Skip to main content
SpringerLink
Log in

Clinical significance of a 10-mm cutoff size for adrenal lesions: a retrospective study with 547 non-oncologic patients undergoing adrenal computed tomography

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

Abstract

Purpose

To investigate the proportion of clinically significant adrenal lesions in patients with a subcentimeter adrenal lesion, and the sensitivity of a cutoff size of 10 mm on computed tomography (CT).

Methods

This retrospective study included consecutive 547 non-oncologic patients who underwent adrenal CT. Clinically significant adrenal lesions were defined as those that were biochemically abnormal (n = 99) or surgically resected according to the clinician’s decision (n = 23). Long-axis diameters (LDs) and short-axis diameters (SDs) of the lesions were measured on CT by two independent readers. Likelihood of the focal lesion was analyzed using a five-point scale (1 = very low; 5 = very high). 66 Sensitivities for clinically significant lesions were analyzed according to cutoff size. Proportions of the clinically significant lesions for subcentimeter lesions were analyzed according to the visual score.

Results

Sensitivities for clinically significant lesions for cutoffs of 10, 15, and 20 mm were 93%, 79%, and 63% for LD and 85%, 61%, and 49% for SD for Reader 1 and 89%, 78%, and 65% for LD and 80%, 65%, and 48% for SD for Reader 2, respectively (p < 0.001 for 10 mm versus the other cutoffs). In subcentimeter lesions with visual scores of 1–3, the proportions of clinically significant lesions were 5.4% for LD or SD for Reader 1 and 6.6% for LD and 7.7% for SD for Reader 2, respectively.

Conclusion

A lesion LD of ≥ 10 mm was a reasonable cutoff for determining adrenal abnormality. Subcentimeter lesions without visually high suspicion had a low risk of clinical significant lesions in our study cohort. Higher cutoffs significantly decreased sensitivity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Mayo-Smith WW, Song JH, Boland GL, Francis IR, Israel GM, Mazzaglia PJ, Berland LL, Pandharipande PV (2017) Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 14:1038-1044. https://doi.org/10.1016/j.jacr.2017.05.001

    Article  PubMed  Google Scholar 

  2. Glazer DI, Mayo-Smith WW (2020) Management of incidental adrenal masses: an update. Abdom Radiol (NY) 45:892-900. https://doi.org/10.1007/s00261-019-02149-2

    Article  Google Scholar 

  3. Expert Panel on Urological I, Mody RN, Remer EM, Nikolaidis P, Khatri G, Dogra VS, Ganeshan D, Gore JL, Gupta RT, Heilbrun ME, Lyshchik A, Mayo-Smith WW, Purysko AS, Savage SJ, Smith AD, Wang ZJ, Wolfman DJ, Wong-You-Cheong JJ, Yoo DC, Lockhart ME (2021) ACR Appropriateness Criteria(R) Adrenal Mass Evaluation: 2021 Update. J Am Coll Radiol 18:S251-S267. https://doi.org/10.1016/j.jacr.2021.08.010

    Article  Google Scholar 

  4. Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM (2016) 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 175:G1-G34. https://doi.org/10.1530/EJE-16-0467

    Article  CAS  PubMed  Google Scholar 

  5. Nieman LK (2010) Approach to the patient with an adrenal incidentaloma. J Clin Endocrinol Metab 95:4106-4113. https://doi.org/10.1210/jc.2010-0457

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kang S, Oh YL, Park SY (2021) Distinguishing pheochromocytoma from adrenal adenoma by using modified computed tomography criteria. Abdom Radiol (NY) 46:1082–1090. https://doi.org/10.1007/s00261-020-02764-4

  7. Koo TK, Li MY (2016) A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med 15:155-163. https://doi.org/10.1016/j.jcm.2016.02.012

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jakobsson U, Westergren A (2005) Statistical methods for assessing agreement for ordinal data. Scand J Caring Sci 19:427-431. https://doi.org/10.1111/j.1471-6712.2005.00368.x

