A Critical Analysis of Computed Tomography Washout in Lipid-Poor Adrenal Incidentalomas
- PDF / 882,421 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 43 Downloads / 141 Views
ORIGINAL ARTICLE – ENDOCRINE TUMORS
A Critical Analysis of Computed Tomography Washout in LipidPoor Adrenal Incidentalomas Serkan Akbulut, MD1, Ozgun Erten, MD1, Bora Kahramangil, MD1, Mehmet Gokceimam, MD1, Yoo Seok Kim, MD1, Pengpeng Li, MD1, Erick M. Remer, MD2, and Eren Berber, MD1 1
Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH ; 2Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
ABSTRACT Background. Contrast-enhanced computed tomography (CT) with washout has emerged as an option to distinguish lipid-poor adenomas from non-adenomas. Objective. The aim of this study was to assess the utility of CT washout in characterizing indeterminate lipid-poor adrenal incidentalomas. Methods. From an Institutional Review Board-approved database, patients with adrenal incidentalomas who had adrenal protocol CT scans with a 15-min washout between 2003 and 2019 were identified. Non-contrast CT attenuation and washout patterns of different tumor types were compared. Results. Overall, 156 patients with 175 adrenal lesions were included. Average tumor size was 3.0 cm, non-contrast CT density was 24.7 Hounsfield units (HU), and absolute washout was 52.6%. In 102 lesions (58.3%), CT washout was C 60%; 94 (92.2%) of these were benign adrenocortical adenomas, 7 (6.9%) were pheochromocytomas, and 1 (0.9%) was an adrenal hematoma. Furthermore, in 73 tumors (41.7%), CT washout was \ 60%; diagnosis was benign adrenocortical adenoma in 45 (61.6%) lesions, pheochromocytoma in 8 (11%) lesions, metastasis in 9 (12.3%) lesions, adrenocortical cancer in 6 (8.2%) lesions, and ‘others’ in 5 (6.9%) lesions. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of [ 60% absolute CT washout for
Ó Society of Surgical Oncology 2020 First Received: 7 June 2020 Accepted: 22 October 2020 E. Berber, MD e-mail: [email protected]
detecting an adrenal adenoma was 67.6%, 77.8%, 92.2%, 38.4%, and 69.7%, respectively. Conclusion. CT washout should be incorporated into the management algorithm of indeterminate adrenal incidentalomas with a high non-contrast CT attenuation to ‘rulein’ benign tumors. For small tumors with mild elevation of plasma metanephrines, it should be kept in mind that adenomas and pheochromocytomas may have similar imaging and washout characteristics.
An adrenal incidentaloma (AI) is identified in up to 5% of patients undergoing computed tomography (CT) scans.1,2 According to 2017 Organization for Economic Co-operation and Development statistics, the number of CT and magnetic resonance imaging (MRI) scans performed yearly per 1000 population in the US is 256 and 111, respectively.3 This would translate to millions of patients who would need to be worked-up for their AIs annually. As the incidence of AI increases with age,4 the magnitude of the problem is likely to expand with an aging population. The work-up of incidental adrenal tumors requires a complex algorithm that utilizes hormonal testing and imaging to rule out adrenocortical
Data Loading...
