European Radiology

, Volume 29, Issue 2, pp 806–817 | Cite as

Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis

  • Ivan PlatzekEmail author
  • Dominik Sieron
  • Verena Plodeck
  • Angelika Borkowetz
  • Michael Laniado
  • Ralf-Thorsten Hoffmann
Magnetic Resonance



To perform a systematic review and meta-analysis of published data to evaluate the utility of chemical shift imaging (CSI) for differentiating between adrenal adenomas and non-adenomas.


A systematic search of the MEDLINE, Web of Science Core Collection, EMBASE and Cochrane Central Register of Controlled Trials electronic databases was performed. The methodological quality of the included studies was assessed by using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool. A bivariate random effect model was used to determine summary and subgroup sensitivity and specificity and calculate summary receiver operating characteristic curves (SROC).


Eighteen studies with 1138 patients and 1280 lesions (859 adenomas, 421 non-adenomas) in total were included. In addition to summary analysis, quantitative analyses of the adrenal signal intensity index (SII, 978 lesions, 14 studies), adrenal-to-spleen ratio (ASR; 394 lesions, 7 studies) and visual analysis (560 lesions, 5 studies) were performed. The resultant data showed considerable heterogeneity (inconsistency index I2 of 94%, based on the diagnostic odds ratio, DOR). The pooled sensitivity of CSI for adenoma was 0.94 [95% confidence interval (CI) 0.88–0.97] and pooled specificity was 0.95 (95% CI 0.89–0.97). The area (AUC) under the SROC curve was 0.98 (95% CI 0.96–0.99). The corresponding AUCs were 0.98, 0.99 and 0.95 for SII, ASR and visual evaluation, respectively.


CSI has high sensitivity, specificity and accuracy for adrenal adenoma. Diagnostic performance does not improve when quantitative indices are used.

Key Points

• Inclusion of CSI in abdominal MRI protocols provides an effective solution for classifying adrenal masses discovered on MR exams

• Visual evaluation of adrenal CSI is sufficient; use of quantitative indices does not improve diagnostic accuracy


Adrenal gland neoplasms Adrenocortical adenoma Chemical shift imaging Magnetic resonance imaging 



American College of Radiology


Adrenal-to-liver ratio


Adrenal-to-muscle ratio


Adrenal-to-spleen ratio


Chemical shift imaging


Dynamic contrast-enhanced MRI


Diagnostic odds ratio


European Society of Radiology


Effective sample size


Quality assessment of diagnostic accuracy studies


Signal intensity index


Summary receiver operating characteristic



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Ivan Platzek, MD

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Mrs. Uta Schwanebeck, from the Kompetenzzentrum für Klinische Studien (KKS), Technical University of Dresden, kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was not required for this study because the study is a systematic review and meta-analysis. The authors of this study did not have access to primary data, just metadata extracted from previously published studies. Because of this, the current study does not influence the well-being or privacy of patients.

Ethical approval

Institutional review board approval was not required because the study is a systematic review and meta-analysis. The authors of this study did not have access to primary data, just metadata extracted from previously published studies. Because of this, the current study does not influence the well-being or privacy of patients.

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported, except as a part of the primary studies included in this meta-analysis, which are listed in the reference list.


• retrospective

• meta-analysis

• performed at one institution

Supplementary material

330_2018_5626_MOESM1_ESM.docx (9.5 mb)
ESM 1 (DOCX 9687 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyDresden University HospitalDresdenGermany
  2. 2.Department of RadiologySpital TiefenauBernSwitzerland
  3. 3.Department of UrologyDresden University HospitalDresdenGermany

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