Differentiating Adrenal Adenomas From Nonadenomas Using 18F-FDG PET/CT

Caoili, Elaine M.; Korobkin, Melvyn; Brown, Richard K.; Mackie, Gavin C.; Shulkin, Barry L.

doi:10.1016/j.acra.2007.01.009

Cited by 99 publications

(61 citation statements)

References 16 publications

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“…The use of an integrated PET/CT enables confident localisation and characterisation of adrenal lesions [18]. Unenhanced attenuation data from an integrated PET/CT can characterise most benign adenomas given that the 10-HU threshold to differentiate benign from indeterminate lesions has been firmly established in clinical practice [19][20][21][22][23]. The use of a 10-HU threshold brings the sensitivity up to 79% and decreases the specificity to 96% [13,16,23].…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…CT densitometry and washout measurements (if a delayed contrast-enhanced CT is performed) can be incorporated into the analysis. The sensitivity of PET-CT ranged between 98.5 and 100% and specificity ranged between 92 and 93.8% (60)(61)(62)(63). The addition of washout measurements on contrast-enhanced CT in one study increased specificity to 100% (64).…”

Section: Epidemiologymentioning

confidence: 93%

“…Recent studies demonstrated that a maximal SUV ratio (adrenal to liver maximal SUV activity) !1.45-1.60 is highly predictive of a benign lesion (59)(60)(61)(62)(63). The use of PET/CT may offer advantages over PET alone as the morphology of the lesion can be assessed by CT, although its metabolic activity is measured concomitantly by PET, allowing for accurate anatomic localization of any FDG focal uptake.…”

Section: Epidemiologymentioning

confidence: 99%

AME Position Statement on adrenal incidentaloma

Terzolo

Stigliano

Chiodini

et al. 2011

European Journal of Endocrinology

456

412

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Objective: To assess currently available evidence on adrenal incidentaloma and provide recommendations for clinical practice. Design: A panel of experts (appointed by the Italian Association of Clinical Endocrinologists (AME)) appraised the methodological quality of the relevant studies, summarized their results, and discussed the evidence reports to find consensus. Radiological assessment: Unenhanced computed tomography (CT) is recommended as the initial test with the use of an attenuation value of %10 Hounsfield units (HU) to differentiate between adenomas and non-adenomas. For tumors with a higher baseline attenuation value, we suggest considering delayed contrast-enhanced CT studies. Positron emission tomography (PET) or PET/CT should be considered when CT is inconclusive, whereas fine needle aspiration biopsy may be used only in selected cases suspicious of metastases (after biochemical exclusion of pheochromocytoma). Hormonal assessment: Pheochromocytoma and excessive overt cortisol should be ruled out in all patients, whereas primary aldosteronism has to be considered in hypertensive and/or hypokalemic patients. The 1 mg overnight dexamethasone suppression test is the test recommended for screening of subclinical Cushing's syndrome (SCS) with a threshold at 138 nmol/l for considering this condition. A value of 50 nmol/l virtually excludes SCS with an area of uncertainty between 50 and 138 nmol/l. Management: Surgery is recommended for masses with suspicious radiological aspects and masses causing overt catecholamine or steroid excess. Data are insufficient to make firm recommendations for or against surgery in patients with SCS. However, adrenalectomy may be considered when an adequate medical therapy does not reach the treatment goals of associated diseases potentially linked to hypercortisolism.

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“…The use of integrated PET-CT can further improve the capacity to distinguish between malignant and benign tumors by increasing the quality of the image. This improvement is also due to the combination of CT attenuation measurements with the intensity of FDG uptake, as described by the standardized uptake value (SUV) for the adrenal lesion (Metser et al, 2006;Caoili et al, 2007). In what concerns fine-needle aspiration biopsy (FNA) one must stress that usually it is not successful in distinguishing between malignant and benign tumors and there are doubts about the risk of disseminating a carcinoma through the abdominal cavity; it can however be of some utility in differentiating an adrenal tumor from a metastasis to the adrenal and in evaluating staging for a known cancer (Jhala et al, 2004;Kocijancic et al, 2004).…”

Section: Adrenal Cortex Cancer -Diagnosis and Clinical Presentationmentioning

confidence: 99%

Adrenal Cortex Tumors and Hyperplasias

Pignatelli¹

2011

Contemporary Aspects of Endocrinology

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Differentiating Adrenal Adenomas From Nonadenomas Using 18F-FDG PET/CT

Cited by 99 publications

References 16 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

AME Position Statement on adrenal incidentaloma

Adrenal Cortex Tumors and Hyperplasias

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Differentiating Adrenal Adenomas From Nonadenomas Using 18F-FDG PET/CT

Cited by 99 publications

References 16 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

AME Position Statement on adrenal incidentaloma

Adrenal Cortex Tumors and Hyperplasias

Contact Info

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