Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed t
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REVIEW
Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature Asha Kandathil • Ka Kit Wong • Daniel J. Wale • Maria Chiara Zatelli • Anna Margherita Maffione Milton D. Gross • Domenico Rubello
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Received: 22 July 2014 / Accepted: 25 September 2014 Ó Springer Science+Business Media New York 2014
Abstract PET/CT with 18F-fluorodeoxyglucose (FDG) or using different radiocompounds has proven accuracy for detection of adrenal metastases in patients undergoing cancer staging. It can assist the diagnostic work-up in oncology patients by identifying distant metastases to the adrenal(s) and defining oligometastatic disease that may benefit from targeted intervention. In patients with incidentally discovered adrenal nodules, so-called adrenal ‘‘incidentaloma’’ FDG PET/CT is emerging as a useful test to distinguish benign from malignant etiology. Current published evidence suggests a role for FDG PET/CT in assessing the malignant potential of an adrenal lesion that has been ‘indeterminately’ categorized with unenhanced
A. Kandathil K. K. Wong D. J. Wale M. D. Gross Nuclear Medicine/Radiology Department, University of Michigan Hospital, Ann Arbor, MI 48109, USA K. K. Wong M. D. Gross Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA M. C. Zatelli Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy A. M. Maffione D. Rubello (&) Department of Services in Diagnosis and Cure, Santa Maria della Misericordia Hospital, Rovigo, Italy e-mail: [email protected] D. Rubello Department of Nuclear Medicine, Padova University, 35100 Padova, Italy D. Rubello Service of Nuclear Medicine & PET/CT Unit at Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy
CT, adrenal protocol contrast-enhanced CT, or chemicalshift MRI. FDG PET/CT could be used to stratify patients with higher risk of malignancy for surgical intervention, while recommending surveillance for adrenal masses with low malignant potential. There are caveats for interpretation of the metabolic activity of an adrenal nodule on PET/CT that may lead to false-positive and false-negative interpretation. Adrenal lesions represent a wide spectrum of etiologies, and the typical appearances on PET/CT are still being described, therefore our goal was to summarize the current diagnostic strategies for evaluation of adrenal lesions and present metabolic and anatomic appearances of common and uncommon adrenal lesions. In spite of the emerging role of PET/CT to differentiate benign from malignant adrenal mass, especially in difficult cases, it should be emphasized that PET/CT is not needed for most patients and that many diagnostic problems can be resolved by CT and/or MR imaging. Keywords Incidentaloma Adrenocortical adenoma Pheochromocytoma PET/CT MRI CT
Introduction Incidentally discovered adrenal lesions (commonly referred to a
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