Role of 18F-FDG PET/CT in the differential diagnosis of primary benign and malignant unilateral adrenal tumors

Abstract

Background: This retrospective study was performed to estimate the clinical role of whole-body positron emission tomography/computed tomography (PET/CT) using 2-[ 18 F] fluoro-2-deoxy-D-glucose (FDG) in the differential diagnosis of primary benign and malignant unilateral adrenal tumors. Methods: A total of 64 patients (31 male, 33 female; age range: 3-76 years, mean: 48.5) with a confirmed unilateral adrenal tumor underwent 18 F-FDG PET/CT examination for diagnosis and staging. The whole-body 18 F-FDG PET/CT examination excluded metastasis, and all patients were confirmed by operation and biopsy pathology. Their clinical data and pathological results were collected. On visual analysis of PET/CT imaging, adrenal uptake was based on a three-scale grading system. The region of interest (ROI) was delineated in the liver and the renal lesion site. Standardized uptake value (SUV) measurements were determined on a standardized reconstruction, and the maximum values (SUV max ) of the lesion and liver were measured. The ratio of tumor to the liver was defined as T/L. Visual interpretation, SUV max -receiver operating characteristics (ROC) method, and T/L-ROC method were used to analyze the diagnostic accuracy.Results: A total of 64 lesions (48 benign, 16 malignant lesions) were detected. The visual analysis found that 100% of Grade I cases were benign, 90.9% of Grade II cases were benign, and 65.1% of Grade III cases were benign. The SUV max of malignant lesions (10.0±5.8) was higher than that of benign lesions (5.4±5.3, P<0.05). The T/L was 3.39±1.79 for malignant lesions and 1.99±2.09 for benign lesions (P<0.05). In the differentiation of primary benign and malignant unilateral adrenal tumors, the sensitivity, specificity, and accuracy of the SUV max -ROC method (cut-off value =5.65) were 81.25%, 72.91%, 75.00%, and the positive and negative predictive values were 50.00% and 92.11%, respectively. The sensitivity, specificity, and accuracy of the T/L-ROC method (cut-off value =1.52) were 93.73%, 62.50%, 70.31%, and the positive and negative predictive values were 46.88% and 96.77%, respectively.Conclusions: 18 F-FDG PET/CT improved diagnostic accuracy in differentiating primary benign and malignant unilateral adrenal tumors. There was a high negative predictive value, and for positive prediction, other tracer imaging is needed for differential diagnosis.

Case report: Incidental MALT lymphoma of the left adrenal gland mimicking a metastatic spread within durvalumab maintenance treatment in inoperable stage III non-small cell lung cancer

“…Ma et al. displayed that SUVmax of malignant lesions (10.0 ± 5.8) was higher than that of benign lesions (5.4 ± 5.3, P < 0.05), and as a result of this finding, the SUV-ROC method has a sensitivity of 81.25% and specificity of 72.91% ( 23 ). Another study by Perry et al.…”

Personalized molecular visualization and radiotheranostics of adrenal tumors

“…ПЭТ/КТ с 18-фтор-дезоксиглюкозой ( 18 F-ФДГ) основан на разнице интенсивности метаболизма глюкозы между опухолевыми клетками и интактными тканями [52]. Изначально 18 F-ФДГ ПЭТ/КТ использовалась для дифференциальной диагностики добро-и злокачественных образований различной локализации (с уровнем чувствительности 92-100%, специфичности 80-100%) [53][54][55]. 18 F-ФДГ ПЭТ/КТ чаще всего используется в онкологии для визуализации, стадирования и мониторинга терапии.…”

“…Было продемонстрировано, что гормонально активные образования надпочечников характеризуются высоким захватом 18 F-ФДГ в сравнении с неактивными [55,[62][63][64], что открывает новые возможности РФП в оценке статуса как опухолей коры надпочечников, так и образований мозгового слоя [64][65][66]. На данный момент перед специалистами стоит задача в определении единой точки отсечения уровня захвата (SUVmax, Adrenal/Liver SUVmax) для дифференциальной диагностики между активными и неактивными опухолями коры надпочечников, и подобной точки для различия доброкачественных и злокачественных ФХ [67].…”

Quantitative parameters of static imaging and fast kinetics imaging in 18F-FDG total-body PET/CT for the assessment of histological feature of pulmonary lesions

“…As an accurate noninvasive imaging method, positron emission tomography/computed tomography (PET/CT) with 2-[ 18 F]-fluoro-2-deoxy-D-glucose ( 18 F-FDG) has received widespread clinical recognition for the diagnosis and evaluation of pulmonary lesions ( 2 - 4 ). In clinical practice, a PET/CT examination is currently mainly performed as static imaging, and the data are evaluated in units of standardized uptake value (SUV) ( 5 , 6 ). However, due to factors such as plasma glucose level, body composition, lesion type, and scan time, the semiquantitative indicator SUV not only always has great variability but also low specificity for malignant lesions ( 7 , 8 ).…”