The role of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiating between benign and malignant adrenal lesions

Kara, Pelin Özcan; Kara, Taylan; Gedik, Gonca Kara; Kara, Fatih; Şahin, Özlem Öztürk; Günay, Emel Ceylan; Sarı, Oktay

doi:10.1097/mnm.0b013e32834199e7

Cited by 48 publications

(22 citation statements)

References 21 publications

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“…A definitive range of N is set with respect to the conventional values used in clinics such that SUV cut-off value of 2.5 (or 40 – 50% of SUV max ) corresponds to a sensitivity of 100% (Kara et al, 2011). By following the assumption that 40 – 50% of SUV max is of significance, N is selected to lie in the interval {2 – 2.5} in our implementation.…”

Section: Experiments and Resultsmentioning

confidence: 99%

Joint segmentation of anatomical and functional images: Applications in quantification of lesions from PET, PET-CT, MRI-PET, and MRI-PET-CT images

Bağcı

Udupa

Mendhiratta

et al. 2013

Medical Image Analysis

154

175

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We present a novel method for the joint segmentation of anatomical and functional images. Our proposed methodology unifies the domains of anatomical and functional images, represents them in a product lattice, and performs simultaneous delineation of regions based on random walk image segmentation. Furthermore, we also propose a simple yet effective object/background seed localization method to make the proposed segmentation process fully automatic. Our study uses PET, PET-CT, MRI-PET, and fused MRI-PET-CT scans (77 studies in all) from 56 patients who had various lesions in different body regions. We validated the effectiveness of the proposed method on different PET phantoms as well as on clinical images with respect to the ground truth segmentation provided by clinicians. Experimental results indicate that the presented method is superior to threshold and Bayesian methods commonly used in PET image segmentation, is more accurate and robust compared to the other PET-CT segmentation methods recently published in the literature, and also it is general in the sense of simultaneously segmenting multiple scans in real-time with high accuracy needed in routine clinical use.

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Section: Experiments and Resultsmentioning

confidence: 99%

Joint segmentation of anatomical and functional images: Applications in quantification of lesions from PET, PET-CT, MRI-PET, and MRI-PET-CT images

Bağcı

Udupa

Mendhiratta

et al. 2013

Medical Image Analysis

154

175

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show abstract

“…A cut-off value of 1,8 for the adrenal tumor-to-liver ratio corresponded to 87% sensitivity and 91% specificity whereas a cut-off value of 1,68 corresponded to 90% sensitivity and 91% specificity 2. However, the inherent problem in using uptake ratios, such as the adrenal tumor-to-liver ratio, is that the specificity in this assessment is impaired by the fact that some benign adrenal lesions also demonstrate a moderate to high 18 FDG uptake, such as benign and malignant pheochromocytomas that generally have a moderate to high 18 FDG uptake 25-26.…”

Section: Nuclear Medicine Imagingmentioning

confidence: 99%

“…Incidentalomas which at CT appear morphologically benign and measure ≤10HU in the pre-contrast CT examination can be diagnosed as a benign adrenocortical adenoma with 98-99% specificity 1-2. According to Swedish National guidelines benign adrenocortical adenomas measuring less than 3-4 cm in transaxial diameter generally require no further imaging or radiological follow-up but the routines in this respect varies in different countries.…”

Section: Radiological Imagingmentioning

confidence: 99%

Imaging of Adrenal Masses with Emphasis on Adrenocortical Tumors

Sundín¹

2012

Theranostics

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Because of the more widespread and frequent use of cross-sectional techniques, mainly computed tomography (CT), an increasing number of adrenal tumors are detected as incidental findings (“incidentalomas”). These incidentaloma patients are much more frequent than those undergoing imaging because of symptoms related to adrenal disease. CT and magnetic resonance imaging (MRI) are in most patients sufficient for characterization and follow-up of the incidentaloma. In a minor portion of patients, biochemical screening reveals a functional tumor and further diagnostic work-up and therapy need to be performed according to the type of hormonal overproduction. In oncological patients, especially when the morphological imaging criteria indicate an adrenal metastasis, biopsy of the lesion should be considered after pheochromocytoma is ruled out biochemically. In the minority of patients in whom CT and MRI fail to characterize the tumor and when time is of essence, functional imaging mainly by positron emission tomography (PET) is available using various tracers. The most used PET tracer, [18F]fluoro-deoxy-glucose (18FDG), is able to differentiate benign from malignant adrenal tumors in many patients. 11C-metomidate (11C-MTO) is a more specialized PET tracer that binds to the 11-beta-hydroxylase enzyme in the adrenal cortex and thus makes it possible to differ adrenal tumors (benign adrenocortical adenoma and adrenocortical cancer) from those of non-adrenocortical origin.

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“…A recent study confirms this almost maximum specificity and reports 65% sensitivity and 99% specificity [33]. The sensitivity to detect fat is comparably high by magnetic resonance imaging (MRI) using in-and out-of-phase sequences, and incidentalomas may therefore be characterized as benign adrenocortical adenomas also by this method [26,27].…”

Section: Introductionmentioning

confidence: 78%

Metomidate-Based Imaging of Adrenal Masses

Hahner

Sundín

2011

HORM CANC

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Due to broader use of conventional imaging techniques, adrenal tumors are detected with increasing frequency comprising a wide variety of different tumor entities. Despite improved conventional imaging techniques, a significant number of adrenal lesions remain that cannot be easily determined. A particular diagnostic challenge are lesions in patients with known extra-adrenal malignancy because these patients frequently harbor adrenal metastases. Furthermore, adrenal masses with low fat content and no detectable hormone excess are difficult to diagnose properly. Fine needle biopsy is invasive, often unsuccessful, and puts patients at risk, e. g., in cases of pheochromocytoma or adrenal cancer. Noninvasive characterization using radiotracers has therefore been established in recent years. (18)F-FDG PET helps to differentiate benign from malignant lesions. However, it does not distinguish between adrenocortical or nonadrenocortical lesions (e.g., metastases or adrenocortical carcinoma). More recently, enzyme inhibitors have been developed as tracers for adrenal imaging. Metomidate is most widely used. It binds with high specificity and affinity to CYP11B enzymes of the adrenal cortex. As these enzymes are exclusively expressed in adrenocortical cells, uptake of labeled metomidate tracers has been shown to be highly specific for adrenocortical neoplasia. (11)C-metomidate PET and (123)I-iodometomidate SPECT imaging has been introduced into clinical use. Both tracers not only distinguish between adrenocortical and nonadrenocortical lesions but are also able to visualize metastases of adrenocortical carcinoma. The very specific uptake has recently led to first application of (131)I-iodometomidate for radiotherapy in ACC. In conclusion, metomidate-based imaging is an important complementary tool to diagnose adrenal lesions that cannot be determined by other methods.

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The role of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiating between benign and malignant adrenal lesions

Cited by 48 publications

References 21 publications

Joint segmentation of anatomical and functional images: Applications in quantification of lesions from PET, PET-CT, MRI-PET, and MRI-PET-CT images

Joint segmentation of anatomical and functional images: Applications in quantification of lesions from PET, PET-CT, MRI-PET, and MRI-PET-CT images

Imaging of Adrenal Masses with Emphasis on Adrenocortical Tumors

Metomidate-Based Imaging of Adrenal Masses

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