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Does 18F-FDG PET/CT add diagnostic accuracy in incidentally identified non-secreting adrenal tumours?

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The widespread use of high-resolution cross-sectional imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) for the investigation of the abdomen is associated with an increasing detection of incidental adrenal masses. We evaluated the ability of 18F-fluorodeoxyglucose positron emission tomography to distinguish benign from malignant adrenal masses when CT or MRI results had been inconclusive.

Methods

We included only patients with no evidence of hormonal hypersecretion and no personal history of cancer or in whom previously diagnosed cancer was in prolonged remission. PET/CT scans were acquired after 90 min (mean, range 60–140 min) after FDG injection. The visual interpretation, maximum standardised uptake values (SUVmax) and adrenal compared to liver uptake ratio were correlated with the final histological diagnosis or clinico-radiological follow-up when surgery had not been performed.

Results

Thirty-seven patients with 41 adrenal masses were prospectively evaluated. The final diagnosis was 12 malignant, 17 benign tumours, and 12 tumours classified as benign on follow-up.

The visual interpretation was more accurate than SUVmax alone, tumour diameter or unenhanced density, with a sensitivity of 100% (12/12), a specificity of 86% (25/29) and a negative predictive value of 100% (25/25).

The use of 1.8 as the threshold for tumour/liver SUVmax ratio, retrospectively established, demonstrated 100% sensitivity and specificity.

Conclusion

FDG PET/CT accurately characterises adrenal tumours, with an excellent sensitivity and negative predictive values. Thus, a negative PET may predict a benign tumour that would potentially prevent the need for surgery of adrenal tumours with inconclusive conventional imaging.

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References

  1. Korobkin M. CT characterization of adrenal masses: the time has come. Radiology 2000;217:629–32.

    PubMed  CAS  Google Scholar 

  2. Dunnick NR, Korobkin M. Imaging of adrenal incidentalomas: current status. AJR Am J Roentgenol 2002;179:559–68.

    PubMed  Google Scholar 

  3. Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer 1950;3:74–85.

    Article  PubMed  CAS  Google Scholar 

  4. Mignon F., M. B. Tumeurs non sécrétantes de la surrénale et incidentalome. EMC (Elsevier SAS, Paris), Radiodiagnostic–Urologie–Gynécologie, 2006;34.

  5. Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol 1998;171:201–4.

    PubMed  CAS  Google Scholar 

  6. Lee MJ, Hahn PF, Papanicolaou N, Egglin TK, Saini S, Mueller PR, Simeone JF. Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size, and observer analysis. Radiology 1991;179:415–8.

    PubMed  CAS  Google Scholar 

  7. Korobkin M, Brodeur FJ, Yutzy GG, Francis IR, Quint LE, Dunnick NR, et al. Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. AJR Am J Roentgenol 1996;166:531–6.

    PubMed  CAS  Google Scholar 

  8. Pena CS, Boland GW, Hahn PF, Lee MJ, Mueller PR. Characterization of indeterminate (lipid-poor) adrenal masses: use of washout characteristics at contrast-enhanced CT. Radiology 2000;217:798–802.

    PubMed  CAS  Google Scholar 

  9. Caoili EM, Korobkin M, Francis IR, Cohan RH, Dunnick NR. Delayed enhanced CT of lipid-poor adrenal adenomas. AJR Am J Roentgenol 2000;175:1411–5.

    PubMed  CAS  Google Scholar 

  10. Caoili EM, Korobkin M, Francis IR, Cohan RH, Platt JF, Dunnick NR, Raghupathi KI. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology 2002;222:629–33.

    Article  PubMed  Google Scholar 

  11. Mitchell DG, Crovello M, Matteucci T, Petersen RO, Miettinen MM. Benign adrenocortical masses: diagnosis with chemical shift MR imaging. Radiology 1992;185:345–51.

    PubMed  CAS  Google Scholar 

  12. Mayo-Smith WW, Lee MJ, McNicholas MM, Hahn PF, Boland GW, Saini S. Characterization of adrenal masses (<5 cm) by use of chemical shift MR imaging: observer performance versus quantitative measures. AJR Am J Roentgenol 1995;165:91–5.

    PubMed  CAS  Google Scholar 

  13. Korobkin M, Lombardi TJ, Aisen AM, Francis IR, Quint LE, Dunnick NR, et al. Characterization of adrenal masses with chemical shift and gadolinium-enhanced MR imaging. Radiology 1995;197:411–8.

    PubMed  CAS  Google Scholar 

  14. Outwater EK, Siegelman ES, Huang AB, Birnbaum BA. Adrenal masses: correlation between CT attenuation value and chemical shift ratio at MR imaging with in-phase and opposed-phase sequences. Radiology 1996;200:749–52.

    PubMed  Google Scholar 

  15. Jhaveri KS, Wong F, Ghai S, Haider MA. Comparison of CT histogram analysis and chemical shift MRI in the characterization of indeterminate adrenal nodules. AJR Am J Roentgenol 2006;187:1303–8.

    Article  PubMed  Google Scholar 

  16. Lumachi F, Borsato S, Tregnaghi A, Marino F, Fassina A, Zucchetta P, et al. High risk of malignancy in patients with incidentally discovered adrenal masses: accuracy of adrenal imaging and image-guided fine-needle aspiration cytology. Tumor 2007;93:269–74.

    Google Scholar 

  17. Jana S, Zhang T, Milstein DM, Isasi CR, Blaufox MD. FDG-PET and CT characterization of adrenal lesions in cancer patients. Eur J Nucl Med Mol Imaging 2006;33:29–35.

    Article  PubMed  Google Scholar 

  18. Blake MA, Slattery JM, Kalra MK, Halpern EF, Fischman AJ, Mueller PR, et al. Adrenal lesions: characterization with fused PET/CT image in patients with proved or suspected malignancy—initial experience. Radiology 2006;238:970–7.

