Can Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT?

Tu, Wendy; Verma, Raman; Krishna, Satheesh; McInnes, Matthew D. F.; Flood, Trevor A.; Schieda, Nicola

doi:10.2214/ajr.17.19276

Cited by 19 publications

(19 citation statements)

References 51 publications

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“…In our study, T2-weighted SI was also significantly lower in lipid-poor adenomas compared with a large group of adrenal metastases from various primary malignancies using both subjective and quantitative assessment with a five-point Likert scale and through the measurement of a simple T2weighted SI ratio. The use of texture analysis in adrenal assessment has been predominantly applied in CT, with few studies evaluating texture features of adrenal masses on MR images (24,(45)(46)(47)(48)(49)(50). In our study, both qualitative and quantitative analyses of tumor heterogeneity revealed that metastases were significantly more heterogeneous compared with lipid-poor adenomas, which is comparable to a prior study which compared adrenal metastases from renal cell carcinoma and adenomas at T2-weighted MRI (21).…”

Section: Discussionsupporting

confidence: 81%

“…T2-weighted SI and heterogeneity may be very useful in cases of renal cell carcinoma and hepatocellular carcinomas, as metastases may show microscopic fat simulating lipid-rich adenomas at chemical shift MRI (8,51) and because both tumors are hypervascular and may wash out into the adenoma range at washout CT examinations (52). When using CT, tumor heterogeneity has been found to be a consistently useful feature, with metastases demonstrating increased heterogeneity compared with adenomas (24,45). In a study examining the apparent diffusion coefficient histogram analysis in adrenal nodules, heterogeneity was found to be significantly lower for adenomas compared with pheochromocytomas (48).…”

Section: Discussionmentioning

confidence: 99%

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Utility of T2-weighted MRI to Differentiate Adrenal Metastases from Lipid-Poor Adrenal Adenomas

Abreu‐Gomez

Udare

et al. 2020

Radiology: Imaging Cancer

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Materials and Methods: With institutional review board approval, this study retrospectively compared 40 consecutive patients (mean age, 66 years 6 10 [standard deviation]) with metastases to 23 patients (mean age, 60 years 6 15) with lipid-poor adenomas at 1.5and 3-T MRI between June 2016 and March 2019. A blinded radiologist measured T2-weighted signal intensity (SI) ratio (SI nodule / SI psoas muscle), T2-weighted histogram features, and chemical shift SI index. Two blinded radiologists (radiologist 1 and radiologist 2) assessed T2-weighted SI and T2-weighted heterogeneity using five-point Likert scales. Results: Subjectively, T2-weighted SI (P , .001 for radiologist 1 and radiologist 2) and T2-weighted heterogeneity (P , .001, for radiologist 1 and radiologist 2) were higher in metastases compared with adenomas when assessed by both radiologists. Agreement between the radiologists was substantial for T2-weighted SI (Cohen k = 0.67) and T2-weighted heterogeneity (k = 0.62). Metastases had higher T2-weighted SI ratio than adenomas (3.6 6 1.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Utility of T2-weighted MRI to Differentiate Adrenal Metastases from Lipid-Poor Adrenal Adenomas

Abreu‐Gomez

Udare

et al. 2020

Radiology: Imaging Cancer

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“…CT attenuation value (Tu et al 2018), rim enhancement and the presence of irregular margins were not found to differentiate significantly between adenomas and malignant lesions (Tu et al 2018). However, adenomas exhibit less than 10 Hounsfield Units (HU) on the unenhanced CT or show significant contrast washout (>60% absolute washout or >40% relative washout) (Park et al 2012, Wale et al 2017, Tu et al 2018. On MRI, adenomas exhibit high intracellular lipid content with a chemical-shift index greater than 15% (McCarthy et al 2016) (Fig.…”

Section: Imagingmentioning

confidence: 99%

“…The radiological distinction of adrenal metastases from an adenoma on CT imaging is based on tumour size and heterogeneity, these features exhibiting high specificity but low sensitivity. CT attenuation value (Tu et al 2018), rim enhancement and the presence of irregular margins were not found to differentiate significantly between adenomas and malignant lesions (Tu et al 2018). However, adenomas exhibit less than 10 Hounsfield Units (HU) on the unenhanced CT or show significant contrast washout (>60% absolute washout or >40% relative washout) (Park et al 2012, Wale et al 2017, Tu et al 2018.…”

