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Cited by 59Adrenal and Paraganglionic TumorsPituitary Gland Disorders and TreatmentsNeuroendocrine Tumor Research Advances

Diagnostic accuracy of computed tomography to identify adenomas among adrenal incidentalomas in an endocrinological population

Marty, M, Gaye, D, Perez, P, Auder, C, Nunes, M L, Ferriere, A, Haissaguerre, M, Tabarin, A·2018·European Journal of Endocrinology
DOI 10.1530/eje-17-1056
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Abstract

CONTEXT: The recent recommendations of the European Endocrine Society states that the performance of computed tomography (CT) to characterize 'true' adrenal incidentalomas (AIs) remains debatable. OBJECTIVE: To determine relevant thresholds for usual CT parameters for the diagnosis of benign tumors using robust reference standard among a large series of 'true' AIs recruited in an endocrinological setting. DESIGN: Retrospective study of 253 AIs in 233 consecutive patients explored in a single university hospital: 183 adenomas, 33 pheochromocytomas, 23 adrenocortical carcinomas, 5 other malignant tumors and 9 other benign tumors. Reference standard was histopathology in 118 AIs, biological diagnosis of pheochromocytoma in 2 AIs and size stability after at least 1 year of follow-up in 133 AIs. METHODS: Sensitivity, specificity and positive and negative predictive values were estimated for various thresholds of size, unenhanced attenuation (UA), relative and absolute wash-out (RPW, APW) of contrast media. 197 scans were reviewed independently in a blinded fashion by two expert radiologists to assess inter-observer reproducibility of measurements. RESULTS: Criteria associated with a 100% positive predictive value for the diagnosis of benign AI were: a combination of size and UA: 30 mm and 20 HU or 40 mm and 15 HU, respectively; RPW >53%; and APW >78%. Non-adenomatous AIs with rapid contrast wash-out were exclusively benign pseudocysts and pheochromocytomas, suggesting that classical thresholds of 60% and 40% for APW and RPW, respectively, can be safely used for patients with normal metanephrine values. Inter-observer reproducibility of all parameters was excellent (intra-class correlation coefficients: 0.96-0.99). CONCLUSIONS: Our study, the largest conducted in AIs recruited in an endocrinological setting, suggests safe thresholds for quantitative CT parameters to avoid false diagnoses of benignity.

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Crossref · 10.1530/eje-17-1056

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  • 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 [299]

  • Absolute washout >60% suggests benign adenoma.

    “Absolute washout values of >60% (early enhanced HU – delayed HU)/(early enhanced HU – unenhanced HU) × 100% suggest a benign adenoma (295,299).”

    From Adrenal incidentaloma (2020) · cites this paper as [299]

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Authors
Marty, M., Gaye, D., Perez, P., Auder, C., Nunes, M. L., Ferriere, A., Haissaguerre, M., & Tabarin, A.
Affiliations
  • 1Departments of Endocrinology, Diabetes and Nutrition
  • Université de Bordeaux (FR)
  • Inserm (FR)
Corresponding author
Tabarin, A
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2018-05
Volume
178
Issue
5
Pages
439-446
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-17-1056
OpenAlex
W2802443841
Cited by
59
References
20
Citations by year
2026: 6 · 2025: 7 · 2024: 8 · 2023: 8 · 2022: 8 · 2021: 8 · 2020: 8 · 2019: 3 · 2018: 2
FWCI
5.44
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • Oskar-Bordeaux (Universite de Bordeaux) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
Keywords
adrenal incidentaloma, adrenal adenoma, computed tomography, diagnostic accuracy, pheochromocytoma, adrenal metastasis, tumor size threshold, benign versus malignant differentiation, interobserver reproducibility, reference materials
MeSH terms
Adenoma, Adrenal Gland Neoplasms, Aged, Diagnosis, Differential, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pheochromocytoma, Retrospective Studies, Tomography, X-Ray Computed

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