Distinguishing Adrenal Adenomas from Nonadenomas: Combined Use of Diagnostic Parameters of Unenhanced and Short 5-minute Dynamic Enhanced CT Protocol

Kamiyama, Takuro; Fukukura, Yoshihiko; Yoneyama, T.; Takumi, Koji; Nakajo, Masayuki

doi:10.1148/radiol.2502080302

Cited by 62 publications

(64 citation statements)

References 17 publications

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“…• Included: We identified 37 studies for inclusion in the systematic review (49,52,61,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112), with only 18 of them fulfilling the criteria for inclusion in the actual meta-analysis (61,79,80,81,82,83,84,85,86,87,88,89,90,91...…”

Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)mentioning

confidence: 99%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,254

1,571

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By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected recommendations: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1 mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50 nmol/L (1.8 µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1 mg dexamethasone >138 nmol/L (>5 µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients www.eje-online.org European Journal of Endocrinology175:2 G2 Clinical Practice Guideline M Fassnacht and others ESE and ENSAT guideline on adrenal incidentalomawith an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal inciden...

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Section: Assessment Of the Risk Of Malignancy By Imaging (Question 1a)mentioning

confidence: 99%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,254

1,571

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“…It is useful only if delayed scans with washout characteristics are performed. Adenomas show a rapid washout of contrast medium in comparison with primary carcinomas, metastases, and phaeochromocytomas in which washout of contrast medium is slower [65][66][67][68] . An absolute washout of more than 60% and a relative washout of more than 40% is indicative of adenoma; conversely, values of absolute washout below 60% and those of relative washout below 40% correspond to non-adenomas (carcinoma, metastases, phaeochromocytoma) (ref.…”

Section: Adrenal Incidentalomasmentioning

confidence: 99%

“…[69][70][71] ). The sensitivity, specificity, and accuracy of washout characteristics in distinguishing adenoma from malignancy are 89-98%, 92-95%, and 91-96%, respectively 40,68,[72][73][74][75][76][77] . Calculation of absolute or relative reduction in density can thus be used to distinguish adenomas from non-adenomas.…”

Section: Adrenal Incidentalomasmentioning

confidence: 99%

Adrenal disease: a clinical update and overview of imaging. A review

Čtvrtlík¹,

Koranda²,

Tichý³

2014

BIOMED PAP

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Aim. The aim of this article is to provide an overview of the most frequent clinically significant adrenal diseases and to describe the latest trends in their diagnostics, particularly by means of imaging techniques. Methods. The authors reviewed standard textbooks and subsequently conducted a search using the PubMed (Public/ Publisher MEDLINE) electronic database by the year 2013 with the following search terms: adrenal masses, adrenal adenoma, phaeochromocytoma, adrenocortical carcinoma, metastases, incidentalomas, hypercortisolism, hyperaldosteronism. Results. If adrenal disease is clinically suspected, hormone tests are performed to detect adrenal hyperfunction and imaging studies are used to assess the nature of adrenal lesion. The most frequent syndromes include hypercortisolism, primary hyperaldosteronism, and phaeochromocytoma. The clinically most significant pathologies of the adrenal glands are adenomas and adrenal hyperplasia, adrenocortical carcinomas, phaeochromocytomas, and metastases. Given the availability and improved quality of imaging techniques, adrenal incidentalomas are detected increasingly often. In these cases, it is necessary to rule out hormonal activity and malignancy. Incidentalomas can be associated with clinical syndromes of adrenal hormone overproduction. In most cases, they are clinically silent. In some cases, the definitive diagnosis can be determined as early as during the initial examination with an imaging technique (most frequently, a CT scan). If the finding is inconsistent, other imaging techniques can be used: CT contrast washout analysis, MRI, SPECT or PET/CT. Conclusion. In the case of adrenal gland disorders, correct interpretation of the results of laboratory tests and imaging studies is essential for further management of these patients.

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“…An adrenal mass can be characterized as an adenoma if the lesion measures <10 Hounsfield units (HU) or has negative pixel values on histogram analysis (Fig. 1g) (2)(3)(4)17,18,25,(32)(33)(34)(35). If an unenhanced CT has characterized an adrenal mass as an adenoma, then a subsequent MR is not needed for further evaluation.…”

Section: Magnetic Resonance Imaging (Mri) Techniquesmentioning

confidence: 99%

“…The details of washout CT kinetics is discussed elsewhere (34,(57)(58)(59). In brief, adenomas tend to lose greater CT attenuation than nonadenomas on imaging performed between 1 and 15 minutes after iodine contrast administration.…”

Section: Gadolinium-enhanced Imagingmentioning

confidence: 99%

Adrenal MRI: Techniques and clinical applications

Siegelman

2012

Magnetic Resonance Imaging

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Distinguishing Adrenal Adenomas from Nonadenomas: Combined Use of Diagnostic Parameters of Unenhanced and Short 5-minute Dynamic Enhanced CT Protocol

Abstract: Combining the diagnostic parameters of the CT protocol can yield diagnostic results comparable to those with previously reported longer dynamic enhanced CT protocols.

Cited by 62 publications

References 17 publications

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Adrenal disease: a clinical update and overview of imaging. A review

Adrenal MRI: Techniques and clinical applications

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