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

Authors

  • Prasanth P. S. Department of Radiology, SUT Academy of Medical Sciences, Thiruvananthapuram, Kerala, India
  • Indu Kandanga Department of Radiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
  • Robert P. Ambooken Department of Radiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
  • Priya P. Sankaran Department of Radiology, Kasturba Medical College, Manipal, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20180069

Keywords:

Adrenal lesion, NECT, Non-adrenal primary, 18 FDG PET

Abstract

Background: 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.

References

Dunnick NR, Korobkin M. Imaging of adrenal incidentalomas: current status. AJR. 2002;179:559-68.

Terzolo M, Bovio S, Pia A, Reimondo G, Angeli A. Management of adrenalin cidentaloma. Best Pract Res Clin Endocrinol Metab. 2009;23:233-24.

Gufler H, Eichner G, Grossmann A, Krentz H, Schulze CG, Sauer S, et al. Differentiation of adrenal adenomas from metastases with unenhanced computed tomography. J Comput Assist Tomogr. 2004;28(6):818-22.

Lee MJ, Hahn PF, Papanicolaou N, Egglin TK, Saini S, Mueller PR, et al. Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size, and observer analysis. Radiology. 1991;179(2):415-8.

Korobkin M, Giordano TJ, Brodeur FJ, Francis IR, Siegelman ES, Quint LE, et al. Adrenal adenomas: relationship between histologic lipid and CT and MR findings. Radiology. 1996;200(3):743-7.

Korobkin M, Brodeur FJ, Francis IR, Quint LE, Dunnick NR, Londy F. CT time-attenuation washout curves of adrenal adenomas and nonadenomas. AJR. 1998;170:747-52.

Szolar DH, Kammerhuber FH. Adrenal adenomas and nonadenomas: assessment of washout at delayed contrast-enhanced CT. Radiology. 1998;207:369-75.

Pena CS, Boland GW, Hahn PF, Lee MJ, Mueller PR. Characterization of indeterminate (lipid poor) adrenal masses: use of washout characteristics at contrastenhanced CT. Radiology. 2000;217:798-802.

Johnson PT, Horton KM, Fishman EK. Adrenal mass imaging with multidetector CT: pathologic conditions, pearls, and pitfalls. Radio Graphics. 2009;29:1333-51.

Caoili EM, Korobkin M, Francis IR, Cohan RH, Platt JF, Dunnick NR, et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology. 2002;222(3):629-33.

Fujiyoshi F, Nakajo M, Kukukura Y, Tsuchimochi S. Characterization of adrenal tumors by chemical shift fast-low angle shot MR imaging: comparison of four methods of quantitative evaluation. AJR. 2003;180:1649-57.

Chong S, Lee KS, Kim HY, Kim YK, Kim BT, Chung MJ, et al. Integrated PETCT for the Characterization of Adrenal Gland Lesions in Cancer Patients: Diagnostic Efficacy and Interpretation Pitfalls. RadioGraphics. 2006;26:1811-26.

Elaini AB, Shetty SK, Chapman VM, Sahani DV, Boland GW, Sweeney AT, et al. Improved detection and characterization of adrenal disease with PET-CT. Radiographics. 2007;27(3):755-67.

Boland GW, Goldberg MA, Lee MJ, Mayo-Smith WW, Dixon J, McNicholas MM, et al. Indeterminate adrenal mass in patients with cancer: evaluation at PET with 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology. 1995;194(1):131-4.

Erasmus JJ, Patz Jr EF, McAdams HP, Murray JG, Herndon J, Coleman RE, et al. Evaluation of adrenal masses in patients with bronchogenic carcinoma using 18F-fluorodeoxyglucose positron emission tomography. AJR. Am J Roentgenol. 1997;168(5):1357-60.

Maurea S, Mainolfi C, Bazzicalupo L, Panico MR, Imparato C, Alfano B, et al. Imaging of adrenal tumors using FDG PET: comparison of benign and malignant lesions. AJR. Am J Roentgenol. 1999;173(1):25-9.

Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A. 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med. 2000;42:1795-9.

Kumar R, Xiu Y, Jian QY, Takalkar A, El-Haddad G, Potenta S, et al. 18F-FDG PET in evaluation of adrenal lesions in patients with lung cancer. J Nu Med. 2004;45(12):2058-62.

Boland GW, Lee M, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR. 1998;171(1):201-4.

Maurea S, Mainolfi C, Bazzicalupo L, Panico MR, Imparato C, Alfano B, et al. Imaging of adrenal tumors using FDG PET: comparison of benign and malignant lesions. AJR. 1999;173(1):25-9.

Perri M, Erba P, Volterrani D, Guidoccio F, Lazzeri E, Caramella D, et al. Adrenal masses in patients with cancer: PET/CT characterization with combined CT histogram and standardized uptake value PET analysis. Ame J Roentgenol. 2011;197(1):209-16.

Metser U, Miller E, Lerman H, Lievshitz G, Avital S, Even-Sapir E. 18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med. 2006;47(1):32-7.

Brady MJ, Thomas J, Wong TZ, Franklin KM, Ho LM, Paulson EK. Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer: a proposal for an efficient diagnostic algorithm. Radiology. 2009;250:523-30.

Boland GW, Blake MA, Holalkere NS, Hahn PF. PET/CT for the characterization of adrenal masses in patients with cancer: qualitative versus quantitative accuracy in 150 consecutive patients. AJR. 2009;192:956-62.

Dong A, Cui Y, Wang Y, Zuo C, Bai Y. (18)F-FDG PET/CT of adrenal lesions. AJR Am J Roentgenol. 2014;203(2):245-52.

Shimizu A, Oriuchi N, Tsushima Y, Higuchi T, Aoki J, Endo K. High [18F] 2-fluoro-2-deoxy-D-glucose (FDG) uptake of adrenocortical adenoma showing subclinical Cushing's syndrome. Annals Nuc Med. 2003;17(5):403-6.

Lang BH, Cowling BJ, Li JY, Wong KP, Wan KY. High False Positivity in Positron Emission Tomography is a Potential Diagnostic Pitfall in Patients with Suspected Adrenal Metastasis. World J Surg. 2015;39(8):1902-8.

Jana S, Zhang T, Milstein DM, Isasi CR, Blaufox MD. FDG-PET and CT characterization of adrenal lesions in cancer patients. Eur J Nucl Med Mol Imaging. 2006;33(1):29-35.

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Published

2018-01-18

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Original Research Articles