Differentiation of Adrenal Adenomas From Metastases With Unenhanced Computed Tomography

Gufler, Hubert; Eichner, Gerrit; Großmann, Annette; Krentz, Helga; Schulze, Christian Georg; Sauer, Sabine; Grau, Gabriele

doi:10.1097/00004728-200411000-00015

Cited by 16 publications

(7 citation statements)

References 16 publications

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“…Some have also suggested using combinations of these parameters, but to our knowledge, neither the independent nor the multivariate performance of the parameters has been evaluated. Various descriptive radiologic features, such as the characteristics of the lesion margin and internal morphology, have also been explored as potential discriminators [14, 15]. …”

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confidence: 99%

Utility of Intermediate-Delay Washout CT Images for Differentiation of Malignant and Benign Adrenal Lesions: A Multivariate Analysis

Altınmakas

Wei

et al. 2018

American Journal of Roentgenology

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OBJECTIVE. The objective of this study was to identify features that impact the diagnostic performance of intermediate-delay washout CT for distinguishing malignant from benign adrenal lesions. MATERIALS AND METHODS. This retrospective study evaluated 127 pathologically proven adrenal lesions (82 malignant, 45 benign) in 126 patients who had undergone portal venous phase and intermediate-delay washout CT (1–3 minutes after portal venous phase) with or without unenhanced images. Unenhanced images were available for 103 lesions. Quantitatively, lesion CT attenuation on unenhanced (UA) and delayed (DL) images, absolute and relative percentage of enhancement washout (APEW and RPEW, respectively), descriptive CT features (lesion size, margin characteristics, heterogeneity or homogeneity, fat, calcification), patient demographics, and medical history were evaluated for association with lesion status using multiple logistic regression with stepwise model selection. Area under the ROC curve (Az) was calculated from both univariate and multivariate analyses. The predictive diagnostic performance of multivariate evaluations was ascertained through cross-validation. RESULTS. Az for DL, APEW, RPEW, and UA was 0.751, 0.795, 0.829, and 0.839, respectively. Multivariate analyses yielded the following significant CT quantitative features and associated Az when combined: RPEW and DL (Az = 0.861) when unenhanced images were not available and APEW and UA (Az = 0.889) when unenhanced images were available. Patient demographics and presence of a prior malignancy were additional significant factors, increasing Az to 0.903 and 0.927, respectively. The combined predictive classifier, without and with UA available, yielded 85.7% and 87.3% accuracies with cross-validation, respectively. CONCLUSION. When appropriately combined with other CT features, washout derived from intermediate-delay CT with or without additional clinical data has potential utility in differentiating malignant from benign adrenal lesions.

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confidence: 99%

Utility of Intermediate-Delay Washout CT Images for Differentiation of Malignant and Benign Adrenal Lesions: A Multivariate Analysis

Altınmakas

Wei

et al. 2018

American Journal of Roentgenology

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“…2,9 Moreover, currently there is no imaging modality available that allows the distinction between adrenal adenoma and adrenal metastasis with 100% diagnostic accuracy. 10 Therefore, in the absence of other metastasis, a patient with synchronous colorectal carcinoma and suspicious adrenal tumor should have both lesions resected to achieve a cure.…”

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confidence: 99%

Synchronous Laparoscopic Resection of Colorectal and Renal/Adrenal Neoplasms

Lee²,

Yiu³

et al. 2007

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Synchronous laparoscopic resections of coexisting abdominal diseases are shown to be feasible without additional postoperative morbidity. We report our experience with synchronous laparoscopic resection of colorectal carcinoma and renal/adrenal neoplasms with an emphasis on surgical and oncologic outcomes. Five patients diagnosed to have synchronous colorectal carcinoma and renal/adrenal neoplasms (renal cell carcinoma in 2 patients, adrenal cortical adenoma in 2 patients, and adrenal metastasis in 1 patient) underwent synchronous laparoscopic resection. The median operative time was 420 minutes and the median operative blood loss was 1000 mL. Three patients developed minor complications, including wound infection in 2 patients and retention of urine in 1 patient. There was no operative mortality. The median duration of hospital stay was 11 days. At a median follow-up of 17.6 months, no patient developed recurrence of disease. Synchronous laparoscopic resection of colorectal and renal/adrenal neoplasms is technically feasible and safe.

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“…CT characteristics used for scoring are combined morphologic criteria with the density measurements on NECT proposed by Gufler et al 3 The total score is obtained by adding 10% of the density values to the size in centimeters, plus 2 if the contour of the lesion is blurred and plus 1 if the structure is inhomogeneous. Score of less than 7 is taken as benign and more than or equal to 7 as malignant.…”

Section: Methodsmentioning

confidence: 99%

“…This is in concordance with previous study by Gufler et al, who proposed the scoring which we have adopted for our study. 3 The total score is obtained by adding 10% of the density values to the size in centimeters, plus 2 if the contour of the lesion is blurred and plus 1 if the structure is inhomogeneous. The highest predictive power was calculated at a cutoff value of 7.05, with 100% sensitivity and 96.8% specificity for the detection of metastasis.…”

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confidence: 99%

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

Prasanth¹,

Kandanga

Ambooken

et al. 2018

Int J Adv Med

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INTRODUCTIONCharacterizing adrenal lesions in patients with a known primary malignancy has a vital role in treatment and prognostication. Approximately 40-57% of adrenal incidentalomas are benign in these patients. 1 The prevalence of adrenal metastases in patients with known primary malignancy ranges between 32% and 73% in different series.2 CT, MRI and FDG PET are widely used to characterize adrenal lesions.In a retrospective study by Gufler et al, the combined morphologic criteria with the density measurements on NECT, found a high accuracy in differentiating adrenal adenomas from metastases in patients with a known malignancy.3 They proposed a scoring system based on density, contour, homogeneity and size.This study evaluates the sensitivity and specificity of this NECT scoring system and comparing it with that of 18F FDG PET. ABSTRACTBackground: 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.

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Differentiation of Adrenal Adenomas From Metastases With Unenhanced Computed Tomography

Cited by 16 publications

References 16 publications

Utility of Intermediate-Delay Washout CT Images for Differentiation of Malignant and Benign Adrenal Lesions: A Multivariate Analysis

Utility of Intermediate-Delay Washout CT Images for Differentiation of Malignant and Benign Adrenal Lesions: A Multivariate Analysis

Synchronous Laparoscopic Resection of Colorectal and Renal/Adrenal Neoplasms

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

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