Predictive model of pheochromocytoma based on the imaging features of the adrenal tumours

Abstract

The purpose of our study was to develop a predictive model to rule out pheochromocytoma among adrenal tumours, based on unenhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) features. We performed a retrospective multicentre study of 1131 patients presenting with adrenal lesions including 163 subjects with histological confirmation of pheochromocytoma (PHEO), and 968 patients showing no clinical suspicion of pheochromocytoma in whom plasma and/or urinary metanephrines and/or catecholamines were within reference ranges (non-PHEO). We found that tumour size was significantly larger in PHEO than non-PHEO lesions (44.3 ± 33.2 versus 20.6 ± 9.2 mm respectively; P < 0.001). Mean unenhanced CT attenuation was higher in PHEO (52.4 ± 43.1 versus 4.7 ± 17.9HU; P < 0.001). High lipid content in CT was more frequent among non-PHEO (83.6% versus 3.8% respectively; P < 0.001); and this feature alone had 83.6% sensitivity and 96.2% specificity to rule out pheochromocytoma with an area under the receiver operating characteristics curve (AUC-ROC) of 0.899. The combination of high lipid content and tumour size improved the diagnostic accuracy (AUC-ROC 0.961, sensitivity 88.1% and specificity 92.3%). The probability of having a pheochromocytoma was 0.1% for adrenal lesions smaller than 20 mm showing high lipid content in CT. Ninety percent of non-PHEO presented loss of signal in the “out of phase” MRI sequence compared to 39.0% of PHEO (P < 0.001), but the specificity of this feature for the diagnosis of non-PHEO lesions low. In conclusion, our study suggests that sparing biochemical screening for pheochromocytoma might be reasonable in patients with adrenal lesions smaller than 20 mm showing high lipid content in the CT scan, if there are no typical signs and symptoms of pheochromocytoma.

Elucidating the Role of Metabolic and Cardiovascular Risk Factors in Benign Adrenal Tumors

“…The diagnosis of adrenal tumors typically relies on CT and/or MRI imaging, as they offer high speci city [38] . However, most benign adrenal tumors are asymptomatic, and thus, clinically, these tumors are mostly incidentally detected through radiological examinations [39,40] . Due to their asymptomatic nature, this disease is often overlooked, and many asymptomatic or mildly symptomatic patients may not actively seek CT scans due to the expense and potential radiation risks associated with the procedure.…”

Risk prediction model establishment with tri-phasic CT image features for differential diagnosis of adrenal pheochromocytomas and lipid-poor adenomas: Grouping method

“…Through an extensive systematic search of relevant publications, we have developed the first prediction model for identifying PCCs from LPAs using the grouping method based on a relatively large sample. An earlier study ( 23 ) also established a predictive model for the distinction of PCCs from non−PCCs, which consisted of LRAs (CTu < 10 HU). However, our study excluded LRAs, because CTu < 10 HU on an unenhanced CT scan image was reliable to diagnose LRAs.…”

An Integrated CT and MRI Imaging Model to Differentiate between Adrenal Adenomas and Pheochromocytomas

“…This second group was extracted from the ADRENAL-PATHOLOGY database of the Ramón y Cajal Hospital [12]. Patients in the first group were selected from the PHEO-RISK study database, as previously described [13]. Patients of both groups were identified through a systematic electronic search in the Pathology, Endocrinology, Biochemistry, and/or Admission department files of the different hospitals (Figure 1).…”

“…As we have previously described [13], 163 patients with PHEO and 968 subjects with non-PHEO lesions were employed for the development of the PHEO predictive model. The combination of tumor size and high lipid content in the unenhanced CT scan achieved a diagnostic accuracy of 96.1% for the diagnosis of non-PHEO lesions (Figure 2).…”