Characterization of Atypical Pheochromocytomas with Correlative MRI and Planar/Hybrid Radionuclide Imaging: A Preliminary Study

Galatola, Roberta; Attanasio, Ludovica; Romeo, Valeria; Mainolfi, Ciro Gabriele; Klain, Michele; Simeoli, Chiara; Modica, Roberta; Guadagno, Elia; Aprea, Giovanni; Basso, Luca; Nicolai, Emanuele; Salvatore, Marco; Maurea, Simone

doi:10.3390/app11209666

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…Furthermore, in some pioneering studies, scholars have been able to identify the adrenal tumour parenchyma and cystic necrosis components by using positron emission tomography (PET)-CT and dynamic contrast enhanced (DCE) techniques. In pheochromocytoma, especially that presenting with cystic components, the active areas of tumour metabolism are concentrated in the relatively thin cyst wall of the tumour (30). This finding can effectively be used to differentiate pheochromocytoma from other benign cystic masses.…”

Section: Discussionmentioning

confidence: 99%

Dual-energy spectral detector computed tomography differential diagnosis of adrenal adenoma and pheochromocytoma: Changes in the energy level curve, a phenomenon caused by lipid components?

et al. 2023

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Background and objectivesPheochromocytoma and adrenal adenoma are common space-occupying lesions of the adrenal gland, and incorrect surgery may lead to adrenal crisis. We used a new method, dual-energy spectral detector computed tomography (SDCT), to differentiate between the two.Materials and methodsWe analysed the imaging images of patients with SDCT scans and pathologically confirmed adrenal adenomas (n=70) and pheochromocytomas (n=15). The 40, 70, and 100 KeV virtual monoenergetic images (VMIs) were reconstructed based on the SCDT arterial phase, and the correlation between the arterial/venous phase iodine concentration (AP-IC/VP-IC), the effective atomic number (Z-effect), the slope of the Hounsfield unit attenuation plot (VMI slope) and the pathological results was tested. The Shapiro−Wilk test was used to determine whether the above data conformed to a normal distribution. For parameters with P greater than 0.05, Student’s t test was used, and the Mann−Whitney test was used for the remaining parameters. A ROC curve was drawn based on the results.ResultsStudent’s t test showed that the 40 KeV VMI and the VMI slope were both statistically significant (P<0.01). The Mann−Whitney U test showed that ID-A was statistically significant (P=0.004). ROC curve analysis showed that 40 keV VMI (AUC=0.818), AP-IC (AUC=0.736), difference (AUC=0.817) and VMI-Slope (0.817) could be used to differentiate adrenal adenoma from pheochromocytoma.ConclusionThe effect of lipid components on SDCT parameters can be used to differentiate adrenal adenoma from pheochromocytoma.

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Section: Discussionmentioning

confidence: 99%

Dual-energy spectral detector computed tomography differential diagnosis of adrenal adenoma and pheochromocytoma: Changes in the energy level curve, a phenomenon caused by lipid components?

et al. 2023

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“…In case of atypical pheochromocytomas that undergo cystic degeneration, integrating MRI findings with those of correlative planar/hybrid radionuclide images should be considered as tumour accumulation of MIBG and/or FDG in the residual solid tissue or in the peripheral tumour rim may help to classify properly these lesions and disclose their real nature [ 37 , 38 ].…”

Section: Diagnosis and Stagingmentioning

confidence: 99%

“…In oligo-metastatic PPGLs, locoregional approaches including radiotherapy, stereotaxic surgery, radiofrequency ablation or cryoablation, percutaneous ethanol injection, may represent reasonable options for local control and managing mass effect symptoms or hormone-related symptoms [ 11 , 21 , 37 , 118 , 119 , 120 ]. However, indications must be individualized and discussed within multidisciplinary team as no prospective data are available.…”

Section: Therapeutic Optionsmentioning

confidence: 99%

The Management of Phaeochromocytomas and Paragangliomas in the Era of Precision Medicine: Where Are We Now? Evidence-Based Systemic Treatment Options and Future Cluster Oriented Perspectives

