Characteristic CT features of pheochromocytomas - probability model calculation tool based on a multicentric study

Abstract

Objectives. The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model. Methods. This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign"). Results. Pheochromocytomas have a significantly more spherical shape (P<0.001), whereas an elliptical shape significantly reduces the probability of a pheochromocytoma (odds ratio = 0.015), as does another shape (odds ratio = 0.006). A "ring sign" is also more frequent in pheochromocytomas compared to other adrenal tumors (P=0.001, odds ratio = 6.49). A sharp necrosis also increases the probability of a pheochromocytoma more than unsharp necrosis (odds ratio 231.6 vs. 20.2). The probability calculation model created on the basis of the results confirms a high sensitivity and specificity (80% and 95%). Conclusion. This study confirms the value of anatomical features in the assessment of adrenal masses with the ability to significantly improve the identification of pheochromocytomas. Advanced assessment of the tumor shape was defined and a original comprehensive calculating tool of the pheochromocytoma probability was created on the basis of the results presented here and could be used in clinical routine.

Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension

“…All patients with adrenal incidentaloma with tumour density more than 10 HU should be screened for PPGL even in the absence of hypertension [18,[32][33][34][35]. This is also justified by the finding that hypertension among patients with adrenal incidentalomas is not more frequent in patients with PPGL than in those without PPGL [17].…”

Spiral Computed Tomography in the Quantitative Measurement of the Adjacent Structure of the Left Atrial Appendage in Patients with Atrial Fibrillation

“…The myocardial tissue of the left atrium extends into the outer layer of the pulmonary vein wall, which, in turn, forms a myocardial sleeve. This extended myocardial sleeve is the release point for the abnormal potential activity, and it has been demonstrated that approximately 94% of the abnormal potential triggers are from the pulmonary veins [ 18 ]. Supraventricular arrhythmias, such as atrial fibrillation, generally have a long history, significant myocardial fibrosis, more complications, high risk of stroke with drug therapy, poor efficacy, and arrhythmogenic effects with the long-term application of antiarrhythmic drugs in such patients.…”

Diagnostic Value of Unenhanced CT Attenuation and CT Histogram Analysis in Differential Diagnosis of Adrenal Tumors

“…Moreover, endocrinological data are not usually available in the other previous articles mentioned in this discussion. However, our own data regarding adrenal mass diameter have been published in another article, in which the study group partially overlaps with the study group in this manuscript [21].…”