Adrenal Masses in Patients With Cancer: PET/CT Characterization With Combined CT Histogram and Standardized Uptake Value PET Analysis

Perri, Marzio; Erba, Paola Anna; Volterrani, Duccio; Guidoccio, Federica; Lazzeri, Elena; Caramella, Davide; Mariani, Giuliano

doi:10.2214/ajr.10.5342

Cited by 41 publications

(46 citation statements)

References 30 publications

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“…The combination of unenhanced CT and SUV max ratio is highly accurate in distinguishing between benign and malignant adrenal lesions [25]. In our study, applying the suggested unenhanced attenuation and SUV max ratio cut-off values of 10 HU and 2.5, respectively, substantially increased the accuracy of the test and would have decreased the number of false-positive results.…”

Section: Discussionmentioning

confidence: 61%

Utilisation of combined¹⁸F-FDG PET/CT scan for differential diagnosis between benign and malignant adrenal enlargement

Kim

Kim²,

Lee³

et al. 2013

BJR

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Objective: To assess the properties of adrenal lesions with and without known primary cancer and investigate predictors for differential diagnosis between benign and malignant adrenal enlargement. Methods: This retrospective study used fluorine-18 fludeoxyglucose positron emission tomography (PET)/CT in 325 patients with adrenal lesions (229 with known primary cancer and 96 without primary cancer). Age, sex, the presence of right and left masses, nodules or hyperplasia, unenhanced attenuation, maximum standardised uptake value (SUV max ) ratio, and the presence of metastasis in other body parts and locations of the primary cancer were assessed. Univariate and multivariate analyses were used to assess variables associated with risk of adrenal metastasis. Results: Patients with adrenal metastasis vs those without had a higher frequency of primary lung cancer (52.3% vs 30.7%) but a lower frequency of gastrointestinal cancer (7.9% vs 16.6%). The frequency of other abnormalities, including adenoma and hyperplasia, was similar between patients with and without known primary cancer. A higher proportion of patients with adrenal metastasis regardless of primary cancer site were younger, had a nodule or a mass, had an unenhanced attenuation of .10 HU, had an SUV max ratio of .2.5, and had metastasis in other body parts. Analysis found independent associations of age, unenhanced attenuation of .10 HU, SUV max ratio of .2.5 and the presence of metastasis in other body parts with adrenal metastasis. The combination of the four variables was strongly associated with adrenal metastasis. Conclusion: PET/CT was useful in characterising adrenal lesions as benign or malignant and helpful in identifying adrenal metastasis and cancer severity. Advances in knowledge: PET/CT can help in the differential diagnosis between benign and malignant adrenal enlargement.The adrenal gland is a common site of metastasis in patients with cancer. Up to 50% of adrenal lesions in patients with known primary non-adrenal cancers are malignant disease [1-4]. The most common malignant lesions that metastasise to the adrenal gland include lung, liver, colon, lymphoma, melanoma, breast, kidney, oesophagus, pancreas and stomach cancer [4][5][6]. However, diagnosis of an adrenal lesion as malignant or benign can be problematic. Characterisation of these adrenal lesions is therefore critical to stage the primary disease, direct therapy and predict prognosis. Although CT and MRI are typically used to characterise a lesion, a small but important number of adrenal lesions are found to be indeterminate on crosssectional images [7][8][9].Several reports have documented the effectiveness of standalone fluorine-18 fludeoxyglucose ( 18 F-FDG) positron emission tomography (PET) to differentiate benign from malignant adrenal lesions [8][9][10]. Interest has focused on the ability of integrated in-line PET/CT to definitively characterise these lesions given that this technique combines the anatomical and densitometrical applications of CT and the functional and metabol...