    Article  PubMed  Google Scholar 

  19. Caoili EM, Korobkin M, Brown RK, Mackie G, Shulkin BL. Differentiating adrenal adenomas from nonadenomas using (18)F-FDG PET/CT: quantitative and qualitative evaluation. Acad Radiol 2007;14:468–75.

    Article  PubMed  Google Scholar 

  20. Kumar R, Xiu Y, Yu JQ, Takalkar A, El-Haddad G, Potenta S, et al. 18F-FDG PET in evaluation of adrenal lesions in patients with lung cancer. J Nucl Med 2004;45:2058–62.

    PubMed  Google Scholar 

  21. Maurea S, Klain M, Mainolfi C, Ziviello M, Salvatore M. The diagnostic role of radionuclide imaging in evaluation of patients with nonhypersecreting adrenal masses. J Nucl Med 2001;42:884–92.

    PubMed  Google Scholar 

  22. Erasmus JJ, Patz EF, McAdams HP, Murray JG, Herndon J, Coleman RE, et al. Evaluation of adrenal masses in patients with bronchogenic carcinoma using 18F-fluorodeoxyglucose positron emission tomography. AJR Am J Roentgenol 1997;168:1357–60.

    PubMed  CAS  Google Scholar 

  23. Park BK, Kim CK, Kim B, Choi JY. Comparison of delayed enhanced CT and 18F-FDG PET/CT in the evaluation of adrenal masses in oncology patients. J Comput Assist Tomogr 2007;1:550–6.

    Google Scholar 

  24. Boland GW, Goldberg MA, Lee MJ, Mayo-Smith WW, Dixon J, McNicholas MM, et al. Indeterminate adrenal mass in patients with cancer: evaluation at PET with 2-[F-18]-fluoro-2-deoxy-d-glucose. Radiology 1995;194:131–4.

    PubMed  CAS  Google Scholar 

  25. Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A. 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med 2001;42:1795–9.

    PubMed  Google Scholar 

  26. Metser U, Miller E, Lerman H, Lievshitz G, Avital S, Even-Sapir E. 18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med 2006;47:32–7.

    PubMed  Google Scholar 

  27. Sahdev A, Reznek RH. Imaging evaluation of the non-functioning indeterminate adrenal mass. Trends Endocrinol Metab 2004;15:271–6.

    Article  PubMed  CAS  Google Scholar 

  28. Bartrons R, Caro J. Hypoxia, glucose metabolism and the Warburg’s effect. J Bioenerg Biomembr 2007;39:223–9.

    Article  PubMed  CAS  Google Scholar 

  29. Shulkin BL, Thompson NW, Shapiro B, Francis IR, Sisson JC. Pheochromocytomas: imaging with 2-[fluorine-18]fluoro-2-deoxy-d-glucose PET. Radiology 1999;212:35–41.

    PubMed  CAS  Google Scholar 

  30. Timmers HJ, Kozupa A, Chen CC, Carrasquillo JA, Ling A, Eisenhofer G, et al. Superiority of fluorodeoxyglucose positron emission tomography to other functional imaging techniques in the evaluation of metastatic SDHB-associated pheochromocytoma and paraganglioma. J Clin Oncol 2007;25:2262–9.

    Article  PubMed  Google Scholar 

  31. Jaskowiak CJ, Bianco JA, Perlman SB, Fine JP. Influence of reconstruction iterations on 18F-FDG PET/CT standardized uptake values. J Nucl Med 2005;46:424–8.

    PubMed  Google Scholar 

  32. Wong CY, Thie J, Parling-Lynch KJ, Zakalik D, Margolis JH, Gaskill M, et al. Glucose-normalized standardized uptake value from (18)F-FDG PET in classifying lymphomas. J Nucl Med 2005;46:1659–63.

    PubMed  Google Scholar 

  33. Westerterp M, Pruim J, Oyen W, Hoekstra O, Paans A, Visser E, et al. Quantification of FDG PET studies using standardised uptake values in multi-centre trials: effects of image reconstruction, resolution and ROI definition parameters. Eur J Nucl Med Mol Imaging 2007;34:392–404.

    Article  PubMed  Google Scholar 

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Acknowledgement

This study was supported in part by CIS Bio International grant (DMVF-08-16).

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Authors and Affiliations

  1. Service Central de Biophysique et de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France

    L. Tessonnier, C. Colavolpe, O. Mundler & D. Taïeb

  2. Service de Chirurgie Générale et Endocrinienne, Centre Hospitalo-Universitaire de la Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France

    F. Sebag, F. F. Palazzo & J. F. Henry

  3. Faculté de Médecine, Institut National de la Santé et de la Recherche Médicale (U555), Centre Hospitalo-Universitaire de la Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France

    C. De Micco

  4. Service de Santé Publique et d’Information Médicale, Centre Hospitalo-Universitaire de la Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France

    J. Mancini

  5. Service d’Endocrinologie, Diabète et des Maladies Métaboliques, Centre Hospitalo-Universitaire de la Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France

    B. Conte-Devolx

Authors
  1. L. Tessonnier
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  2. F. Sebag
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  3. F. F. Palazzo
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  10. D. Taïeb
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Correspondence to D. Taïeb.

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Tessonnier, L., Sebag, F., Palazzo, F.F. et al. Does 18F-FDG PET/CT add diagnostic accuracy in incidentally identified non-secreting adrenal tumours?. Eur J Nucl Med Mol Imaging 35, 2018–2025 (2008). https://doi.org/10.1007/s00259-008-0849-3

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  • DOI: https://doi.org/10.1007/s00259-008-0849-3

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