Abstract
Because of the increasing use of cross-sectional imaging, mainly computed tomography (CT), adrenal tumours are frequently detected in patients who undergo imaging for other reasons than adrenal disease. These incidentally depicted adrenal lesions, “incidentalomas,” comprise a wide variety of different tumour entities. In a minor portion of these patients, biochemical screening reveals a functional tumour and further diagnostic work-up and therapy need to be performed according to the type of hormonal overproduction. In patients without a cancer history almost all adrenal incidentalomas are benign which is in contrast to patients with a known extra-adrenal malignancy who frequently harbour adrenal metastases. Most of the adrenal lesions can be characterised by CT and magnetic resonance imaging based on their morphological appearance and/or by attenuation/signal characteristics consistent with the content of microscopic (cytoplasmatic) or macroscopic fat. A significant number of adrenal lesions can, however, not be easily determined and require radiological follow-up of tumour size in order to exclude that the tumour is malignant or necessitate further work-up by functional imaging methods or biopsy. Non-invasive characterisation by functional radionuclide imaging with scintigraphy and positron emission tomography (PET) is therefore an important adjunct. The most commonly used PET tracer, [18F]FDG, is useful to differ benign from malignant lesions and, before the surgical decision, to establish whether an adrenal metastasis is the only lesion or, in case of disseminated disease, to confirm that non-surgical treatment instead should be chosen. 18-FDG-PET is also useful in pheochromocytoma and ACC. The enzyme inhibitor 11C-metomidate has been developed as a PET tracer for adrenal imaging to differ adrenocortical from non-adrenocortical tumours. 11C-metomidate-PET is currently also tried to diagnose Conn adenomas in primary aldosteronism, but further development is needed before the method can be established for this purpose.
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References
Hammarstedt L, Muth A, Wängberg B, Björneld L, Sigurjónsdóttir HA, Götherström G, Almqvist E, Widell H, Carlsson S, Ander S, Hellström M (2010) Adrenal Study Group of Western Sweden. Adrenal lesion frequency: A prospective, cross-sectional CT study in a defined region, including systematic re-evaluation. Acta Radiol 51:1149–1156
Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Alì A, Giovagnetti M, Opocher G, Angeli A (2000) A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 85:637–644
Abrams HL, Spiro R, Goldstein N (1950) Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer 3:74–85
Copeland PM (1983) The incidentally discovered adrenal mass. Ann Intern Med 98:940–945
Hammarstedt L, Muth A, Sigurjónsdóttir HÁ, Almqvist E, Wängberg B, Hellström M (2012) Adrenal Study Group of Western Sweden. Adrenal lesions in patients with extra-adrenal malignancy—benign or malignant? Acta Oncol 51:215–221
Gnannt R, Fischer M, Goetti R, Karlo C, Leschka S, Alkadhi H (2012) Dual-energy CT for characterization of the incidental adrenal mass: preliminary observations. AJR Am J Roentgenol 198:138–144
Gupta RT, Ho LM, Marin D, Boll DT, Barnhart HX, Nelson RC (2010) Dual-energy CT for characterization of adrenal nodules: initial experience. AJR Am J Roentgenol 194:1479–1483
Mostbeck G (2011) CEUS of adrenal mass lesions–the break-through? Ultraschall Med 32:437–439
Friedrich-Rust M, Glasemann T, Polta A, Eichler K, Holzer K, Kriener S, Herrmann E, Nierhoff J, Bon D, Bechstein WO, Vogl T, Zeuzem S, Bojunga J (2011) Differentiation between benign and malignant adrenal mass using contrast-enhanced ultrasound. Ultraschall Med 32:460–471
Friedrich-Rust M, Schneider G, Bohle RM, Herrmann E, Sarrazin C, Zeuzem S, Bojunga J (2008) Contrast-enhanced sonography of adrenal masses: differentiation of adenomas and nonadenomatous lesions. AJR Am J Roentgenol 191:1852–1860
Dietrich CF, Ignee A, Barreiros AP, Schreiber-Dietrich D, Sienz M, Bojunga J, Braden B (2010) Contrast-enhanced ultrasound for imaging of adrenal masses. Ultraschall Med 31:163–168
Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR (1998) Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol 171:201–204
