Distinction between benign and malignant adrenal masses: value of T1-weighted chemical-shift MR imaging.

Outwater, Eric K.; Siegelman, Evan S.; Radecki, Paul D.; Piccoli, Catherine W.; Mitchell, Donald G.

doi:10.2214/ajr.165.3.7645474

Cited by 180 publications

(80 citation statements)

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“…Because CT density values are related to tissue attenuation coefficients, fat containing structures will lower the measure ments of Hounsfield units more than other soft-tissuestructures, includingwater if fat is present in sufficient concentration. Korobkin et al [12] 18]. However, CT continues to remain the procedure of choice for evaluating adrenal massesbecauseof its widespread availability, high speed, and low cost.…”

Section: Discussionmentioning

confidence: 99%

Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature.

Boland¹,

Lee²,

Gazelle³

et al. 1998

American Journal of Roentgenology

615

156

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OBJECTIVE. Unenhanced CT scanning canreliablycharacterize incidentally detectedadrenal masses when observers use density measurements of the adrenal gland. However, con troversyexistsasto theoptimaldensitythresholdrequiredto differentiatebenignfrom malig nant lesions. This study attempts to establish a consensus by performing a pooled analysis of data found in the CT literature. MATERIALS AND METHODS. TenCT reports wereanalyzed, fromwhichindividualadrenal lesion density measurements were obtained for 495 adrenal lesions (272 benign le sionsand 223 malignantlesions).Thresholdanalysisgenerateda rangeof sensitivitiesand specificities for lesion characterization at different density thresholds. RESULTS.Sensitivity forcharacterizing a lesionasbenignranged from47% ata threshold of 2 H to 88% at a threshold of 20 H. Similarly, specificity varied from 100% at a thresh old of 2 H to 84% at a threshold of 20 H.

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Section: Discussionmentioning

confidence: 99%

Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature.

Boland¹,

Lee²,

Gazelle³

et al. 1998

American Journal of Roentgenology

615

156

View full text Add to dashboard Cite

show abstract

“…The studies reported quantitative or qualitative analysis of signal intensity loss in the adrenal lesions relative to reference tissues (liver, muscle, and spleen) on in-phase and opposed-phase sequences as means to differentiate adenomas from non-adenomas. The loss of signal on out-of-phase images in relation to spleen (to avoid the confounding of liver steatosis) differentiated adenomas from nonadenomas with a sensitivity of 84-100% and a specificity of 92-100% (37)(38)(39)(40). In general, adenomas appear as hypo-or iso-intense in comparison with the liver on T1-weighted images and hyper-or iso-intense to the liver on T2-weighted images.…”

Section: Epidemiologymentioning

confidence: 99%

AME Position Statement on adrenal incidentaloma

Terzolo

Stigliano

Chiodini

et al. 2011

European Journal of Endocrinology

449

423

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Objective: To assess currently available evidence on adrenal incidentaloma and provide recommendations for clinical practice. Design: A panel of experts (appointed by the Italian Association of Clinical Endocrinologists (AME)) appraised the methodological quality of the relevant studies, summarized their results, and discussed the evidence reports to find consensus. Radiological assessment: Unenhanced computed tomography (CT) is recommended as the initial test with the use of an attenuation value of %10 Hounsfield units (HU) to differentiate between adenomas and non-adenomas. For tumors with a higher baseline attenuation value, we suggest considering delayed contrast-enhanced CT studies. Positron emission tomography (PET) or PET/CT should be considered when CT is inconclusive, whereas fine needle aspiration biopsy may be used only in selected cases suspicious of metastases (after biochemical exclusion of pheochromocytoma). Hormonal assessment: Pheochromocytoma and excessive overt cortisol should be ruled out in all patients, whereas primary aldosteronism has to be considered in hypertensive and/or hypokalemic patients. The 1 mg overnight dexamethasone suppression test is the test recommended for screening of subclinical Cushing's syndrome (SCS) with a threshold at 138 nmol/l for considering this condition. A value of 50 nmol/l virtually excludes SCS with an area of uncertainty between 50 and 138 nmol/l. Management: Surgery is recommended for masses with suspicious radiological aspects and masses causing overt catecholamine or steroid excess. Data are insufficient to make firm recommendations for or against surgery in patients with SCS. However, adrenalectomy may be considered when an adequate medical therapy does not reach the treatment goals of associated diseases potentially linked to hypercortisolism.

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“…Usually, malignant masses are hypointense on T1-weighted images and hyperintense on T2-weighted images, with strong enhancement after contrast injection and delayed washout. More recent studies have used the lipid content of adenomas, which causes a loss in signal intensity on chemical-shift MRI (Outwater et al 1995(Outwater et al , 1996. However, MRI may be helpful in the diagnosis of pheochromocytoma, where it outperforms CT scanning.…”

Section: Imaging Of Adrenal Incidentalomamentioning

confidence: 99%

Adrenal incidentalomas — a continuing management dilemma

Nawar

Aron²

2005

Endocr Relat Cancer

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Adrenal incidentalomas (AI), adrenal tumors detected through an imaging procedure done for reasons unrelated to adrenal dysfunction, is becoming a common clinical problem with the more frequent utilization of different imaging techniques. Most such tumors are benign and hormonally inactive. A variety of diagnostic strategies have been developed to distinguish the latter; however, they are still controversial. Even after a commissioned systematic review of the literature and a state of the science conference sponsored by the National Institutes of Health, the optimal strategy for hormonal screening of a patient with AI is unknown, but we anticipate further refinements and major advances in the field. Surgery is the ultimate solution for the diagnostic-therapeutic dilemma of AI. Careful planning is required, and the learning curve which influences clinical decision making is especially relevant to immediate outcomes. The benefit of making a diagnosis of a clinically significant AI must be considered in the context of the patient's overall condition and preferences.

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Distinction between benign and malignant adrenal masses: value of T1-weighted chemical-shift MR imaging.

Abstract: OBJECTIVE.Accuracy

Cited by 180 publications

References 0 publications

Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature.

Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature.

AME Position Statement on adrenal incidentaloma

Adrenal incidentalomas — a continuing management dilemma

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