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Erschienen in: Annals of Nuclear Medicine 2/2014

01.02.2014 | Original Article

Characterization of lipid-rich adrenal tumors by FDG PET/CT: Are they hormone-secreting or not?

verfasst von: Kentaro Takanami, Tomohiro Kaneta, Ryo Morimoto, Fumitoshi Satoh, Yasuhiro Nakamura, Kei Takase, Shoki Takahashi

Erschienen in: Annals of Nuclear Medicine | Ausgabe 2/2014

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Abstract

Objectives

The purpose of this study was to evaluate the diagnostic ability of FDG PET/CT to predict the hormone-secretion status of lipid-rich adrenal tumors.

Methods

This study included 29 lipid-rich (CT number <10 HU) adrenal tumors 2 cm or larger in diameter in 28 patients who underwent FDG PET/CT. The diagnoses were based on endocrine examinations, including adrenal venous sampling and subsequent surgical resection, or on the endocrinological and morphological imaging follow-up during a period of at least 6 months. The FDG uptake of the adrenal tumors was evaluated semi-quantitatively using maximum standardized uptake values (SUVmax) and a ratio of the adrenal SUVmax compared to the liver SUVmax (SUVratio) was used for comparison. The statistical significance of differences was assessed using the Mann–Whitney U test, and a p value <0.05 was considered to be statistically significant.

Results

The lipid-rich adrenal tumors were proved to be 16 non-hormone-secreting tumors (15 adenomas and one myelolipoma) and 13 hormone-secreting tumors (five subclinical cortisol-producing adenomas, six aldosterone-producing adenomas and two adenomas that produced both cortisol and aldosterone). None of the patients had pheochromocytoma or a malignant adrenal tumor. The SUVmax (median, range) of the hormone-secreting tumors (3.2, 2.0–8.3) was higher than that of the non-hormone-secreting tumors (2.4, 1.8–3.3) (p < 0.05). Similarly, the SUVratio of the hormone-secreting tumors (0.95, 0.70–3.10) was higher than that of the non-hormone-secreting tumors (0.72, 0.54–0.95) (p < 0.01). There was no significant difference in the tumor diameter between the two groups (p = 0.8). The sensitivity, specificity and accuracy of FDG PET/CT for differentiating hormone-secreting tumors from non-hormone-secreting tumors were 0.69, 0.81 and 0.76 for cutoff SUVratio of 0.8, and were 0.46, 1 and 0.76 for the cutoff SUVratio of 1.0, respectively.

