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Adrenal-to-liver SUV ratio is the best parameter for differentiation of adrenal metastases from adenomas using 18F-FDG PET/CT

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Abstract

Purpose

To investigate the best standardized uptake value (SUV) index for differentiation of adrenal metastases from adrenocortical adenomas using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT).

Materials and methods

A total of 129 patients (82 males and 47 females; mean age 65.4 years) with extra-adrenal primary malignancies who had known or suspected adrenal lesions underwent FDG PET/CT examinations for detection, staging, re-staging, or recurrence of tumor. Among these patients, 45 adrenal lesions (22 adenomas and 23 metastases) in 41 patients were evaluated. The maximum SUVs for adrenal lesions (adrenal SUVmax) and mean liver and spleen SUVs were recorded, and the ratio of the adrenal SUVmax to the mean liver SUV (adrenal-to-liver SUV ratio) and that of the adrenal SUVmax to the mean spleen SUV (adrenal-to-spleen SUV ratio) were obtained. Diagnostic performances for the adrenal SUVmax, adrenal-to-liver SUV ratio, and adrenal-to-spleen SUV ratio were compared.

Results

The mean adrenal SUVmax, adrenal-to-liver SUV ratio, and adrenal-to-spleen SUV ratio were higher for adrenal metastases (8.4 ± 3.8, 3.0 ± 1.3, and 4.0 ± 1.9, respectively) than for adrenocortical adenomas (2.9 ± 1.0, 0.9 ± 0.3, and 1.3 ± 0.3, respectively) (P < 0.001). The area under the curve was higher for the adrenal-to-liver SUV ratio (0.99) than for the adrenal SUVmax (0.96) and adrenal-to-spleen SUV ratio (0.98). In the differentiation of adrenocortical adenomas and adrenal metastases, an adrenal-to-liver SUV ratio cutoff value of 1.37 yielded a sensitivity of 96 % and specificity of 100 %.

Conclusion

In FDG PET/CT analysis, the adrenal-to-liver SUV ratio had a greater ability to differentiate adrenocortical adenomas and adrenal metastases than did the adrenal SUVmax or adrenal-to-spleen SUV ratio.

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Acknowledgments

This work was supported in part by the Grant for Scientific Research Expenses for Health, Labor, and Welfare Programs; Foundation for the Promotion of Cancer Research; and Research on Cancer Prevention and Health Services.

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Authors and Affiliations

  1. Department of Radiology, Gifu Central Hospital, 3-25 Kawabe, Gifu, 501-1198, Japan

    Haruo Watanabe

  2. Radiology Services, Gifu University Hospital, Gifu, Japan

    Masayuki Kanematsu

  3. Research Center for Cancer Prevention and Screening, National Cancer Center Hospital, Tsukiji, Japan

    Noriyuki Moriyama

  4. Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan

    Masayuki Kanematsu, Satoshi Goshima, Hiroshi Kondo, Hiroshi Kawada & Yoshifumi Noda

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  1. Haruo Watanabe
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  2. Masayuki Kanematsu
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  3. Satoshi Goshima
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  4. Hiroshi Kondo
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  5. Hiroshi Kawada
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  6. Yoshifumi Noda
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  7. Noriyuki Moriyama
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Correspondence to Haruo Watanabe.

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Watanabe, H., Kanematsu, M., Goshima, S. et al. Adrenal-to-liver SUV ratio is the best parameter for differentiation of adrenal metastases from adenomas using 18F-FDG PET/CT. Ann Nucl Med 27, 648–653 (2013). https://doi.org/10.1007/s12149-013-0730-8

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  • DOI: https://doi.org/10.1007/s12149-013-0730-8

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