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Accuracy of focal cystic appearance within adrenal nodules on contrast-enhanced CT to distinguish pheochromocytoma and malignant adrenal tumors from adenomas

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the accuracy of cystic appearance within adrenal masses on contrast-enhanced CT in distinguishing pheochromocytomas and malignant adrenal tumors from adenomas.

Methods

We performed a retrospective review of adult patients with pathologically proven adrenal tumors who underwent contrast-enhanced abdominal CT. There were 92 patients (mean age 64.7 years, 52 men) with 22 pheochromocytomas, 34 malignant masses, and 36 adenomas. Two abdominal radiologists independently reviewed CT images to determine the presence of cystic appearance within the adrenal masses, defined as focal regions of low attenuation within the tumor that subjectively had fluid density.

Results

Cystic appearance was present in 12/22 (55%, 95% CI 32–76%) pheochromocytomas (mean size 5.3 cm), 15/34 (44%, 95% CI 27–62%) malignant masses (mean size 5.8 cm), and 2/36 (5.6%, 95% CI 0.7–9%) adenomas (mean size 3.2 cm). Sensitivity and specificity of cystic appearance for distinguishing pheochromocytoma or malignant masses from adenomas were 48.2% (95% CI 34.7–62.0%) and 94.4% (95% CI 81.3–99.3%), respectively. Cystic appearance was a significant predictor of tumor type (p = 0.015) even after controlling for tumor size. Reader agreement for cystic appearance was almost perfect with a kappa of 0.85.

Conclusion

Cystic appearance in adrenal tumors on contrast-enhanced CT has high specificity and low sensitivity for distinguishing pheochromocytoma and malignant adrenal masses from adenomas.

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Acknowledgements

The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Radiology, Davis Medical Center, University of California, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA

    Michael T. Corwin, Ana S. Mitchell, Ghaneh Fananapazir & Thomas W. Loehfelm

  2. Department of Public Health Sciences, University of California, Davis, One Shields Avenue, Med-Sci 182 B, Davis, CA, 95616, USA

    Machelle Wilson

  3. Department of Surgery, Davis Medical Center, University of California, 2221 Stockton Blvd, Sacramento, CA, 95817, USA

    Michael J. Campbell

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Corwin, M.T., Mitchell, A.S., Wilson, M. et al. Accuracy of focal cystic appearance within adrenal nodules on contrast-enhanced CT to distinguish pheochromocytoma and malignant adrenal tumors from adenomas. Abdom Radiol 46, 2683–2689 (2021). https://doi.org/10.1007/s00261-020-02925-5

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