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Cited by 314Adrenal and Paraganglionic TumorsRenal cell carcinoma treatmentMedical Imaging Techniques and Applications

Adrenocortical carcinomas and adrenal pheochromocytomas: mass and enhancement loss evaluation at delayed contrast-enhanced CT

Szolar, Dieter H., Korobkin, Melvyn, Reittner, Pia, Berghold, Andrea, Bauernhofer, Thomas, Trummer, Harald, Schoellnast, Helmut, Preidler, Klaus W. +1 more·2005·Radiology
DOI 10.1148/radiol.2342031876
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Abstract

PURPOSE: To retrospectively measure the adrenal gland attenuation and the percentage loss of adrenal gland enhancement at delayed contrast medium-enhanced computed tomography (CT) in patients with adrenocortical carcinomas and pheochromocytomas and to compare these data with those in patients with adenomas and metastases. MATERIALS AND METHODS: The study protocol was approved by the ethics committee, which waived informed consent. Eleven patients with proved adrenocortical carcinoma, 17 with proved pheochromocytoma, 23 with adrenal adenoma, and 16 with metastasis to the adrenal gland underwent helical CT. Nonenhanced CT was followed by contrast-enhanced CT 1 minute and 10 minutes later. Attenuation and enhancement loss values were calculated. RESULTS: The mean attenuation of adenomas (8 HU +/- 18 [standard deviation]) was significantly lower than those of adrenocortical carcinomas (39 HU +/- 14), pheochromocytomas (44 HU +/- 11), and metastases (34 HU +/- 11) on nonenhanced CT scans (P < .001). Although the mean attenuation values for nonadenomas (ie, adrenocortical carcinomas, pheochromocytomas, and metastases) were significantly higher than the value for adenomas on the 1-minute contrast-enhanced CT scans (P < .001), there was more overlap in attenuation between adenomas and nonadenomas on contrast-enhanced scans than on nonenhanced scans. On the 10-minute delayed contrast-enhanced scans, the mean attenuation of adenomas (32 HU +/- 17) was significantly lower than the mean attenuations of carcinomas (72 HU +/- 15), pheochromocytomas (83 HU +/- 14), and metastases (66 HU +/- 13) (P < .001). At optimal threshold values of 50% for absolute percentage of enhancement loss and 40% for relative percentage of enhancement loss at 10 minutes, both the sensitivity and the specificity for the diagnosis of adenoma were 100% when adenomas were compared with carcinomas, pheochromocytomas, and metastases. CONCLUSION: The enhancement loss in adrenocortical carcinomas and pheochromocytomas is similar to that in adrenal metastases but significantly less than that in adrenal adenomas. The percentage change in contrast material washout is a useful adjunct to absolute CT attenuation values in differentiating adrenal adenomas from adrenocortical carcinomas and pheochromocytomas.

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Crossref · 10.1148/radiol.2342031876

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  • Approximately 30% of benign adrenal adenomas are lipid-poor (attenuation >10 HU) and cannot be reliably characterized on unenhanced CT due to overlapping density with malignant lesions and pheochromocytomas.

    “Approximately 30% of benign adrenal adenomas do not contain large amounts of fat and have an attenuation value of >10 HU (ie, lipid-poor adenomas), these lesions cannot be reliably characterized on unenhanced CT due to an overlapping density with malignant lesions and pheochromocytomas (295,296).”

    From Adrenal incidentaloma (2020) · cites this paper as [296]

  • Relative washout >40% suggests benign adenoma.

    “Values of > 40% suggest a benign adenoma (296,299,300) (Fig. 6).”

    From Adrenal incidentaloma (2020) · cites this paper as [296]

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Authors
Szolar, D. H., Korobkin, M., Reittner, P., Berghold, A., Bauernhofer, T., Trummer, H., Schoellnast, H., Preidler, K. W., & Samonigg, H.
Affiliations
University of Graz (AT)
ORCID
Venue
Radiology
Publisher
Radiological Society of North America (RSNA)
Published
2005-02
Volume
234
Issue
2
Pages
479-485
ISSN
  • 0033-8419 (ISSN-L)
  • 1527-1315
DOI
10.1148/radiol.2342031876
OpenAlex
W2137978892
Cited by
314
References
26
Citations by year
2026: 5 · 2025: 6 · 2024: 9 · 2023: 5 · 2022: 17 · 2021: 13 · 2020: 13 · 2019: 14 · 2018: 18 · 2017: 14 · 2016: 10 · 2015: 18 · 2014: 15 · 2013: 25 · 2012: 22
FWCI
14.42
Type
journal article
Language
en
Open access
closed
Locations
  • Radiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
Keywords
adrenocortical carcinoma, adrenal pheochromocytoma, adrenal adenoma, adrenal metastasis, differential diagnosis, adrenal imaging, sensitivity and specificity, adrenal mass characterization
MeSH terms
Adenoma, Adolescent, Adrenal Cortex Neoplasms, Adrenal Gland Neoplasms, Adult, Aged, Female, Humans, Male, Middle Aged, Pheochromocytoma, Sensitivity and Specificity, Tomography, X-Ray Computed, Adrenocortical Carcinoma

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