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Cited by 119Adrenal and Paraganglionic TumorsNeuroendocrine Tumor Research AdvancesMedical Imaging Techniques and Applications

Can established CT attenuation and washout criteria for adrenal adenoma accurately exclude pheochromocytoma?

Patel, Jeet, Davenport, Matthew S., Cohan, Richard H., Caoili, Elaine M.·2013·American Journal of Roentgenology
DOI 10.2214/ajr.12.9620
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Abstract

OBJECTIVE: The purpose of this article is to determine the proportion of pheochromocytomas that mimic adrenal adenoma using established CT washout and attenuation criteria. MATERIALS AND METHODS: The CT characteristics of pheochromocytomas confirmed by histologic analysis (n = 46) and (131)I-metaiodobenzylguanidine (n = 1) were compared with those of 98 adrenal adenomas (negative plasma and urinary metanephrines or catecholamines, and one or more of the following characteristics: unenhanced attenuation ≤ 10 HU, absolute washout ≥ 60%, and relative washout ≥ 40%). CT numbers were measured in all available phases (unenhanced [n = 37], 1-minute contrast enhanced [n = 46], and delayed contrast enhanced [n = 43]) using a region of interest that encompassed the majority of the mass. Absolute washout, relative washout, and degree of enhancement (1-minute minus unenhanced) were calculated. Mass size and heterogeneity were recorded and compared using the Student t test and a chi-square test, respectively. RESULTS: Twenty-four of 47 (51%) pheochromocytomas were imaged with a triphasic examination using a 15-minute delay. Eight of 24 (33%) met relative (6/24 [25%]) or absolute (7/24 [29%]) washout criteria for the diagnosis of a lipid-poor adenoma. Four of these (50% [4/8]) were homogeneous on all three phases. None of the pheochromocytomas had an unenhanced attenuation of 10 HU or less. Pheochromocytomas were significantly larger than adrenal adenomas (mean diameter, 3.9 cm [range, 0.6-14 cm] vs 2.0 cm [range, 0.8-3.9 cm]; p < 0.0001) and were significantly less likely to be homogeneous (15/47 [32%] vs 95/98 [97%]; p < 0.0001), but there was overlap. CONCLUSION: A substantial minority of pheochromocytomas have absolute or relative washout characteristics that overlap with those of lipid-poor adenomas.

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  • On single-phase contrast-enhanced CT at 60-90 seconds, HU values of benign adenomas and nonadenoma lesions overlap significantly.

    “A frequent clinical dilemma is the detection of an AI on a single-phase contrast-enhanced CT typically performed 60 to 90 seconds postcontrast administration when the HU value of benign adenomas and nonadenoma lesions overlap significantly (304).”

    From Adrenal incidentaloma (2020) · cites this paper as [304]

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Authors
Patel, J., Davenport, M. S., Cohan, R. H., & Caoili, E. M.
Affiliations
Michigan Medicine (US)
ORCID
Venue
American Journal of Roentgenology
Publisher
American Roentgen Ray Society
Published
2013-07
Volume
201
Issue
1
Pages
122-127
ISSN
  • 0002-9580 (ISSN-L)
  • 0361-803X
  • 1546-3141
DOI
10.2214/ajr.12.9620
OpenAlex
W2108709260
Cited by
119
References
23
Citations by year
2026: 7 · 2025: 7 · 2024: 10 · 2023: 8 · 2022: 13 · 2021: 9 · 2020: 11 · 2019: 10 · 2018: 11 · 2017: 7 · 2016: 11 · 2015: 11 · 2014: 4
FWCI
8.54
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Roentgenology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
Keywords
pheochromocytoma, adrenal adenoma, CT attenuation, differential diagnosis, triphasic CT, 131I-MIBG, tumor size, tumor heterogeneity, adrenal imaging, false-negative diagnosis, catecholamine deficiency
MeSH terms
Adolescent, Adrenal Gland Neoplasms, Adult, Aged, Aged, 80 and over, Diagnosis, Differential, Female, Humans, Iohexol, Iopamidol, Male, Middle Aged, Pheochromocytoma, Retrospective Studies, Tomography, X-Ray Computed, Chi-Square Distribution, Adrenocortical Adenoma, Radiopharmaceuticals, 3-Iodobenzylguanidine

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