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Section: Discussionmentioning

confidence: 61%

Utilisation of combined¹⁸F-FDG PET/CT scan for differential diagnosis between benign and malignant adrenal enlargement

Kim

Kim²,

Lee³

et al. 2013

BJR

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“…In 325 patients with adrenal lesions, the highest accuracy, sensitivity (99 %) and specificity (91 %), was found when max SUV adrenal:liver ratio [2.5 was combined with HU [ 10 [44]. FDG PET/CT metabolic measurements have been combined with CT histogram and unenhanced CT parameters (Hounsfield units, size), SUV max[2.8 with histograms and Hounsfield units \20 with excellent results [45].…”

Section: Normal Adrenal Anatomy and Metabolic Featuresmentioning

confidence: 99%

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

et al. 2014

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PET/CT with (18)F-fluorodeoxyglucose (FDG) or using different radiocompounds has proven accuracy for detection of adrenal metastases in patients undergoing cancer staging. It can assist the diagnostic work-up in oncology patients by identifying distant metastases to the adrenal(s) and defining oligometastatic disease that may benefit from targeted intervention. In patients with incidentally discovered adrenal nodules, so-called adrenal "incidentaloma" FDG PET/CT is emerging as a useful test to distinguish benign from malignant etiology. Current published evidence suggests a role for FDG PET/CT in assessing the malignant potential of an adrenal lesion that has been 'indeterminately' categorized with unenhanced CT, adrenal protocol contrast-enhanced CT, or chemical-shift MRI. FDG PET/CT could be used to stratify patients with higher risk of malignancy for surgical intervention, while recommending surveillance for adrenal masses with low malignant potential. There are caveats for interpretation of the metabolic activity of an adrenal nodule on PET/CT that may lead to false-positive and false-negative interpretation. Adrenal lesions represent a wide spectrum of etiologies, and the typical appearances on PET/CT are still being described, therefore our goal was to summarize the current diagnostic strategies for evaluation of adrenal lesions and present metabolic and anatomic appearances of common and uncommon adrenal lesions. In spite of the emerging role of PET/CT to differentiate benign from malignant adrenal mass, especially in difficult cases, it should be emphasized that PET/CT is not needed for most patients and that many diagnostic problems can be resolved by CT and/or MR imaging.

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“…6.4, 6.5) [25,26]. A more recent study found that the combination of 18-FDG PET/CT with standard uptake values (SUV) and CT histogram analysis further improves the diagnostic accuracy of adrenal lesions characterization, yielding a sensitivity of 100 % and specificity of 97.3 % [27].…”

Section: State Of the Art Conventional (Multi-detector) Ctmentioning

confidence: 99%

Adrenal Glands

Mileto

Marin

et al. 2013

CT of the Retroperitoneum

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Adrenal Masses in Patients With Cancer: PET/CT Characterization With Combined CT Histogram and Standardized Uptake Value PET Analysis

Abstract: The combination of SUV and CT histogram analysis allowed us to significantly improve the PET/CT diagnostic accuracy for characterizing adrenal lesions, leading to a significant reduction in the number of false-positive cases.

Cited by 41 publications

References 30 publications

Utilisation of combined¹⁸F-FDG PET/CT scan for differential diagnosis between benign and malignant adrenal enlargement

Utilisation of combined¹⁸F-FDG PET/CT scan for differential diagnosis between benign and malignant adrenal enlargement

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

Adrenal Glands

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Adrenal Masses in Patients With Cancer: PET/CT Characterization With Combined CT Histogram and Standardized Uptake Value PET Analysis

Abstract: The combination of SUV and CT histogram analysis allowed us to significantly improve the PET/CT diagnostic accuracy for characterizing adrenal lesions, leading to a significant reduction in the number of false-positive cases.

Cited by 41 publications

References 30 publications

Utilisation of combined18F-FDG PET/CT scan for differential diagnosis between benign and malignant adrenal enlargement

Utilisation of combined18F-FDG PET/CT scan for differential diagnosis between benign and malignant adrenal enlargement

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

Adrenal Glands

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Product

Resources

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Utilisation of combined¹⁸F-FDG PET/CT scan for differential diagnosis between benign and malignant adrenal enlargement

Utilisation of combined¹⁸F-FDG PET/CT scan for differential diagnosis between benign and malignant adrenal enlargement