plane is the biggest of all,on which the left adrenal gland appears like"Y"or"T",the shape of the right adrenal gland is irregular.The left adrenal gland locate generally between left crura of diaphragm/ left kidney and body of pancreas.The anterior of the right adrenal gland is inferior vena,behind of it is right kidney or diaphragm,inferior is right renal artery/vein, superior is diaphragm and the bare area of liver.Conclusion On the serial sagittal planes,the plane that the appearance of upper pole of bilateral kidneys is the permanent appearance plane of the bilateral adrenal glands,in which area appearing in this plane is the biggest in all planes. The left and right spleen artery/vein is the mark of the anterior of the left adrenal gland,inferior vena is the mark of the anterior of the right adrenal gland,and the right/left kidney artery/vein is the mark to recognize the inferior of the bilateral adrenal glands separately.The changes of shape of right adrenal gland on the sagittal planes are obvious,but the left one is invariant.Part 3:SECTIONAL ANATOMY AND CT&MRI OF THE ADRENAL GLAND IN THE CORONAL PLANEObjective The purpose of this study was to provide sectional anatomic data for the coronal imaging diagnosis and surgical treatment of the disease of the adrenal gland.Methods The shape,location,adjacency,and size of the adrenal gland were investigated using 31 sets of serial coronal sections of upper abdomen of Chinese adult cadavers,coronal MR images of 10 upper abdomen of Chinese adult healthy volunteers and coronal reconstructed MSCT images of 5 patients without lesions in the adrenal gland.Results On the serial coronal planes,the adrenal glands emerge visualized mainly on the successive coronal sections between 18mm anterior to the posterior margin of inferior vena cava and 24mm posterior to the posterior margin of inferior vena cava.The left adrenal gland was visualized 2 sections earlier than the right adrenal gland in general.On the coronal section through the anterior part of inferior vena cava and left renal vein(A15),the left adrenal gland was located lateral to abdominal aorta,cephalic to left renal vein,and super medial to the anterior pole of left kidney;its shape was varied as well.On the coronal section through the anterior parts of bilateral renal hili(A18),the existing rate of bilateral adrenal gland were 100%,and the maximal measurements of bilateral adrenal gland were visualized.The length,width,thickness of right adrenal body, thickness of medial limb,and thickness of lateral limb was 32.02±4.12mm, 10.91±1.89mm,5.82±0.26mm,2.78±0.08mm,2.62±0.06mm respectively whereas the measurements of left adrenal gland was 28.31±3.46mm,18.40±1.56mm, 6.84±0.24mm,3.02±0.08mm,2.86±0.10mm respectively.On the coronal section through the posterior part of bilateral sinuses and splenic hilus(A20),right adrenal gland was located between the bare area of right posterior lobe of the liver and the right crus of the diaphragm,whereas left adrenal gland was visualized between the bare area of stomach and the left erus of the diaphragm.On the coronal section through the cones medullaris and cauda equina(Az2),left adrenal gland disappeared,whereas right adrenal gland was situated in the triangular region composed by liver,the upper pole of right kidney,and right crus of the diaphragm, however,its measurements become small obviously.Conclusion The coronal plane is dominant for showing the bilateral adrenal gland.The shapes of adrenal gland are varied whereas the range of values for adrenal thickness was quite narrow.The change of the thickness of adrenal medial and lateral limbs,especially the lateral limb could correctly reflect the change of the adrenal cortex.Part 4:THREE-DIMENSIONAL RECONSTRUCTION OF MSCT OF THE ADRENAL GLANDSObjective Through three-dimensional reconstruction of MSCT,to provide pragmatically anatomical and imaging data for imaging diagnosis and surgical treatment.Methods 20 patients without adrenopathies were investigated to explore the method of three-dimensional reconstruction of 64 slices MSCT of adrenal glands. We focused on their shape as a whole,location and adjacency.Results In the 64 slices MSCT images,whose SL is 1.25 mm,the adrenal glands were easy to be sketched because of the sharpness borders of bilateral adrenal glands.The shapes as well as the interrelation of the adrenal glands and their adjacent structures reconstructed by VR technology could be disclosed dynamically and multi-angularly because of the clear borders and high three-dimensional quality. Conclusion Three-dimensional reconstruction of MSCT of normal adrenal glands could display the adrenal glands and their adjacent structures dynamically and tridimensionally.What's more,it also could disclose the position of the adrenal glands in vivo,which corresponded the field of vision in operation very well.So the study could provide feasibly and practically anatomical reference for adrenal operations in modern urinary surgery.Part 5:THREE DIMENSIONAL SECTIONAL ANATOMIES OF THE ADRENAL GLAND AND ITS APPLICATION IN IMAGING DIAGNOSISObjective To clarify the imaging of the normal adrenal gland as a basis for the evaluation of small lesion and infiltrating character and displacement of adrenal mass adjacent to the organs.Methods The authors have studied the serial