Pheochromocytomas Versus Adenoma: Role of Venous Phase CT Enhancement

Mohammed, Mohammed F.; Elbanna, Khaled Y.; Ferguson, David; Harris, Alison; Khosa, Faisal

doi:10.2214/ajr.17.18472

Cited by 28 publications

(24 citation statements)

References 26 publications

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“…Many efforts have been made to further evaluate the nature of undetermined adrenal lesions using various imaging modalities, but with questionable outcome [6][7][8][9][10][11][12][13][14] . A correct diagnosis is especially important in pheochromocytomas 15,16 and adrenocortical carcinomas 17,18 since hormonal activity or early metastatic spread, respectively, can lead to significant morbidity and mortality [19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

Characteristic CT features of pheochromocytomas - probability model calculation tool based on a multicentric study

Čtvrtlík¹,

Tüdös²,

Szász³

et al. 2019

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Objectives. The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model. Methods. This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign"). Results. Pheochromocytomas have a significantly more spherical shape (P<0.001), whereas an elliptical shape significantly reduces the probability of a pheochromocytoma (odds ratio = 0.015), as does another shape (odds ratio = 0.006). A "ring sign" is also more frequent in pheochromocytomas compared to other adrenal tumors (P=0.001, odds ratio = 6.49). A sharp necrosis also increases the probability of a pheochromocytoma more than unsharp necrosis (odds ratio 231.6 vs. 20.2). The probability calculation model created on the basis of the results confirms a high sensitivity and specificity (80% and 95%). Conclusion. This study confirms the value of anatomical features in the assessment of adrenal masses with the ability to significantly improve the identification of pheochromocytomas. Advanced assessment of the tumor shape was defined and a original comprehensive calculating tool of the pheochromocytoma probability was created on the basis of the results presented here and could be used in clinical routine.

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Section: Introductionmentioning

confidence: 99%

Characteristic CT features of pheochromocytomas - probability model calculation tool based on a multicentric study

Čtvrtlík¹,

Tüdös²,

Szász³

et al. 2019

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Pheochromocytomas are characteristically, although not uniformly, large, heterogeneous masses with the areas of necrosis and cystic changes (15). Prior studies have reported that pheochromocytomas were significantly more likely to contain necrosis compared to adenomas (10,13). For example, Park et al.…”

Section: Discussionmentioning

confidence: 91%

“…reported that 66% of pheochromocytomas were misclassified as adenoma on dedicated adrenal CT. In that study, the criteria for adenoma were APEW > 60% and RPEW > 40% (13). A PP enhancement ≥ 85 HU was found to be much more likely to be pheochromocytoma than adenoma.…”

Section: Discussionmentioning

confidence: 93%

“…However, the cohort of this study mostly consisted of adenoma and metastasis with small number of pheochromocytomas. Other studies comparing wash-out characteristics of adenoma and pheochromocytoma reported that pheochromocytomas might exhibit adenoma-like wash-out on 15-min DP (8–13). However, some of these studies lacked uniform pathology confirmation (10–12) and most focused on 15-min wash-out ratios without taking other quantitative and qualitative features into account.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, imaging plays a crucial role in this group. Notably, additional studies comparing wash-out characteristics of adenoma and pheochromocytoma reported that a significant subset of pheochromocytomas mimicked adenoma on dedicated adrenal CT; therefore, wash-out CT may be misleading (8–13). These studies mostly focused on wash-out ratios without taking qualitative features into account; in addition, some lacked pathology confirmation.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of adrenal CT in the differentiation of adenoma and pheochromocytoma

et al. 2019

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Background Differentiation of adenoma and pheochromocytoma on computed tomography (CT) may be problematic. Purpose To investigate if adenoma and pheochromocytoma can be differentiated with adrenal CT. Material and Methods A total of 147 pathologically proven adrenal masses (119 adenomas, 28 pheochromocytomas) that had undergone adrenal CT were retrospectively evaluated. Lesion attenuation on unenhanced phase (UEP), portal phase (PP), 15-min delayed phase (DP), absolute/relative percentage enhancement wash-out (APEW/RPEW), and qualitative features were recorded. Student’s t-test for parametric data, Mann–Whitney U test for non-parametric data, and Fisher’s exact test for categorical data were used. Diagnostic performance of CT attenuation was assessed by area under the curve (AUC) of the receiver operating characteristics. Results APEW of adenomas was not significantly different from pheochromocytomas; 68.4% and 59% ( P = 0.284). Adenomas had significantly higher RPEW; 57.3% vs. 37.4% ( P = 0.004). Of pheochromocytomas, 50% met APEW >60% or RPEW >40% criteria, and therefore were misclassified as adenoma on wash-out CT. Of those, 80% (4/5) were < 3 cm. UEP, PP, and DP attenuations of pheochromocytomas were significantly higher than adenomas; however, they were overlapping. AUC for UEP, PP, and DP was 0.906, 0.784, and 0.926, respectively. Larger pheochromocytomas were more likely to contain necrosis compared to smaller pheochromocytomas and adenomas; 41.6% vs. 12.5% vs. 3%. Homogeneous enhancement was seen in 25% of pheochromocytomas and 49% of adenomas ( P = 0.018). No significant difference was found in terms of lesion borders and presence of fat/calcification ( P > 0.05). Conclusions A considerable percentage of pheochromocytomas, especially smaller ones, demonstrate adenoma-like wash-out on CT. Heterogeneous enhancement, higher attenuation, and necrosis are more suggestive of pheochromocytoma.

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Distinguishing pheochromocytoma from adrenal adenoma by using modified computed tomography criteria

Kang

Park

2020

Abdom Radiol

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Pheochromocytomas Versus Adenoma: Role of Venous Phase CT Enhancement

Cited by 28 publications

References 26 publications

Characteristic CT features of pheochromocytomas - probability model calculation tool based on a multicentric study

Characteristic CT features of pheochromocytomas - probability model calculation tool based on a multicentric study

Diagnostic performance of adrenal CT in the differentiation of adenoma and pheochromocytoma

Distinguishing pheochromocytoma from adrenal adenoma by using modified computed tomography criteria

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