PET/CT for the Characterization of Adrenal Masses in Patients with Cancer: Qualitative Versus Quantitative Accuracy in 150 Consecutive Patients

Boland, Giles W.; Blake, Michael A.; Holalkere, Nagaraj-Setty; Hahn, Peter F.

doi:10.2214/ajr.08.1431

Cited by 150 publications

(109 citation statements)

References 24 publications

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“…Boland et al found that PET CT had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 99%, 100%, 100%, 93% and 99% for the detection of benign lesions and 100%, 99%, 93% and 100% respectively, for the detection of malignancy. 24 In our study, while the specificity of both NECT scoring system and FDG PET in characterizing adrenal lesions were found to be same, the sensitivity of both had difference which is statistically significant (p value 0.0124). Therefore, it can be said that even if the NECT <7, we have to go for additional imaging, but if the NECT score is >7 we can confidently conclude that it is metastasis.…”

supporting

confidence: 42%

Characterization of adrenal masses with non-enhanced CT and 18F FDG-PET in patients with primary malignancies

Prasanth¹,

Kandanga

Ambooken

et al. 2018

Int J Adv Med

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INTRODUCTIONCharacterizing adrenal lesions in patients with a known primary malignancy has a vital role in treatment and prognostication. Approximately 40-57% of adrenal incidentalomas are benign in these patients. 1 The prevalence of adrenal metastases in patients with known primary malignancy ranges between 32% and 73% in different series.2 CT, MRI and FDG PET are widely used to characterize adrenal lesions.In a retrospective study by Gufler et al, the combined morphologic criteria with the density measurements on NECT, found a high accuracy in differentiating adrenal adenomas from metastases in patients with a known malignancy.3 They proposed a scoring system based on density, contour, homogeneity and size.This study evaluates the sensitivity and specificity of this NECT scoring system and comparing it with that of 18F FDG PET. ABSTRACTBackground: Characterizing adrenal lesions in patients with a known primary malignancy has a vital role in treatment and prognostication. A study by Gufler et al proposed a scoring system based on density, contour, homogeneity and size and found a high accuracy in differentiating adrenal adenomas from metastasis in patients with a known malignancy. This study evaluates the sensitivity and specificity of this NECT scoring system and comparing it with that of 18F FDG PET. Methods: The study was conducted on patients with diagnosed malignancies with adrenal mass, referred for 18F-FDG PET-CT scanning as a part of work up or follows up between October 2014 and March 2016. Whole-body CT and PET images were obtained using standard protocol. NECT scoring and quantitative analysis of FDG uptake in the adrenal lesions (SUVavg analysis) is done separately. Results: Of the 50 patients studied, 33 patients had benign adrenal lesions and the rest had metastatic lesions. Most common site of primary was lung. NECT score yielded a sensitivity of 88.2%, specificity of 100% and positive predictive value of 100%. SUVavg analysis yielded a 100% sensitivity, specificity and positive predictive value. Comparison of the predictive power of the two tests showed a z score of 2.5 and p value of 0.0124. Conclusions: 18-FDG PET can be considered as a gold standard for differentiating between metastasis and benign lesions of adrenal glands in patients with known primary. NECT has a comparable specificity as that of FDG PET, however with lower sensitivity.

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supporting

confidence: 42%

Characterization of adrenal masses with non-enhanced CT and 18F FDG-PET in patients with primary malignancies

Prasanth¹,

Kandanga

Ambooken

et al. 2018

Int J Adv Med

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“…More recent studies have confirmed the high sensitivity of PET/CT in detecting malignant lesions but the specificity is lower (87-97%). This loss of specificity is attributable to a small number of adenomas and other benign lesions that can have increased uptake, thereby mimicking malignant lesions [3,4]. Depending on the primary tumor, CT or PET/CT is a useful first-line exam to stage a known neoplasm.…”

Section: Staging Patients With Known Underlying Extra-adrenal Malignancymentioning

confidence: 99%

“…The objectives of this chapter are as follows: (1) to describe the different workups for adrenal masses, depending on the clinical scenario, (2) define adrenal incidentaloma, (3) describe the imaging techniques to differentiate benign from malignant adrenal masses, and (4) discuss the recommended imaging algorithms of workup of an incidental adrenal mass. The adrenal gland is made up of the catecholamineproducing medulla and the steroid-producing cortex.…”

Section: Introductionmentioning

confidence: 99%

Adrenal Imaging

Francis¹,

Mayo-Smith²

2018

IDKD Springer Series

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“…A normal adrenal gland usually has mild uptake of 0.95 to 2.46 peak standardized uptake values (SUVmax), which is visually lower than that of the background of liver [46] . Although quantitative analyses with SUV have been shown to be useful, visual quantitative analyses are as effective [47] . One reason is that SUV measurements are subject to many sources of variability, including scanning acquisition technique and volume averaging [45] .…”

mentioning

confidence: 99%

“…A study found that when an SUVmax cut-off value of 3.1 was used, the sensitivity was 98.5% and the specificity was 92% [48] . However, adrenal lesions with visual and quantitative uptake equal to or higher than those of the liver are problematic, with a specificity of 88% to 94% [47,49] . In addition, although the SUVmax for adenomas tends to be lower than that for metastases, there remains overlap; thus, another quantification method of the ratio of SUV of the adrenal mass to liver was created to eliminate background tracer uptake in the adrenal lesion [2] .…”

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confidence: 99%

Cross-sectional imaging work-up of adrenal masses

Korivi

Elsayes²

2013

WJR

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Advances in medical imaging with current cross-section modalities enable non-invasive characterization of adrenal lesions. Computed tomography (CT) provides characterization with its non-contrast and wash-out features. Magnetic resonance imaging (MRI) is helpful in further characterization using chemical shift imaging (CSI) and MR spectroscopy. For differentiating between benign and malignant masses, positron emission tomography (PET) imaging is useful with its qualitative analysis, as well as its ability to detect the presence of extra-adrenal metastases in cancer patients. The workup for an indeterminate adrenal mass includes evaluation with a non-contrast CT. If a lesion is less than 10 Hounsfield Units on a non-contrast CT, it is a benign lipid-rich adenoma and no further work-up is required. For the indeterminate adrenal masses, a lipid-poor adenoma can be differentiated from a metastasis utilizing CT wash-out features. Also, MRI is beneficial with CSI and MR spectroscopy. If a mass remains indeterminate, PET imaging may be of use, in which benign lesions demonstrate low or no fluorodeoxyglucose activity. In the few cases in which adrenal lesions remain indeterminate, surgical sampling such as percutaneous biopsy can be performed.

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PET/CT for the Characterization of Adrenal Masses in Patients with Cancer: Qualitative Versus Quantitative Accuracy in 150 Consecutive Patients

Cited by 150 publications

References 24 publications

Characterization of adrenal masses with non-enhanced CT and 18F FDG-PET in patients with primary malignancies

Characterization of adrenal masses with non-enhanced CT and 18F FDG-PET in patients with primary malignancies

Adrenal Imaging

Cross-sectional imaging work-up of adrenal masses

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