Abstract
Adrenal incidentalomas (AIs) are incidentally discovered adrenal neoplasms. Overt endocrine secretion (glucocorticoids, mineralocorticoids, and catecholamines) and malignancy (primary or metastatic disease) are assessed at baseline evaluation. Size, lipid content, and washout characterise benign AIs (respectively, <4 cm, <10 Hounsfield unit, and rapid release); nonetheless, 30% of adrenal lesions are not correctly indicated. Recently, image-based texture analysis from computed tomography (CT) may be useful to assess the behaviour of indeterminate adrenal lesions. We performed a systematic review to provide the state-of-the-art of texture analysis in patients with AI. We considered 9 papers (from 70 selected), with a median of 125 patients (range 20–356). Histological confirmation was the most used criteria to differentiate benign from the malignant adrenal mass. Unenhanced or contrast-enhanced data were available in all papers; TexRAD and PyRadiomics were the most used software. Four papers analysed the whole volume, and five considered a region of interest. Different texture features were reported, considering first- and second-order statistics. The pooled median area under the ROC curve in all studies was 0.85, depicting a high diagnostic accuracy, up to 93% in differentiating adrenal adenoma from adrenocortical carcinomas. Despite heterogeneous methodology, texture analysis is a promising diagnostic tool in the first assessment of patients with adrenal lesions.
Highlights
Adrenal incidentalomas (AIs) are adrenal neoplasms discovered during a procedure not performed for suspected adrenal disease [1,2]
Focusing on the two studies that compared adrenal adenoma and adrenocortical carcinomas, the results showed a very good performance of the computed tomography (CT) texture analysis in differentiating benign from malignant lesions, with an area under the ROC curve (AUC) of 0.86 reported by Elmohr et al [17] and an accuracy of 93% reported by Torresan et al [21] (Figures 1 and 2)
A novel and emerging approach to characterise the behaviour of adrenal lesions is the measurement of steroid precursors using mass spectrometry, which allows the identification of several steroids and intermediate patterns [25]
Summary
Adrenal incidentalomas (AIs) are adrenal neoplasms discovered during a procedure not performed for suspected adrenal disease [1,2]. Overt endocrine secretion (glucocorticoids, mineralocorticoids, and catecholamines, characterising, respectively, Cushing’s syndrome, primary aldosteronism, and pheochromocytoma) should be ruled out in all patients with AI by the measurement of serum cortisol after 1 mg dexamethasone (the overnight suppression test), aldosterone-to-renin ratio, and plasma or urinary metanephrines [2,4,5]. It is recommended to rule out malignancy [2].
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