Unenhanced CT imaging is highly sensitive to exclude pheochromocytoma: a multicenter study
Open accessAbstract
BACKGROUND: A substantial proportion of all pheochromocytomas is currently detected during the evaluation of an adrenal incidentaloma. Recently, it has been suggested that biochemical testing to rule out pheochromocytoma is unnecessary in case of an adrenal incidentaloma with an unenhanced attenuation value ≤10 Hounsfield Units (HU) at computed tomography (CT). OBJECTIVES: We aimed to determine the sensitivity of the 10 HU threshold value to exclude a pheochromocytoma. METHODS: Retrospective multicenter study with systematic reassessment of preoperative unenhanced CT scans performed in patients in whom a histopathologically proven pheochromocytoma had been diagnosed. Unenhanced attenuation values were determined independently by two experienced radiologists. Sensitivity of the 10 HU threshold was calculated, and interobserver consistency was assessed using the intraclass correlation coefficient (ICC). RESULTS: 214 patients were identified harboring a total number of 222 pheochromocytomas. Maximum tumor diameter was 51 (39-74) mm. The mean attenuation value within the region of interest was 36 ± 10 HU. Only one pheochromocytoma demonstrated an attenuation value ≤10 HU, resulting in a sensitivity of 99.6% (95% CI: 97.5-99.9). ICC was 0.81 (95% CI: 0.75-0.86) with a standard error of measurement of 7.3 HU between observers. CONCLUSION: The likelihood of a pheochromocytoma with an unenhanced attenuation value ≤10 HU on CT is very low. The interobserver consistency in attenuation measurement is excellent. Our study supports the recommendation that in patients with an adrenal incidentaloma biochemical testing for ruling out pheochromocytoma is only indicated in adrenal tumors with an unenhanced attenuation value >10 HU.
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Mean Hounsfield unit scores for pheochromocytoma are 30 to 35, with only 0.5% of pheochromocytomas having an unenhanced CT attenuation of 10 HU or less.
“Mean HU scores for pheochromocytoma are 30 to 35 (197) with only 0.5% of pheochromocytoma having an unenhanced CT attenuation of ≤10 HU (97,197,198).”
From Adrenal incidentaloma (2020) · cites this paper as [197]
Buitenwerf et al. reviewed CT images of 222 histologically proven pheochromocytomas, yielding only a single tumor with an unenhanced attenuation of less than 10 HU.
“Buitenwerf et al. (197) reviewed the CT images of 222 histologically proven pheochromocytomas, yielding only a single tumor with an unenhanced attenuation of <10 HU.”
From Adrenal incidentaloma (2020) · cites this paper as [197]
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References 27 · Cited by 72
Research works printed but not linked: 1
- DeLellis R, Heitz P & Eng C. Pathology and Genetics: Tumours of Endocrine Organs (IARC WHO Classification of Tumours). Lyon, France: IARC Press, 2004.
- Authors
- Buitenwerf, E., Korteweg, T., Visser, A., Haag, C. M. S. C., Feelders, R. A., Timmers, H. J. L. M., Canu, L., Haak, H. R., Bisschop, P. H. L. T., Eekhoff, E. M. W., Corssmit, E. P. M., Krak, N. C., Rasenberg, E., van den Bergh, J., Stoker, J., Greuter, M. J. W., Dullaart, R. P. F., Links, T. P., & Kerstens, M. N.
- Affiliations
- University Medical Center Groningen (NL)
- Erasmus MC (NL)
- Radboud University Medical Center (NL)
- Maastricht University Medical Centre (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Leiden University Medical Center (NL)
- Máxima Medisch Centrum (NL)
- 14Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
- Corresponding author
- Buitenwerf, Edward
- ORCID
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-05
- Volume
- 178
- Issue
- 5
- Pages
- 431-437
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2788731763
- Cited by
- 72
- References
- 27
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 9 · 2023: 11 · 2022: 9 · 2021: 6 · 2020: 8 · 2019: 9 · 2018: 4
- FWCI
- 7.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Florence Research (University of Florence) (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
- Keywords
- pheochromocytoma, adrenal incidentaloma, diagnostic sensitivity, biochemical tests, interobserver agreement, adrenal tumors
- MeSH terms
- Academic Medical Centers, Adrenal Gland Neoplasms, Adrenal Glands, Adult, Aged, Diagnosis, Differential, False Negative Reactions, Female, Hospitals, Teaching, Humans, Male, Middle Aged, Netherlands, Pheochromocytoma, Retrospective Studies, Sensitivity and Specificity, Tomography, X-Ray Computed, Observer Variation, Tumor Burden
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