18F-Fluorodeoxyglucose Positron Emission Tomography for the Diagnosis of Adrenocortical Tumors: A Prospective Study in 77 Operated Patients

Groussin, Lionel; Bonardel, G.; Silvera, S.; Tissier, Frédérique; Coste, Joël; Abiven, Gwenaelle; Libé, Rossella; Bienvenu, Marie; Alberini, Jean-Louis; Salenave, Sylvie; Bouchard, Philippe; Bertherat, Jérôme; Dousset, B.; Legmann, P.; Richard, Bruno; Fœhrenbach, H.; Bertagna, Xavier; Tenenbaum, Florence

doi:10.1210/jc.2008-2302

Cited by 196 publications

(142 citation statements)

References 37 publications

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“…Hormonal investigations were performed as previously reported (13,14). The tests commonly used were 24-h UFC, basal plasma adrenocorticotrophin (ACTH), late-night serum and/or salivary cortisol and 1 mg dexamethasone suppression test.…”

Section: Patientsmentioning

confidence: 99%

The 10 Hounsfield units unenhanced computed tomography attenuation threshold does not apply to cortisol secreting adrenocortical adenomas

Chambre

McMurray

Baudry

et al. 2015

European Journal of Endocrinology

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Context: Computed tomography (CT) unenhanced attenuation value of !10 Hounsfield units (HU) has an excellent specificity (98%) to diagnose lipid-rich adrenocortical adenomas (ACAs) with a weaker sensitivity (71%). Objective: To determine from a routine clinical perspective if unenhanced attenuation value is influenced by cortisol secretion in ACAs. Design: This was a retrospective study of cases collected between 2009 and 2012. Setting: This study was conducted in a tertiary-care university hospital. Patients: Seventy-two patients operated on for an ACA (Weiss score %2) were analysed. Thirty-four patients had an ACA oversecreting cortisol (Cush-ACA). Thirty-eight patients had an ACA without cortisol oversecretion (Non Hyper-ACA). Main outcome measure: CT unenhanced attenuation value was correlated with the functional status. The Weiss score items were analysed. Results: Among the 34 patients with a Cush-ACA a minority (nZ7) had an unenhanced attenuation value under 10 HU. Among the high precontrast density (O10 HU) Cush-ACAs, washout analysis after contrast administration was consistent with the benign nature of the tumor in w60% of the cases. Less than 25% clear cells (lipid-rich cells), a Weiss score item, was present in 50% of the Cush-ACAs in favour of a lipid-poor content. Conclusions: Unenhanced attenuation value has a poor sensitivity to diagnose an ACA in case of cortisol oversecretion due to poor lipid content. Nevertheless, the accuracy of washout analysis was preserved in the group of Cush-ACAs.

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Section: Patientsmentioning

confidence: 99%

The 10 Hounsfield units unenhanced computed tomography attenuation threshold does not apply to cortisol secreting adrenocortical adenomas

Chambre

McMurray

Baudry

et al. 2015

European Journal of Endocrinology

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“…In this case, several pre-operative findings were suggestive of a malignant neoplasm: multiple hormonal secretions (production of glucocorticoids and mineralocorticoids), tumor size O6 cm, an attenuation value higher than 10 HU on unenhanced CT scan, and a high 18 F-FDG uptake (3,(13)(14)(15). Recent studies demonstrated that a high 18 F-FDG uptake (an adrenalto-liver SUV max ratio over 1.45, 1.6, and 1.8 according to Groussin et al (14), Nunes et al (3), and Tessonnier et al (15), respectively) was predictive of an aggressive neoplasm (3,15).…”

Section: Discussionmentioning

confidence: 77%

Primary adrenal angiosarcoma and functioning adrenocortical adenoma: an exceptional combined tumor

Lepoutre-Lussey

Rousseau²,

Ghuzlan³

et al. 2012

European Journal of Endocrinology

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Context: Primary adrenal angiosarcoma is an extremely rare neoplasm, as are combined tumors within a given adrenal lesion. Clinical presentation and intervention: A 35-year-old man presented with hypokalemic hypertension leading to the discovery of a 6 cm diameter malignant-appearing right adrenal tumor. The lesion displayed marked 18 F-fluorodeoxyglucose uptake on positron emission tomography scanning. Endocrine investigations revealed secretion of both cortisol and aldosterone by the neoplasm. The entire right adrenal gland along with the periadrenal fat tissue was removed during laparoscopic surgery. Results: Histological examination revealed two intermingled tumor cell proliferations, namely an angiosarcoma and an adrenocortical adenoma. An extensive post-operative search revealed no other primary tumor site, nor metastases. The lesion was then considered to be a primary adrenal angiosarcoma combined with a secreting adrenocortical adenoma. The patient received four cycles of chemotherapy (adriamycin/ifosfamide). At 2-year follow-up, he is alive and well, with no sign of relapse. Conclusion: To the best of our knowledge, this is the first case of an adrenal neoplasm combining a primary angiosarcoma and a functioning adrenocortical adenoma.

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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%

Adrenal Imaging

Francis¹,

Mayo-Smith²

2018

IDKD Springer Series

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18F-Fluorodeoxyglucose Positron Emission Tomography for the Diagnosis of Adrenocortical Tumors: A Prospective Study in 77 Operated Patients

Abstract: In a multidisciplinary team approach, (18)F-FDG PET helps to manage suspicious CT scan lesions. An adrenal to liver maxSUV ratio less than 1.45 is highly predictive of a benign lesion.

Cited by 196 publications

References 37 publications

The 10 Hounsfield units unenhanced computed tomography attenuation threshold does not apply to cortisol secreting adrenocortical adenomas

The 10 Hounsfield units unenhanced computed tomography attenuation threshold does not apply to cortisol secreting adrenocortical adenomas

Primary adrenal angiosarcoma and functioning adrenocortical adenoma: an exceptional combined tumor

Adrenal Imaging

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