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Abstract
SUMMARY
Objective: To describe the characteristics of common adrenal lesions on CT and to compare the diagnostic performance of different methods of measurement in diagnosing adenoma.
Materials and Methods: We conducted a retrospective study in 63 patients with adrenal lesions who were performed preoperative CT and had histologic results at the University Medical Center Hospital between January 2016 and January 2020. A radiologist who had more than 10 years of experience of CT measured: lesion size, mean and standard deviation (SD) attenuation value, pixel histogram, calculated p10 based on histogram or following formula P10=mean – (1,282 x SD). The diagnostic performance of mean value, histogram analysis, calculated p10, absoulte and relative washout index were compared.
Results: The study was composed of 32 patients with 32 adenomas and 31 patients with 33 non-adenoma lesions. Adenomas were more common in female (n = 26 [81.3%]) than in male patients. However, non-adenoma were almost equally distributed between male and female patients (n = 15 female patients [48. 4%]). The mean age of patients in the adenoma group was 44.3 ± 12.6 years (range, 12-75 years), which is not significantly different from the mean age of 41.2 ± 15.1 years for patients in the non-adenoma group (range, 13-77 years) (p = 0.26).
Adenoma group had the mean diameter smaller than non-adenoma
lesions (p <0,001) and more homogeneous attenuation pattern (p=0.001). The sensitivity, specificity and accuracy of the mean attenuation analysis, histogram, calculated p10, absoulte and relative washout were (37.5%, 100.0% and 66.7%, cutoff 10 HU), (84.4 %, 82.8% and 83.6%, cutoff 10%), (78.1 %, 82.1% and 80%, cutoff 0), (88 %, 72% and 80%, cutoff 60%), and (84.0 %, 65.4% and 74.5%, cutoff 40%), respectively.
Conclusion: The mean attenuation analysis, histogram and calculated p10 play a crucial role in differentiation adrenal adenoma from non-adenoma lesion. The accuracy of histogram analysis and calculated 10th percentile outperformed the mean attenuation as a diag-nostic criterion for adenoma.
Article Details
Keywords
adrenal gland, adenoma, computed tomography
References
1 Halefoglu, A. M., Bas, N., Yasar, A. & Basak, M. Differentiation of adrenal adenomas from nonadenomas using CT histogram analysis method: a prospective study. European journal of radiology 73, 643-651 (2010).
2 Herr, K., Muglia, V. F., Koff, W. J. & Westphalen, A. C. Imaging of the adrenal gland lesions. Radiologia brasileira 47, 228-239 (2014).
3 Fassnacht, M. et al. 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 (2016).
4 Park, B. K., Kim, C. K., Kim, B. & Lee, J. H. Comparison of delayed enhanced CT and chemical shift MR for evaluating hyperattenuating incidental adrenal masses. Radiology 243, 760-765 (2007).
5 Boland, G. W., Blake, M. A., Hahn, P. F. & Mayo-Smith, W. W. Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology 249, 756-775 (2008).
6 Pena, C. S., Boland, G. W., Hahn, P. F., Lee, M. J. & Mueller, P. R. Characterization of indeterminate (lipid-poor) adrenal masses: use of washout characteristics at contrast-enhanced CT. Radiology 217, 798-802 (2000).
7 Ho, L. M., Paulson, E. K., Brady, M. J., Wong, T. Z. & Schindera, S. T. Lipid-poor adenomas on unenhanced CT: does histogram analysis increase sensitivity compared with a mean attenuation threshold? American Journal of Roentgenology 191, 234-238 (2008).
8 Zeiger, M. et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocrine Practice 15, 1-20 (2009).
9 Bae, K. T., Fuangtharnthip, P., Prasad, S. R., Joe, B. N. & Heiken, J. P. Adrenal masses: CT characterization with histogram analysis method. Radiology 228, 735-742 (2003).
10 Song, J. H., Chaudhry, F. S. & Mayo-Smith, W. W. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. American Journal of Roentgenology 190, 1163-1168 (2008).
11 Mayo-Smith, W. W. et al. Management of incidental adrenal masses: a white paper of the ACR Incidental Findings Committee. Journal of the American College of Radiology 14, 1038-1044 (2017).
12 Nieman, L. K. Approach to the patient with an adrenal incidentaloma. J Clin Endocrinol Metab 95, 4106 4113, doi:10.1210/jc.2010-0457 (2010).
13 Song, J. H., Chaudhry, F. S. & Mayo-Smith, W. W. The incidental indeterminate adrenal mass on CT (> 10 H)
in patients without cancer: is further imaging necessary? Follow-up of 321 consecutive indeterminate adrenal
masses. American Journal of Roentgenology 189, 1119-1123 (2007).
14 Remer, E. M., Motta-Ramirez, G. A., Shepardson, L. B., Hamrahian, A. H. & Herts, B. R. CT histogram analysis
in pathologically proven adrenal masses. American Journal of Roentgenology 187, 191-196 (2006).
15 Young Jr, W. F. The incidentally discovered adrenal mass. New England Journal of Medicine 356, 601-610 (2007).
16 Korobkin, M. et al. Adrenal adenomas: relationship between histologic lipid and CT and MR findings. Radiology 200, 743-747 (1996).
17 Jhaveri, K. S., Wong, F., Ghai, S. & Haider, M. A. Comparison of CT histogram analysis and chemical shift MRI in the characterization of indeterminate adrenal nodules. American Journal of Roentgenology 187, 1303-1308 (2006).
18 Haider, M. A., Ghai, S., Jhaveri, K. & Lockwood, G. Chemical shift MR imaging of hyperattenuating (> 10 HU)
adrenal masses: does it still have a role? Radiology 231, 711-716 (2004).
19 Sebro, R., Aslam, R., Muglia, V. F., Wang, Z. J. & Westphalen, A. C. Low yield of chemical shift MRI for characterization of adrenal lesions with high attenuation density on unenhanced CT. Abdominal imaging 40,
318-326 (2015).