Value of 18-F-FDG PET/CT and CT in the Diagnosis of Indeterminate Adrenal Masses.

Nathalie Launay,Stéphane Silvera,Paul Legmann,Olivier Vignaux,Xavier Bertagna,Lionel Groussin,Etienne Audureau,Florence Tenenbaum,Frédérique Tissier,Bertrand Dousset

doi:10.1155/2015/213875

Abstract

The purpose of this paper was to study the value of 18-FDG PET/CT and reassess the value of CT for the characterization of indeterminate adrenal masses. 66 patients with 67 indeterminate adrenal masses were included in our study. CT/MRI images and 18F-FDG PET/CT data were evaluated blindly for tumor morphology, enhancement features, apparent diffusion coefficient values, maximum standardized uptake values, and adrenal-to-liver maxSUV ratio. The study population comprised pathologically confirmed 16 adenomas, 19 metastases, and 32 adrenocortical carcinomas. Macroscopic fat was observed in 62.5% of the atypical adenomas at CT but not in malignant masses. On 18F-FDG PET/CT, SUVmax and adrenal-to-liver maxSUV ratio were significantly lower in adenomas than in malignant tumors. An SUVmax value of less than 3.7 or an adrenal-to-liver maxSUV ratio of less than 1.29 is highly predictive of benignity.

Highlights

With the proliferation of cross-sectional imaging, detection of an incidental adrenal mass has become a common problem
The objective of our research is to study the value of 18-FDG PET/computed tomography (CT) and reassess the value of CT for the characterization of indeterminate adrenal masses
Eighteen metastases, and thirtyone adrenocortical carcinomas were examined by CT

Summary

Introduction

With the proliferation of cross-sectional imaging, detection of an incidental adrenal mass has become a common problem. Adrenal incidentalomas are detected on approximately 5 to 8% of all high-resolution abdominal imaging studies [1]. About 12% of adrenal incidentalomas [8], including benign tumors, cannot be characterized by CT or MRI: these indeterminate adrenal masses are considered as suspect and may have CT follow-up and PET-CT exploration, and some may be surgically removed or biopsied in oncology patients. Being able to identify those indeterminate adrenal masses would avoid unnecessary follow-up, surgery, and making erroneous staging in oncology patients. The objective of our research is to study the value of 18-FDG PET/CT and reassess the value of CT for the characterization of indeterminate adrenal masses

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Conclusion