    Article  PubMed  Google Scholar 

  9. Vincent JM, Morrison ID, Armstrong P, Reznek RH (1994) The size of normal adrenal glands on computed tomography. Clin Radiol 49:453-455. https://doi.org/10.1016/s0009-9260(05)81739-8

    Article  CAS  PubMed  Google Scholar 

  10. Mayo-Smith WW, Boland GW, Noto RB, Lee MJ (2001) State-of-the-art adrenal imaging. Radiographics 21:995-1012. https://doi.org/10.1148/radiographics.21.4.g01jl21995

    Article  CAS  PubMed  Google Scholar 

  11. John R, Putta T, Simon B, Eapen A, Jebasingh F, Thomas N, Rajaratnam S (2018) Normal adrenal gland thickness on computerized tomography in an Asian Indian adult population. Indian J Radiol Imaging 28:465-469. https://doi.org/10.4103/ijri.IJRI_129_18

    Article  PubMed  PubMed Central  Google Scholar 

  12. Montagne JP, Kressel HY, Korobkin M, Moss AA (1978) Computed tomography of the normal adrenal glands. AJR Am J Roentgenol 130:963-966. https://doi.org/10.2214/ajr.130.5.963

    Article  CAS  PubMed  Google Scholar 

  13. Schneller J, Reiser M, Beuschlein F, Osswald A, Pallauf A, Riester A, Tietze JK, Reincke M, Degenhart C (2014) Linear and volumetric evaluation of the adrenal gland--MDCT-based measurements of the adrenals. Acad Radiol 21:1465-1474. https://doi.org/10.1016/j.acra.2014.06.008

    Article  PubMed  Google Scholar 

  14. Kebebew E (2021) Adrenal Incidentaloma. N Engl J Med 384:1542-1551. https://doi.org/10.1056/NEJMcp2031112

    Article  PubMed  Google Scholar 

  15. Kawashima A, Sandler CM, Fishman EK, Charnsangavej C, Yasumori K, Honda H, Ernst RD, Takahashi N, Raval BK, Masuda K, Goldman SM (1998) Spectrum of CT findings in nonmalignant disease of the adrenal gland. Radiographics 18:393-412. https://doi.org/10.1148/radiographics.18.2.9536486

    Article  CAS  PubMed  Google Scholar 

  16. Park SY, Oh YT, Jung DC, Rhee Y (2015) Prediction of Adrenal Adenomas With Hypercortisolism by Using Adrenal Computed Tomography: Emphasis on Contralateral Adrenal Thinning. J Comput Assist Tomogr 39:741-746. https://doi.org/10.1097/RCT.0000000000000269

    Article  PubMed  Google Scholar 

  17. Lattin GE, Jr., Sturgill ED, Tujo CA, Marko J, Sanchez-Maldonado KW, Craig WD, Lack EE (2014) From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics 34:805-829. https://doi.org/10.1148/rg.343130127

    Article  PubMed  Google Scholar 

  18. Szolar DH, Korobkin M, Reittner P, Berghold A, Bauernhofer T, Trummer H, Schoellnast H, Preidler KW, Samonigg H (2005) Adrenocortical carcinomas and adrenal pheochromocytomas: mass and enhancement loss evaluation at delayed contrast-enhanced CT. Radiology 234:479-485. https://doi.org/10.1148/radiol.2342031876

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Myoung Kyoung Kim, Kyung A. Kang & Sung Yoon Park

Authors
  1. Myoung Kyoung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyung A. Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sung Yoon Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sung Yoon Park.

Ethics declarations

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 49 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, M.K., Kang, K.A. & Park, S.Y. Clinical significance of a 10-mm cutoff size for adrenal lesions: a retrospective study with 547 non-oncologic patients undergoing adrenal computed tomography. Abdom Radiol 47, 1091–1097 (2022). https://doi.org/10.1007/s00261-021-03405-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-021-03405-0

Keywords

Search

Navigation