Conclusions

A lipid-rich adrenal tumor presenting increased FDG uptake compared with that of the liver is likely to be a hormone-secreting adenoma. Therefore, additional endocrinological investigations are strongly recommended when an FDG-avid lipid-rich incidentaloma is detected on FDG PET/CT.
Literatur
1.
Zurück zum Zitat Korobkin M. CT characterization of adrenal masses: the time has come. Radiology. 2000;217:629–32.PubMedCrossRef Korobkin M. CT characterization of adrenal masses: the time has come. Radiology. 2000;217:629–32.PubMedCrossRef
2.
Zurück zum Zitat Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol. 2008;190:1163–8.PubMedCrossRef Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol. 2008;190:1163–8.PubMedCrossRef
3.
Zurück zum Zitat Lee MJ, Hahn PF, Papanicolaou N, Egglin TK, Saini S, Mueller PR, et al. Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size, and observer analysis. Radiology. 1991;179:415–8.PubMed Lee MJ, Hahn PF, Papanicolaou N, Egglin TK, Saini S, Mueller PR, et al. Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size, and observer analysis. Radiology. 1991;179:415–8.PubMed
4.
Zurück zum Zitat Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol. 1998;171:201–4.PubMedCrossRef Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol. 1998;171:201–4.PubMedCrossRef
5.
Zurück zum Zitat Yamada T, Ishibashi T, Saito H, Matsuhashi T, Majima K, Tsuda M, et al. Adrenal adenomas: relationship between histologic lipid-rich cells and CT attenuation number. Eur J Radiol. 2003;48:198–202.PubMedCrossRef Yamada T, Ishibashi T, Saito H, Matsuhashi T, Majima K, Tsuda M, et al. Adrenal adenomas: relationship between histologic lipid-rich cells and CT attenuation number. Eur J Radiol. 2003;48:198–202.PubMedCrossRef
6.
Zurück zum Zitat Tsushima Y, Ishizaka H, Matsumoto M. Adrenal masses: differentiation with chemical shift, fast low-angle shot MR imaging. Radiology. 1993;186:705–9.PubMed Tsushima Y, Ishizaka H, Matsumoto M. Adrenal masses: differentiation with chemical shift, fast low-angle shot MR imaging. Radiology. 1993;186:705–9.PubMed
7.
Zurück zum Zitat Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology. 2004;231:305–32.PubMedCrossRef Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology. 2004;231:305–32.PubMedCrossRef
8.
Zurück zum Zitat Groussin L, Bonardel G, Silvera S, Tissier F, Coste J, Abiven G, et al. 18F-Fluorodeoxyglucose positron emission tomography for the diagnosis of adrenocortical tumors: a prospective study in 77 operated patients. J Clin Endocrinol Metab. 2009;94:1713–22.PubMedCrossRef Groussin L, Bonardel G, Silvera S, Tissier F, Coste J, Abiven G, et al. 18F-Fluorodeoxyglucose positron emission tomography for the diagnosis of adrenocortical tumors: a prospective study in 77 operated patients. J Clin Endocrinol Metab. 2009;94:1713–22.PubMedCrossRef
9.
Zurück zum Zitat Shulkin BL, Thompson NW, Shapiro B, Francis IR, Sisson JC. Pheochromocytomas: imaging with 2-[fluorine-18]fluoro-2-deoxy-d-glucose PET. Radiology. 1999;212:35–41.PubMedCrossRef Shulkin BL, Thompson NW, Shapiro B, Francis IR, Sisson JC. Pheochromocytomas: imaging with 2-[fluorine-18]fluoro-2-deoxy-d-glucose PET. Radiology. 1999;212:35–41.PubMedCrossRef
10.
Zurück zum Zitat Taieb D, Sebag F, Barlier A, Tessonnier L, Palazzo FF, Morange I, et al. 18F-FDG avidity of pheochromocytomas and paragangliomas: a new molecular imaging signature? J Nucl Med. 2009;50:711–7.PubMedCrossRef Taieb D, Sebag F, Barlier A, Tessonnier L, Palazzo FF, Morange I, et al. 18F-FDG avidity of pheochromocytomas and paragangliomas: a new molecular imaging signature? J Nucl Med. 2009;50:711–7.PubMedCrossRef
11.
Zurück zum Zitat Boland GW, Blake MA, Hahn PF, Mayo-Smith WW. Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology. 2008;249:756–75.PubMedCrossRef Boland GW, Blake MA, Hahn PF, Mayo-Smith WW. Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology. 2008;249:756–75.PubMedCrossRef
12.
Zurück zum Zitat Shimizu A, Oriuchi N, Tsushima Y, Higuchi T, Aoki J, Endo K. High [18F] 2-fluoro-2-deoxy-d-glucose (FDG) uptake of adrenocortical adenoma showing subclinical Cushing’s syndrome. Ann Nucl Med. 2003;17:403–6.PubMedCrossRef Shimizu A, Oriuchi N, Tsushima Y, Higuchi T, Aoki J, Endo K. High [18F] 2-fluoro-2-deoxy-d-glucose (FDG) uptake of adrenocortical adenoma showing subclinical Cushing’s syndrome. Ann Nucl Med. 2003;17:403–6.PubMedCrossRef
13.
