Abstract
OBJECTIVE
To examine the clinical utility of 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) for diagnosing whether an adrenal mass is malignant, in contemporary clinical practice.
DESIGN
Retrospective medical record review of patients from 2 databases at a large hospital. The first database consisted of patients who underwent FDG-PET between the years 2009 to 2011 while the second database included patients who had histological diagnosis of adrenal mass between the years 1997 to 2011.
RESULTS
3.4% of 2921 patients had adrenal FDG uptake. Approximately 43% of them did not exhibit corresponding adrenal mass. FDG-PET performance parameters were better if a cutoff of SUV (standardized uptake value) ≥3 was used to define positivity. The imaging characteristics of malignant adrenal masses and pheochromocytoma were similar but differed remarkably compared to those of benign tumors. Serial imaging revealed that the malignant adrenal masses consistently exhibited high CT attenuation, while more than half of them initially exhibited SUV<3 and in some cases FDG uptake indistinguishable from the background. The FDG-PET results were confirmatory in 87% of patients, contributory in 11%, but definitely misleading in 2%.
CONCLUSIONS
FDG-PET is not required for adrenal mass diagnosis in most patients in contemporary practice but may help clinical decision making in specific situations.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bovio S, Cataldi A, Reimondo G, et al, 2006 Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest 29: 298–302.
Davenport C, Liew A, Doherty B, et al, 2011 The prevalence of adrenal incidentaloma in routine clinical practice. Endocrine 40: 80–83.
Young WF Jr, 2007 The incidentally discovered adrenal mass. N Engl J Med 356: 601–610.
Anagnostis P, Karagiannis A, Tziomalos K, Kakafika AI, Athyros VG, Mikhailidis DP, 2009 Adrenal incidentaloma: a diagnostic challenge. Hormones (Athens) 8:163–184.
Nieman LK, 2010 Approach to the patient with an adrenal incidentaloma. J Clin Endocrinol Metab 95: 4106–4113.
Mantero F, Terzolo M, Arnaldi G, et al, 2000 A survey on adrenal incidentaloma in Italy. J Clin Endocrinol Metab 85: 637–644.
Wang TS, Cheung K, Roman SA, Sosa JA, 2012 A cost-effectiveness analysis of adrenalectomy for nonfunctional adrenal incidentalomas: Is there a size threshold for resection? Surgery 152: 1125–1132.
Hamrahian AH, Ioachimescu AG, Remer EM, 2005 Clinical utility of noncontrast computed tomography attenuation value (hounsfield units) to differentiate adrenal adenomas/hyperplasias from nonadenomas: Cleveland Clinic experience. J Clin Endocrinol Metab 90: 871–877.
Israel GM, Korobkin M, Wang C, Hecht EN, Krinsky GA, 2004 Comparison of unenhanced CT and chemical shift MRI in evaluating lipid-rich adrenal adenomas. AJR Am J Roentgenol 183: 215–219.
Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A, 2001 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med 42: 1795–1799.
Metser U, Miller E, Lerman H, Lievshitz G, Avital S, Even-Sapir E, 2006 18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med 47: 32–37.
Caoili EM, Korobkin M, Brown RK, Mackie G, Shulkin BL, 2007 Differentiating adrenal adenomas from non-adenomas using (18)F-FDG PET/CT: quantitative and qualitative evaluation. Acad Radiol 14: 468–475.
Han SJ, Kim TS, Jeon SW, et al, 2007 Analysis of adrenal masses by 18F-FDG positron emission tomography scanning. Int J Clin Pract 61: 802–809.
Okada M, Shimono T, Komeya Y, et al, 2009 Adrenal masses: the value of additional fluorodeoxyglucosepositron emission tomography/computed tomography (FDG-PET/CT) in differentiating between benign and malignant lesions. Ann Nucl Med 23: 349–354.
Boland GW, Dwamena BA, Jagtiani Sangwaiya M, et al, 2011 Characterization of adrenal masses by using FDG PET: a systematic review and meta-analysis of diagnostic test performance. Radiology 259: 117–126.
Zeiger MA, Thompson GB, Duh QY, et al, 2009 The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocr Pract 15: Suppl 1: 1–20.
Terzolo M, Stigliano A, Chiodini I, et al, 2011 AME position statement on adrenal incidentaloma. Eur J Endocrinol 164: 851–870.
Terzolo M, Bovio S, Pia A, Reimondo G, Angeli A, 2009 Management of adrenal incidentaloma. Best Pract Res Clin Endocrinol Metab 23: 233–243.
Harrison B, 2012 The indeterminate adrenal mass. Langenbecks Arch Surg 397: 147–154.
Browner WS, Newman TB, 1987 Are all significant P values created equal? the analogy between diagnostic tests and clinical research. JAMA 257: 2459–2463.
Brady MJ, Thomas J, Wong TZ, Franklin KM, Ho LM, Paulson EK, 2009 Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer: a proposal for an efficient diagnostic algorithm. Radiology 250: 523–530.
Pagani JJ, 1983 Normal adrenal glands in small cell lung carcinoma: CT-guided biopsy. AJR Am J Roentgenol 140: 949–951.
Gupta NC, Graeber GM, Tamim WJ, Rogers Js, Irisari L, Bishop HA, 2001 Clinical utility of PET-FDG imaging in differentiation of benign from malignant adrenal masses in lung cancer. Clin Lung Cancer 3: 59–64.
Pruthi A, Basu S, Ramani SK, Arya S, 2010 Bilateral symmetrical adrenal hypermetabolism on FDG PET in paraneoplastic Cushing syndrome in breast carcinoma: correlation with contrast-enhanced computed tomography. Clin Nucl Med 35: 960–961.
Yu R, Phillips E, 2012 Growth speed of sporadic pheochromocytoma. Clin Endocrinol (Qxf) 77: 331–332.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pitts, A., Ih, G., Wei, M. et al. Clinical utility of FDG-PET for diagnosis of adrenal mass: a large single-center experience. Hormones 12, 417–427 (2013). https://doi.org/10.1007/BF03401307
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03401307