Section: Imagingmentioning

confidence: 99%

Neoplastic metastases to the endocrine glands

Angelousi

Alexandraki

Kyriakopoulos

et al. 2020

Endocrine-Related Cancer

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Endocrine organs are metastatic targets for several primary cancers, either through direct extension from nearby tumour cells or dissemination via the venous, arterial and lymphatic routes. Although any endocrine tissue can be affected, most clinically relevant metastases involve the pituitary and adrenal glands with the commonest manifestations being diabetes insipidus and adrenal insufficiency respectively. The most common primary tumours metastasing to the adrenals include melanomas, breast and lung carcinomas, which may lead to adrenal insufficiency in the presence of bilateral adrenal involvement. Breast and lung cancers are the most common primaries metastasing to the pituitary, leading to pituitary dysfunction in approximately 30% of cases. The thyroid gland can be affected by renal, colorectal, lung and breast carcinomas, and melanomas, but has rarely been associated with thyroid dysfunction. Pancreatic metastasis can lead to exo-/endocrine insufficiency with renal carcinoma being the most common primary. Most parathyroid metastases originate from breast and lung carcinomas and melanoma. Breast and colorectal cancers are the most frequent ovarian metastases; prostate cancer commonly affects the testes. In the presence of endocrine deficiencies, glucocorticoid replacement for adrenal and pituitary involvement can be life saving. As most metastases to endocrine organs develop in the context of disseminated disease, surgical resection or other local therapies should only be considered to ameliorate symptoms and reduce tumour volume. Although few consensus statements can be made regarding the management of metastases to endocrine tissues because of the heterogeneity of the variable therapies, it is important that clinicians are aware of their presence in diagnosis.

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“…Concerning adrenal lesions, CTTA has shown some promise in differentiating malignant from benign lesions. However, external validity of the findings in relation to lung cancer is hampered by small samples, single-center design, or non-lung cancer population [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Metastases or benign adrenal lesions in patients with histopathological verification of lung cancer: Can CT texture analysis distinguish?

Andersen

Bødtger

Andersen

et al. 2021

European Journal of Radiology

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Introduction: Distant metastases are found in the many of patients with lung cancer at time of diagnosis. Several diagnostic tools are available to distinguish between metastatic spread and benign lesions in the adrenal gland. However, all require additional diagnostic steps after the initial CT. The purpose of this study was to evaluate if texture analysis of CT-abnormal adrenal glands on the initial CT correctly differentiates between malignant and benign lesions in patients with confirmed lung cancer. Materials and methods: In this retrospective study 160 patients with endoscopic ultrasound-guided biopsy from the left adrenal gland and a contrast-enhanced CT in portal venous phase were assessed with texture analysis. A region of interest encircling the entire adrenal gland was used and from this dataset the slice with the largest cross section of the lesion was analyzed individually. Results: Several texture parameters showed statistically significantly difference between metastatic and benign lesions but with considerable between-groups overlaps in confidence intervals. Sensitivity and specificity were assessed using ROC-curves, and in univariate binary logistic regression the area under the curve ranged from 36 % (Kurtosis 0.5) to 69 % (Entropy 2.5) compared to 73 % in the best fitting model using multivariate binary logistic regression. Conclusion:In lung cancer patients with abnormal adrenal gland at imaging, adrenal gland texture analyses appear not to have any role in discriminating benign from malignant lesions.

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Can Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT?

Abstract: Adrenal metastases cannot be reliably differentiated from adenomas at single-phase contrast-enhanced CT. Increased tumor size and heterogeneity were specific findings but showed unacceptably low sensitivity.

Cited by 19 publications

References 51 publications

Utility of T2-weighted MRI to Differentiate Adrenal Metastases from Lipid-Poor Adrenal Adenomas

Utility of T2-weighted MRI to Differentiate Adrenal Metastases from Lipid-Poor Adrenal Adenomas

Neoplastic metastases to the endocrine glands

Metastases or benign adrenal lesions in patients with histopathological verification of lung cancer: Can CT texture analysis distinguish?

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