Zurück zum Zitat Zettinig G, Mitterhauser M, Wadsak W, Becherer A, Pirich C, Vierhapper H, et al. Positron emission tomography imaging of adrenal masses: (18)F-fluorodeoxyglucose and the 11beta-hydroxylase tracer (11)C-metomidate. Eur J Nucl Med Mol Imaging. 2004;31:1224–30.PubMedCrossRef Zettinig G, Mitterhauser M, Wadsak W, Becherer A, Pirich C, Vierhapper H, et al. Positron emission tomography imaging of adrenal masses: (18)F-fluorodeoxyglucose and the 11beta-hydroxylase tracer (11)C-metomidate. Eur J Nucl Med Mol Imaging. 2004;31:1224–30.PubMedCrossRef
14.
Zurück zum Zitat Ansquer C, Scigliano S, Mirallie E, Taieb D, Brunaud L, Sebag F, et al. 18F-FDG PET/CT in the characterization and surgical decision concerning adrenal masses: a prospective multicentre evaluation. Eur J Nucl Med Mol Imaging. 2010;37:1669–78.PubMedCrossRef Ansquer C, Scigliano S, Mirallie E, Taieb D, Brunaud L, Sebag F, et al. 18F-FDG PET/CT in the characterization and surgical decision concerning adrenal masses: a prospective multicentre evaluation. Eur J Nucl Med Mol Imaging. 2010;37:1669–78.PubMedCrossRef
15.
Zurück zum Zitat Han SJ, Kim TS, Jeon SW, Jeong SJ, Yun M, Rhee Y, et al. Analysis of adrenal masses by 18F-FDG positron emission tomography scanning. Int J Clin Pract. 2007;61:802–9.PubMedCrossRef Han SJ, Kim TS, Jeon SW, Jeong SJ, Yun M, Rhee Y, et al. Analysis of adrenal masses by 18F-FDG positron emission tomography scanning. Int J Clin Pract. 2007;61:802–9.PubMedCrossRef
16.
Zurück zum Zitat Boland GW. Adrenal imaging: why, when, what, and how? Part 1. Why and when to image? AJR Am J Roentgenol. 2010;195:W377–81.PubMedCrossRef Boland GW. Adrenal imaging: why, when, what, and how? Part 1. Why and when to image? AJR Am J Roentgenol. 2010;195:W377–81.PubMedCrossRef
17.
Zurück zum Zitat Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med. 2003;138:424–9.PubMedCrossRef Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med. 2003;138:424–9.PubMedCrossRef
18.
Zurück zum Zitat Szolar DH, Korobkin M, Reittner P, Berghold A, Bauernhofer T, Trummer H, et al. Adrenocortical carcinomas and adrenal pheochromocytomas: mass and enhancement loss evaluation at delayed contrast-enhanced CT. Radiology. 2005;234:479–85.PubMedCrossRef Szolar DH, Korobkin M, Reittner P, Berghold A, Bauernhofer T, Trummer H, et al. Adrenocortical carcinomas and adrenal pheochromocytomas: mass and enhancement loss evaluation at delayed contrast-enhanced CT. Radiology. 2005;234:479–85.PubMedCrossRef
19.
Zurück zum Zitat Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med. 2007;48:932–45.PubMedCrossRef Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med. 2007;48:932–45.PubMedCrossRef
20.
Zurück zum Zitat Chong S, Lee KS, Kim HY, Kim YK, Kim BT, Chung MJ, et al. Integrated PET-CT for the characterization of adrenal gland lesions in cancer patients: diagnostic efficacy and interpretation pitfalls. Radiographics. 2006;26:1811–24 (discussion 24–6).PubMedCrossRef Chong S, Lee KS, Kim HY, Kim YK, Kim BT, Chung MJ, et al. Integrated PET-CT for the characterization of adrenal gland lesions in cancer patients: diagnostic efficacy and interpretation pitfalls. Radiographics. 2006;26:1811–24 (discussion 24–6).PubMedCrossRef
21.
Zurück zum Zitat Young WF Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007;356:601–10.PubMedCrossRef Young WF Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007;356:601–10.PubMedCrossRef
22.
Zurück zum Zitat Blake MA, Slattery JM, Kalra MK, Halpern EF, Fischman AJ, Mueller PR, et al. Adrenal lesions: characterization with fused PET/CT image in patients with proved or suspected malignancy—initial experience. Radiology. 2006;238:970–7.PubMedCrossRef Blake MA, Slattery JM, Kalra MK, Halpern EF, Fischman AJ, Mueller PR, et al. Adrenal lesions: characterization with fused PET/CT image in patients with proved or suspected malignancy—initial experience. Radiology. 2006;238:970–7.PubMedCrossRef
23.
Zurück zum Zitat Metser U, Miller E, Lerman H, Lievshitz G, Avital S, Even-Sapir E. 18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med. 2006;47:32–7.PubMed Metser U, Miller E, Lerman H, Lievshitz G, Avital S, Even-Sapir E. 18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med. 2006;47:32–7.PubMed
24.
Zurück zum Zitat Kawasaki Y, Ishidoya S, Kaiho Y, Ito A, Satoh F, Morimoto R, et al. Laparoscopic simultaneous bilateral adrenalectomy: assessment of feasibility and potential indications. Int J Urol. 2011;18:762–7.PubMedCrossRef Kawasaki Y, Ishidoya S, Kaiho Y, Ito A, Satoh F, Morimoto R, et al. Laparoscopic simultaneous bilateral adrenalectomy: assessment of feasibility and potential indications. Int J Urol. 2011;18:762–7.PubMedCrossRef
