Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis

Platzek, Ivan; Sieroń, Dominik; Plodeck, Verena; Borkowetz, Angelika; Laniado, Michael; Hoffmann, Ralf‐Thorsten

doi:10.1007/s00330-018-5626-5

Cited by 37 publications

(21 citation statements)

References 40 publications

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“…MRI with chemical shift imaging should only be the first choice where CT is less desirable, for example during pregnancy, in children, or for patients with allergies to iodinated contrast (this is not an issue in noncontrast scans) ( 307 ). The use of chemical shift MRI to detect intracellular fat within lipid-rich adrenal adenomas and differentiate these from other lesions was first described in 1992 ( 310 ) ( Fig. 7 ).…”

Section: Imaging Evaluation Of An Aimentioning

confidence: 99%

“…There are both qualitative (visual analysis) and quantitative methods of imaging evaluation which involve assessing change in signal intensity of adrenal lesions between in-phase and out-of-phase sequences ( 309 ). A recent systematic review and meta-analysis reported that visual analysis and quantitative analysis of adrenal signal intensity index and adrenal-to-spleen ratio all have high accuracy for lipid-rich adenoma detection (95-98%), and diagnostic performance is not significantly improved by adrenal signal intensity index or the adrenal-to-spleen ratio ( 310 ). Consequently, if AIs are detected on MRI and findings are unambiguous for a benign lipid-rich adenoma further imaging may not be warranted.…”

Section: Imaging Evaluation Of An Aimentioning

confidence: 99%

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Adrenal Incidentaloma

et al. 2020

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An adrenal incidentaloma is now established as a common endocrine diagnosis that requires a multidisciplinary approach for effective management. The majority of patients can be reassured and discharged, but a personalized approach based upon image analysis, endocrine workup and clinical symptoms and signs are required in every case. ACC remains a real concern but is restricted to <2% of all cases. Functional AI lesions are commoner (but still probably <10% of total) and the greatest challenge remains the diagnosis and optimum management of autonomous cortisol secretion. Modern-day surgery has improved outcomes and novel radiological and urinary biomarkers will improve early detection and patient stratification in future years to come.

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Section: Imaging Evaluation Of An Aimentioning

confidence: 99%

Section: Imaging Evaluation Of An Aimentioning

confidence: 99%

Adrenal Incidentaloma

et al. 2020

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“…Attenuation characteristics by Hounsfield Unit (HU) of adrenal masses are generally accepted to differentiate adenomas from non-adenomas masses. Nevertheless, CT and MRI scanning cannot distinguish between adenomas with and without hormone secretion (15, 16, 17). Hence, in addition to the imaging findings, endocrinologic assessment of the adrenal masses is necessary as well as the issue of malignancy.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic efficacy of 18F-FDG PET/CT in patients with adrenal incidentaloma

Akkuş

Güney

et al. 2019

Endocrine Connections

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Background The management of adrenal incidentaloma is still a challenge with respect to determining its functionality (hormone secretion) and malignancy. In this light, we performed 18F-FDG PET/CT scan to assess the SUVmax values in different adrenal masses including Cushing syndrome, pheochromocytoma, primary hyperaldosteronism and non-functional adrenal adenomas. Methods Total 109 (73 F, 36 M) patients with adrenal mass (incidentaloma), mean age of 53.3 ± 10.2 years (range, 24–70) were screened by 18F-FDG PET/CT. Data of 18F-FDG PET/CT imaging of the patients were assessed by the same specialist. Adrenal masses were identified according to the calculated standardized uptake values (SUVs). Clinical examination, 24-h urine cortisol, catecholamine metabolites, 1-mg dexamethasone suppression test, aldosterone/renin ratio and serum electrolytes were analyzed. Results Based on the clinical and hormonal evaluations, there were 100 patients with non-functional adrenal mass, four with cortisol-secreting, four with pheochromocytomas and one with aldosterone-secreting adenoma. Mean adrenal mass diameter of 109 patients was 2.1 ± 4.3 (range, 1–6.5 cm). The 18F-FDG PET/CT imaging of the patients revealed that lower SUVmax values were found in non-functional adrenal masses (SUVmax 3.2) when compared to the functional adrenal masses including four with cortisol-secreting adenoma (SUVmax 10.1); four with pheochromcytoma (SUVmax 8.7) and one with aldosterone-secreting adenomas (SUVmax 3.30). Cortisol-secreting (Cushing syndrome) adrenal masses showed the highest SUVmax value (10.1), and a cut-off SUVmax of 4.135 was found with an 84.6% sensitivity and 75.6% specificity cortisol-secreting adrenal adenoma. Conclusions Consistent with the similar studies, non-functional adrenal adenomas typically do not show increased FDG uptake and a certain form of functional adenoma could present various FDG uptake in FDG PET/CT. Especially functional adrenal adenomas (cortisol secreting was the highest) showed increased FDG uptake in comparison to the non-functional adrenal masses. Therefore, setting a specific SUVmax value in the differentiation of malignant adrenal lesion from the benign one is risky and further studies, including a high number of functional adrenal mass are needed.

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“…Although the preferred imaging method for evaluating the adrenal gland is CT, MRI can be performed in some patients due to some clinical advantages, such as the absence of radiation exposure. T1 and T2 weighted imaging can help in benign malignant separation, moreover, MR with chemical shift imaging method can be used for this purpose [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Nonfunctional adrenal incidentalomas may be related to bisphenol-A

et al. 2020

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Purpose Bisphenol-A (BPA) is an endocrine-disrupting chemical that may affect the hormones and their receptors. The aim of this study is to determine whether BPA has an effect on the development of nonfunctional adrenal incidentaloma (NFAI). Methods Fifty patients who were admitted to endocrinology outpatient clinics and diagnosed as NFAI were included in the study. Fifty healthy people without adrenal mass and adrenal pathology in the upper abdominal computerized tomography or magnetic resonance imaging were also included as control group. Age, gender and body mass index of the study groups were similar. The serum samples for BPA were stored at −80 °C in refrigerator until working in the lab. Serum BPA levels were measured using ELISA technique. Results Mean serum BPA level was 7.06 ± 3.96 ng/ml in NFAI patients and 4.79 ± 3.01 ng/ml in control group. Serum BPA level was significantly higher in NFAI group than control group ( p = 0.001). Serum BPA levels were also found to be significantly higher in women with NFAI than in men with NFAI ( p = 0.019). Conclusions The mechanisms of NFAI development have not been clarified yet. Increased BPA exposure with developed industrialization may play a role in NFAI formation. For the reduction of BPA exposure, the use of plastic prepacked products, plastic containers, and safety measures are essential for public health.

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Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis

Abstract: • Inclusion of CSI in abdominal MRI protocols provides an effective solution for classifying adrenal masses discovered on MR exams • Visual evaluation of adrenal CSI is sufficient; use of quantitative indices does not improve diagnostic accuracy.

Cited by 37 publications

References 40 publications

Adrenal Incidentaloma

Adrenal Incidentaloma

Diagnostic efficacy of 18F-FDG PET/CT in patients with adrenal incidentaloma

Nonfunctional adrenal incidentalomas may be related to bisphenol-A

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