Bracigliano,

Marretta,

Guerrera

et al. 2024

Pharmaceuticals

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Pheochromocytomas (PCCs) and Paragangliomas (PGLs), commonly known as PPGLs to include both entities, are rare neuroendocrine tumors that may arise in the context of hereditary syndromes or be sporadic. However, even among sporadic PPGLs, identifiable somatic alterations in at least one of the known susceptibility genes can be detected. Therefore, about 3/4 of all PPGL patients can be assigned to one of the three molecular clusters that have been identified in the last years with difference in the underlying pathogenetic mechanisms, biochemical phenotype, metastatic potential, and prognosis. While surgery represents the mainstay of treatment for localized PPGLs, several therapeutic options are available in advanced and/or metastatic setting. However, only few of them hinge upon prospective data and a cluster-oriented approach has not yet been established. In order to render management even more personalized and improve the prognosis of this molecularly complex disease, it is undoubtable that genetic testing for germline mutations as well as genome profiling for somatic mutations, where available, must be improved and become standard practice. This review summarizes the current evidence regarding diagnosis and treatment of PPGLs, supporting the need of a more cluster-specific approach in clinical practice.

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“…Diagnosing this type of pheochromocytoma is quite challenging, as we cannot rely on anatomical imaging modalities (MRI and CT). Accordingly, a recent study showed that 78% of pheochromocytomas with atypical anatomical imaging features (on CT or MRI) were totally or predominantly cystic [42]. In this situation, the most accurate way to assess these lesions is using a variety of functional imaging modalities like iodine metaiodobenzylguanidine (MIBG) scintigraphy, 18 fluoro (F) deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), 18 FDG-PET/MRI, 18 F-Fluoro-dihydroxyphenylalanine ( 18 F-DOPA) PET/CT, and somatostatin receptor (SSTR) agonist-based PET/CT imaging [42,43].…”

Section: Question 4: Which Adrenal Cyst Subtypes Exist?mentioning

confidence: 99%

“…Accordingly, a recent study showed that 78% of pheochromocytomas with atypical anatomical imaging features (on CT or MRI) were totally or predominantly cystic [42]. In this situation, the most accurate way to assess these lesions is using a variety of functional imaging modalities like iodine metaiodobenzylguanidine (MIBG) scintigraphy, 18 fluoro (F) deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), 18 FDG-PET/MRI, 18 F-Fluoro-dihydroxyphenylalanine ( 18 F-DOPA) PET/CT, and somatostatin receptor (SSTR) agonist-based PET/CT imaging [42,43]. It was demonstrated that even completely cystic pheochromocytomas captivate radiotracers like MIBG and FDG in the peripheral tumour rim or in residual tumour tissue [42].…”

Section: Question 4: Which Adrenal Cyst Subtypes Exist?mentioning

confidence: 99%

Adrenal Cysts: To Operate or Not to Operate?

Bozic Antic,

Djurisic,

Nikolic

2024

JCM

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Adrenal cysts are uncommon and usually asymptomatic, and therefore are usually incidentally discovered adrenal lesions. They have a broad pathohistological spectrum that includes pseudocysts and endothelial (vascular), parasitic, and epithelial (mesothelial) cysts. Although most adrenal cysts are benign and hormonally non-functional lesions, some can have ambiguous imaging appearances and mimic malignant adrenal neoplasms. On the other hand, the actual malignant neoplasms could undergo cystic transformation. Additionally, immune cell infiltrations, thrombosis, or haemorrhage seen in sepsis can frequently cause adrenal cyst development, raising a question about the possible connection between severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and adrenal cystic lesions. Due to the disease’s rarity, the likelihood of malignancy, and the lack of specific guidelines, the management of adrenal cysts is always challenging especially in a young person. This review discusses the important diagnostic and the current treatment possibilities for adrenal cystic lesions. Aiming to emphasize clinical dilemmas and help clinicians navigate the challenges when encountering a patient with an adrenal cyst in everyday practice, we based our review on a practical question–answer framework centred around the case of a young woman with an incidentally discovered large adrenal cyst.

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Characterization of Atypical Pheochromocytomas with Correlative MRI and Planar/Hybrid Radionuclide Imaging: A Preliminary Study

Cited by 5 publications

References 23 publications

Dual-energy spectral detector computed tomography differential diagnosis of adrenal adenoma and pheochromocytoma: Changes in the energy level curve, a phenomenon caused by lipid components?

Dual-energy spectral detector computed tomography differential diagnosis of adrenal adenoma and pheochromocytoma: Changes in the energy level curve, a phenomenon caused by lipid components?

The Management of Phaeochromocytomas and Paragangliomas in the Era of Precision Medicine: Where Are We Now? Evidence-Based Systemic Treatment Options and Future Cluster Oriented Perspectives

Adrenal Cysts: To Operate or Not to Operate?

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