Ozcan Kara P, Kara T, Kara Gedik G, Kara F, Sahin O, Ceylan Gunay E, Sari O (2011) The role of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiating between benign and malignant adrenal lesions. Nucl Med Commun 32:106–112
Korobkin M, Lombardi TJ, Aisen AM, Francis IR, Quint LE, Dunnick NR, Londy F, Shapiro B, Gross MD, Thompson NW (1995) Characterization of adrenal masses with chemical shift and gadolinium-enhanced MR imaging. Radiology 197:411–418
Korobkin M, Giordano TJ, Brodeur FJ, Francis IR, Siegelman ES, Quint LE, Dunnick NR, Heiken JP, Wang HH (1996) Adrenal adenomas: relationship between histologic lipid and CT and MR findings. Radiology 200:743–747
Korobkin M, Brodeur FJ, Francis IR, Quint LE, Dunnick NR, Londy F (1998) CT time-attenuation washout curves of adrenal adenomas and nonadenomas. AJR Am J Roentgenol 170:747–752
Caoili EM, Korobkin M, Francis IR, Cohan RH, Dunnick NR (2000) Delayed enhanced CT of lipid-poor adrenal adenomas. AJR Am J Roentgenol 175:1411–1415
Caoili EM, Korobkin M, Francis IR, Cohan RH, Platt JF, Dunnick NR, Raghupathi KI (2002) Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology 222:629–633
Kebapci M, Kaya T, Gurbuz E, Adapinar B, Kebapci N, Demirustu C (2003) Differentiation of adrenal adenomas (lipid rich and lipid poor) from nonadenomas by use of washout characteristics on delayed enhanced CT. Abdom Imaging 28:709–715
Volpe C, Enberg U, Sjögren A, Wahrenberg H, Jacobsson H, Törring O, Hamberger B, Thorén M (2008) The role of adrenal scintigraphy in the preoperative management of primary aldosteronism. Scand J Surg 97:248–253
Gambhir SS, Czernin J, Schwimmer J, Silverman DH, Coleman RE, Phelps ME (2001) A tabulated summary of the FDG PET literature. J Nucl Med 42(5 Suppl):1S–93S
Reske SN, Kotzerke J (2001) FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, “Onko-PET III”, 21 July and 19 September 2000. Eur J Nucl Med 28:1707–1723
von Schulthess GK, Steinert HC, Hany TF (2006) Integrated PET/CT: current applications and future directions. Radiology 238:405–422
Bergström M, Juhlin C, Bonasera TA, Sundin A, Rastad J, Akerström G, Långström B (2000) PET imaging of adrenal cortical tumors with the 11beta-hydroxylase tracer 11C-metomidate. J Nucl Med 41:275–282
Minn H, Salonen A, Friberg J, Roivainen A, Viljanen T, Långsjö J, Salmi J, Välimäki M, Någren K, Nuutila P (2004) Imaging of adrenal incidentalomas with PET using (11)C-metomidate and (18)F-FDG. J Nucl Med 45:972–979
Zettinig G, Mitterhauser M, Wadsak W, Becherer A, Pirich C, Vierhapper H, Niederle B, Dudczak R, Kletter K (2004) Positron emission tomography imaging of adrenal masses: (18)F-fluorodeoxyglucose and the 11beta-hydroxylase tracer (11)C-metomidate. Eur J Nucl Med Mol Imaging 31:1224–1230
Hennings J, Lindhe O, Bergström M, Långström B, Sundin A, Hellman P (2006) [11C]metomidate positron emission tomography of adrenocortical tumors in correlation with histopathological findings. J Clin Endocrinol Metab 91:1410–1414
Hennings J, Hellman P, Ahlström H, Sundin A (2009) Computed tomography, magnetic resonance imaging and 11C-metomidate positron emission tomography for evaluation of adrenal incidentalomas. Eur J Radiol 69:314–2
Hennings J, Sundin A, Hägg A (2010) Hellman P 11C-metomidate positron emission tomography after dexamethasone suppression for detection of small adrenocortical adenomas in primary aldosteronism. Langenbecks Arch Surg 395:963–967
Razifar P, Hennings J, Monazzam A, Hellman P, Långström B, Sundin A (2009) Masked volume wise Principal Component Analysis of small adrenocortical tumours in dynamic [11C]-metomidate Positron Emission Tomography. BMC Med Imaging 9:6
Burton TJ, Mackenzie IS, Balan K, Koo B, Bird N, Soloviev DV, Azizan EA, Aigbirhio F, Gurnell M, Brown MJ (2012) Evaluation of the sensitivity and specificity of (11)C-metomidate positron emission tomography (PET)-CT for lateralizing aldosterone secretion by Conn’s adenomas. J Clin Endocrinol Metab 97:100–109
Hahner S, Stuermer A, Kreissl M, Reiners C, Fassnacht M, Haenscheid H, Beuschlein F, Zink M, Lang K, Allolio B, Schirbel A (2008) [123 I]Iodometomidate for molecular imaging of adrenocortical cytochrome P450 family 11B enzymes. J Clin Endocrinol Metab 93:2358–2365
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Sundin, A. (2014). Radiological and Radionuclide Imaging of Adrenocortical Tumours. In: Hellman, P. (eds) Primary Aldosteronism. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0509-6_11
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