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Response to letter to the editor

  • Daniel I. GlazerEmail author
  • William W. Mayo-Smith
Letter to the Editor
  • 6 Downloads

We thank the authors for their detailed summary of the role of chemical shift MRI imaging (CS-MRI) in the diagnostic workup of incidentally detected indeterminate adrenal nodules. We agree that CS-MRI may be a useful method of characterizing adrenal masses in patients where iodinated contrast material is a concern (for example history of anaphylactic reaction or severe chronic renal insufficiency) or to avoid radiation exposure (young patients) [1]. As you describe, a recent retrospective review of multiple studies reveals that CS-MRI has a pooled sensitivity of 0.94 and a specificity of 0.95 [2]. However, these data did show considerable heterogeneity with sensitivities ranging from 0.57 to 1.0 and specificities ranging from 0.75 to 1.0 [2]. It is likely that this significant variation in sensitivity and specificity results from including all adrenal nodules, regardless of unenhanced attenuation. We believe that appropriately performed adrenal CT is the best method to assess an...

Notes

References

  1. 1.
    Mayo-Smith WW, Song JH, Boland GL, Francis IR, Israel GM, Mazzaglia PJ, et al. Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2017;14(8):1038-44.CrossRefGoogle Scholar
  2. 2.
    Platzek I, Sieron D, Plodeck V, Borkowetz A, Laniado M, Hoffmann RT. Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis. Eur Radiol. 2019;29(2):806-17.CrossRefGoogle Scholar
  3. 3.
    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(1):201-4.CrossRefGoogle Scholar
  4. 4.
    Park BK, Kim CK, Kim B, Lee JH. Comparison of delayed enhanced CT and chemical shift MR for evaluating hyperattenuating incidental adrenal masses. Radiology. 2007;243(3):760-5.CrossRefGoogle Scholar
  5. 5.
    Seo JM, Park BK, Park SY, Kim CK. Characterization of lipid-poor adrenal adenoma: chemical-shift MRI and washout CT. AJR Am J Roentgenol. 2014;202(5):1043-50.CrossRefGoogle Scholar
  6. 6.
    Warda MH, Shehata SM, Zaiton F. Chemical-shift MRI versus washout CT for characterizing adrenal incidentalomas. Clin Imaging. 2016;40(4):780-7.CrossRefGoogle Scholar
  7. 7.
    Koo HJ, Choi HJ, Kim HJ, Kim SO, Cho KS. The value of 15-minute delayed contrast-enhanced CT to differentiate hyperattenuating adrenal masses compared with chemical shift MR imaging. Eur Radiol. 2014;24(6):1410-20.CrossRefGoogle Scholar
  8. 8.
    Haider MA, Ghai S, Jhaveri K, Lockwood G. Chemical shift MR imaging of hyperattenuating (>10 HU) adrenal masses: does it still have a role? Radiology. 2004;231(3):711-6.CrossRefGoogle Scholar
  9. 9.
    Lumachi F, Basso SM, Borsato S, Tregnaghi A, Zucchetta P, Marzola MC, et al. Role and cost-effectiveness of adrenal imaging and image-guided FNA cytology in the management of incidentally discovered adrenal tumours. Anticancer Res. 2005;25(6C):4559-62.PubMedGoogle Scholar
  10. 10.
    Choi YA, Kim CK, Park BK, Kim B. Evaluation of adrenal metastases from renal cell carcinoma and hepatocellular carcinoma: use of delayed contrast-enhanced CT. Radiology. 2013;266(2):514-20.CrossRefGoogle Scholar
  11. 11.
    Schieda N, Krishna S, McInnes MDF, Moosavi B, Alrashed A, Moreland R, et al. Utility of MRI to Differentiate Clear Cell Renal Cell Carcinoma Adrenal Metastases From Adrenal Adenomas. AJR Am J Roentgenol. 2017;209(3):W152-W9.CrossRefGoogle Scholar
  12. 12.
    Patel J, Davenport MS, Cohan RH, Caoili EM. Can established CT attenuation and washout criteria for adrenal adenoma accurately exclude pheochromocytoma? AJR Am J Roentgenol. 2013;201(1):122-7.CrossRefGoogle Scholar
  13. 13.
    Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol. 2008;190(5):1163-8.CrossRefGoogle Scholar
  14. 14.
    Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D, et al. The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocr Pract. 2009;15 Suppl 1:1-20.CrossRefGoogle Scholar
  15. 15.
    Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175(2):G1-G34.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Division of Abdominal Imaging and Intervention, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  2. 2.Division of Abdominal Imaging and Intervention, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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