sections through the abdomen and studied CT,MRI of the 30 abnormalities(22 small lesions,8 tumors).We investigated the imaging character of the adrenal glands in three dimensional planes.Results The left perirenal space open upward and stretch with the bare area of liver and the fat in the inferior of the left diaphragm.The adjacent relationship of the posterior and medial of the bilateral adrenal glands is stable.The left and right crura of diaphragm were visualized superior to them,and inferior to the upper pole of the left and right kidney.The anterior adjacent relationship of the bilateral adrenal glands is various,there is inferior vena in the anterior of the right adrenal gland,and it also can locate between the inferior vena and the right crura of diaphragm,or paste the bare area of liver in the posterior and lateral of the inferior vena.The adrenal gland tumor can press the inferior vena to posterior,posterior and lateral,posterior and medial.The lateral fringe of the right adrenal gland locates nearby the bare area of liver and the inferior space of right liver.The right adrenal gland tumor grows laterally,there will be some impression in the medial of posterior lobe of right liver,also enter the inferior space of the right liver.The lateral and anterior of the left adrenal gland is close together with the bare area of liver,omental bursa and the posterior of the stomach.The lesions of the superior of the left adrenal gland can enter the bare area of liver,or the omental bursa.The anterior and lateral of the inferior fringe of the left adrenal gland situates nearby the posterior fringe of the body of pancreas,spleen vessels.The tumor of the inferior of the left adrenal gland can press the spleen vessels and the body of pancreas forward.The anterior and medial of the left adrenal gland and the superior of the abdominal aorta and its branches lies closely with celiac trunk and the initiation part of the superior mesenteric artery,the tumor of this area can press the celiac trunk and its branches.Conclusion The three-dimensional anatomy of the adrenal glands could explain the impression and erosion to nearby structures clearly by the tumor of the adrenal glands.We found that the shape of normal adrenal gland difference from patient to patient and even in the same patient according to the level of the slice it is difficult to determine.Great changes of the morphologic shape and the anterior structures of the adrenal gland determine the different prominent ways for the diseases of adrenal gland to grow forwards.CONCLUSIONS AND SIGNIFICANCE1.This paper provided new anatomical detail regarding the sectional anatomy of the adrenal glands and related structures and viscera in the coronal plane,using multitude specimens and combining the MRI/MSCT images with the thin coronal section specimens.The coronal plane is dominant for showing the bilateral adrenal gland.The shapes of adrenal gland are varied whereas the range of values for adrenal thickness was quite narrow.The change of the thickness of adrenal medial and lateral limbs,especially the lateral limb could correctly reflect the change of the adrenal cortex.Provide better anatomical information to facilitate diagnosis and surgical treatment of adrenal disease.2.The transverse\sagittal\coronal sectional specimens can match correspond with the CT\MRI images,the results can provide exact sectional anatomy data for the imaging diagnosis of the tiny disease in adrenal glands.On the serial transverse planes,the bilateral upper pole of kidney plane is the reliable one to observe the adrenal glands.The posterior wall of the inferior vena is the mark to recognize the anterior of the right adrenal gland;the spleen vein\artery the mark to recognize the anterior of the left adrenal gland.On the serial sagittal planes,the plane that the appearance of upper pole of bilateral kidneys is the permanent appearance plane of the bilateral adrenal glands,in which area appearing in this plane is the biggest in all planes.The left and right spleen artery/vein is the mark of the anterior of the left adrenal gland.The left and right spleen artery/vein is the mark of the anterior of the left adrenal gland.3.We apply the images of the polylaminate Spiral CT and three-dimensional reconstruction,therefore,the adrenal gland and its adjacent tissues were displayed clearly from various directions,and this technique can display adrenal glands' position in vivo,which matches with the position during surgery.This provides reliable and practical anatomy data for the adrenal glands surgery treatment in urinary surgery.4.This study combines the adrenal glands' anatomy of three-dimensional reconstruction with the images of the adrenal glands;explain the image of diseases in adrenal glands using sectional anatomy.The images of the three-dimensional reconstruction could elucidate the impression,corrosion of adrenal glands tumor. We found that the shape of normal adrenal gland difference from patient to patient and even in the same patient according to the level of the slice it is difficult to determine.Great changes of the morphologic shape and the anterior structures of the adrenal gland determine the different prominent ways for the diseases of adrenal gland to grow forwards.
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