Distinguishing Benign from Malignant Adrenal Masses: Multi–Detector Row CT Protocol with 10-Minute Delay

Blake, Michael A.; Kalra, Mannudeep K.; Sweeney, Ann T.; Lucey, Brian C.; Maher, Michael M.; Sahani, Dushyant V.; Halpern, Elkan F.; Müeller, Peter R.; Hahn, Peter F.; Boland, Giles W.

doi:10.1148/radiol.2382041514

Cited by 240 publications

(151 citation statements)

References 28 publications

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“…CT and MRI are techniques mainly aiming to identify benign lesions, therefore representing tools designed for the exclusion of adrenal malignancy (47,48,49,50). Conversely, FDG-PET/CT is mainly used for the detection of malignant disease (51,52,53).…”

Section: Short Overview On Adrenal Imagingmentioning

confidence: 99%

“…• Included: We identified 37 studies for inclusion in the systematic review (49,52,61,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112), with only 18 of them fulfilling the criteria for inclusion in the actual meta-analysis (61,79,80,81,82,83,84,85,86,87,88,89,90,91...…”

Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)mentioning

confidence: 99%

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Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,335

1,571

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By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected recommendations: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1 mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50 nmol/L (1.8 µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1 mg dexamethasone >138 nmol/L (>5 µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients www.eje-online.org European Journal of Endocrinology175:2 G2 Clinical Practice Guideline M Fassnacht and others ESE and ENSAT guideline on adrenal incidentalomawith an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal inciden...

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Section: Short Overview On Adrenal Imagingmentioning

confidence: 99%

Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)mentioning

confidence: 99%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,335

1,571

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“…However, some lipid-poor adenomas cannot be differentiated from metastatic tumors (1)(2)(3)(4). So-called CT washout method may be accurate for differentiating lipid-poor adenoma from nonadenoma (5,6). However, this technique needs iodinated contrast material administration and additional radiation exposure.…”

mentioning

confidence: 99%

Diagnostic utility of diffusion‐weighted MR imaging and apparent diffusion coefficient value for the diagnosis of adrenal tumors

Tsushima

Takahashi-Taketomi

Endo

2008

Magnetic Resonance Imaging

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Purpose:To determine the utility of diffusion-weighted MR imaging (DWI) for the diagnosis of adrenal tumors. Ϫ3 ; 0.51-1.23; p ϭ 0.14). Pheochromocytomas showed the higher mean ADC value (1.59 Ϯ 0.34*10 Ϫ3 ; 1.04 -1.96) compared with those of adenomas or metastatic tumors (P Ͻ 0.05 and P Ͻ 0.005, respectively). The mean SII of adenomas (62.1 Ϯ 17.9%; 14.5-88.4) was significantly higher than those of pheochromocytomas (4.0 Ϯ 10.0%; Ϫ19.6 -3.3; P Ͻ 0.005) or metastatic tumors (Ϫ1.5 Ϯ 11.7%; Ϫ18.3-8.2; P Ͻ 0.01). There was no correlation between ADC values and SII. Materials and Methods Conclusion:Although pheochromocytomas showed higher ADC values, we did not find that ADC value had diagnostic utility for differentiating adenomas and metastatic tumors.

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“…Previously, some studies suggest that evaluation of Hounsfield units within a ROI or a histogram analysis of a ROI can be used to determine the likelihood that an adrenal gland is abnormal [18][19][20][21][22][23][24][25][26][27]. This however has the inherent drawback that the selection of ROI can be arbitrary and operator dependent.…”

Section: Discussionmentioning

confidence: 99%

Adrenal Gland Abnormality Detection Using Random Forest Classification

et al. 2013

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Adrenal abnormalities are commonly identified on computed tomography (CT) and are seen in at least 5 % of CT examinations of the thorax and abdomen. Previous studies have suggested that evaluation of Hounsfield units within a region of interest or a histogram analysis of a region of interest can be used to determine the likelihood that an adrenal gland is abnormal. However, the selection of a region of interest can be arbitrary and operator dependent. We hypothesize that segmenting the entire adrenal gland automatically without any human intervention and then performing a histogram analysis can accurately detect adrenal abnormality. We use the random forest classification framework to automatically perform a pixel-wise classification of an entire CT volume (abdomen and pelvis) into three classes namely right adrenal, left adrenal, and background. Once we obtain this classification, we perform histogram analysis to detect adrenal abnormality. The combination of these methods resulted in a sensitivity and specificity of 80 and 90 %, respectively, when analyzing 20 adrenal glands seen on volumetric CT datasets for abnormality.

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Distinguishing Benign from Malignant Adrenal Masses: Multi–Detector Row CT Protocol with 10-Minute Delay

Abstract: Precontrast attenuation of less than 0 HU supercedes the washout profile in the evaluation of an individual adrenal mass. Noncalcified, nonhemorrhagic adrenal lesions with precontrast attenuation of more than 43 HU should be considered suspicious for malignancy.

Cited by 240 publications

References 28 publications

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Diagnostic utility of diffusion‐weighted MR imaging and apparent diffusion coefficient value for the diagnosis of adrenal tumors

Adrenal Gland Abnormality Detection Using Random Forest Classification

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