Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature
Abstract
OBJECTIVE: Unenhanced CT scanning can reliably characterize incidentally detected adrenal masses when observers use density measurements of the adrenal gland. However, controversy exists as to the optimal density threshold required to differentiate benign from malignant lesions. This study attempts to establish a consensus by performing a pooled analysis of data found in the CT literature. MATERIALS AND METHODS: Ten CT reports were analyzed, from which individual adrenal lesion density measurements were obtained for 495 adrenal lesions (272 benign lesions and 223 malignant lesions). Threshold analysis generated a range of sensitivities and specificities for lesion characterization at different density thresholds. RESULTS: Sensitivity for characterizing a lesion as benign ranged from 47% at a threshold of 2 H to 88% at a threshold of 20 H. Similarly, specificity varied from 100% at a threshold of 2 H to 84% at a threshold of 20 H. CONCLUSION: The attempt to be absolutely certain that an adrenal lesion is benign may lead to an unacceptably low sensitivity for lesion characterization. The threshold chosen will depend on the patient population and the cost-benefit approach to patient care.
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In patients without known extra-adrenal malignancy, HU ≤10 on noncontrast CT is consistent with lipid-rich benign adenoma.
“In patients without known extra-adrenal malignancy, an HU of ≤10 on a noncontrast CT is consistent with a lipid-rich benign adenoma (294).”
From Adrenal incidentaloma (2020) · cites this paper as [294]
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- Authors
- Boland, G. W., Lee, M. J., Gazelle, G. S., Halpern, E. F., McNicholas, M. M., & Mueller, P. R.
- Affiliations
- Harvard University (US)
- Venue
- American Journal of Roentgenology
- Publisher
- American Roentgen Ray Society
- Published
- 1998-07
- Volume
- 171
- Issue
- 1
- Pages
- 201-204
- ISSN
- 0002-9580 (ISSN-L)
- 0361-803X
- 1546-3141
- OpenAlex
- W2171815806
- Cited by
- 693
- References
- 6
- Citations by year
- 2026: 10 · 2025: 23 · 2024: 21 · 2023: 25 · 2022: 39 · 2021: 36 · 2020: 23 · 2019: 22 · 2018: 29 · 2017: 21 · 2016: 32 · 2015: 33 · 2014: 40 · 2013: 34 · 2012: 25
- FWCI
- 4.44
- 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 › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
- Keywords
- adrenal mass, unenhanced CT, benign versus malignant differentiation, density limit, sensitivity and specificity, incidental adrenal lesions, adrenal incidentaloma
- MeSH terms
- Adrenal Gland Diseases, Adrenal Gland Neoplasms, Diagnosis, Differential, Humans, Sensitivity and Specificity, Tomography, X-Ray Computed
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