25.
Zurück zum Zitat Terzolo M, Bovio S, Reimondo G, Pia A, Osella G, Borretta G, et al. Subclinical Cushing’s syndrome in adrenal incidentalomas. Endocrinol Metab Clin N Am. 2005;34:423–39.CrossRef Terzolo M, Bovio S, Reimondo G, Pia A, Osella G, Borretta G, et al. Subclinical Cushing’s syndrome in adrenal incidentalomas. Endocrinol Metab Clin N Am. 2005;34:423–39.CrossRef
26.
Zurück zum Zitat Satoh F, Abe T, Tanemoto M, Nakamura M, Abe M, Uruno A, et al. Localization of aldosterone-producing adrenocortical adenomas: significance of adrenal venous sampling. Hypertens Res. 2007;30:1083–95.PubMedCrossRef Satoh F, Abe T, Tanemoto M, Nakamura M, Abe M, Uruno A, et al. Localization of aldosterone-producing adrenocortical adenomas: significance of adrenal venous sampling. Hypertens Res. 2007;30:1083–95.PubMedCrossRef
27.
Zurück zum Zitat Weiss LM, Medeiros LJ, Vickery AL Jr. Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol. 1989;13:202–6.PubMedCrossRef Weiss LM, Medeiros LJ, Vickery AL Jr. Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol. 1989;13:202–6.PubMedCrossRef
28.
Zurück zum Zitat Boland GW. Adrenal imaging: why, when, what, and how? Part 2. What technique? AJR Am J Roentgenol. 2011;196:W1–5.PubMedCrossRef Boland GW. Adrenal imaging: why, when, what, and how? Part 2. What technique? AJR Am J Roentgenol. 2011;196:W1–5.PubMedCrossRef
29.
Zurück zum Zitat Perkins NJ, Schisterman EF. The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006;163:670–5.PubMedCentralPubMedCrossRef Perkins NJ, Schisterman EF. The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006;163:670–5.PubMedCentralPubMedCrossRef
30.
Zurück zum Zitat Caoili EM, Korobkin M, Francis IR, Cohan RH, Platt JF, Dunnick NR, et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology. 2002;222:629–33.PubMedCrossRef Caoili EM, Korobkin M, Francis IR, Cohan RH, Platt JF, Dunnick NR, et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology. 2002;222:629–33.PubMedCrossRef
31.
Zurück zum Zitat Tanabe A, Naruse M, Takagi S, Tsuchiya K, Imaki T, Takano K. Variability in the renin/aldosterone profile under random and standardized sampling conditions in primary aldosteronism. J Clin Endocrinol Metab. 2003;88:2489–94.PubMedCrossRef Tanabe A, Naruse M, Takagi S, Tsuchiya K, Imaki T, Takano K. Variability in the renin/aldosterone profile under random and standardized sampling conditions in primary aldosteronism. J Clin Endocrinol Metab. 2003;88:2489–94.PubMedCrossRef
32.
Zurück zum Zitat Miyake M, Tateishi U, Maeda T, Arai Y, Seki K, Hasegawa T, et al. A case of ganglioneuroma presenting abnormal FDG uptake. Ann Nucl Med. 2006;20:357–60.PubMedCrossRef Miyake M, Tateishi U, Maeda T, Arai Y, Seki K, Hasegawa T, et al. A case of ganglioneuroma presenting abnormal FDG uptake. Ann Nucl Med. 2006;20:357–60.PubMedCrossRef
33.
Zurück zum Zitat Minn H, Salonen A, Friberg J, Roivainen A, Viljanen T, Langsjo J, et al. Imaging of adrenal incidentalomas with PET using (11)C-metomidate and (18)F-FDG. J Nucl Med. 2004;45:972–9.PubMed Minn H, Salonen A, Friberg J, Roivainen A, Viljanen T, Langsjo J, et al. Imaging of adrenal incidentalomas with PET using (11)C-metomidate and (18)F-FDG. J Nucl Med. 2004;45:972–9.PubMed
34.
Zurück zum Zitat Terzolo M, Pia A, Reimondo G. Subclinical Cushing’s syndrome: definition and management. Clin Endocrinol (Oxford). 2012;76:12–8.CrossRef Terzolo M, Pia A, Reimondo G. Subclinical Cushing’s syndrome: definition and management. Clin Endocrinol (Oxford). 2012;76:12–8.CrossRef
35.
Zurück zum Zitat Katabami T, Obi R, Shirai N, Naito S, Saito N. Discrepancies in results of low-and high-dose dexamethasone suppression tests for diagnosing preclinical Cushing’s syndrome. Endocr J. 2005;52:463–9.PubMedCrossRef Katabami T, Obi R, Shirai N, Naito S, Saito N. Discrepancies in results of low-and high-dose dexamethasone suppression tests for diagnosing preclinical Cushing’s syndrome. Endocr J. 2005;52:463–9.PubMedCrossRef
36.
Zurück zum Zitat Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med. 2004;45:1519–27.PubMed Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med. 2004;45:1519–27.PubMed
37.
Zurück zum Zitat Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med. 2004;45:1431–4.PubMed Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med. 2004;45:1431–4.PubMed
38.
Zurück zum Zitat Brady MJ, Thomas J, Wong TZ, Franklin KM, Ho LM, Paulson EK. Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer: a proposal for an efficient diagnostic algorithm. Radiology. 2009;250:523–30.PubMedCrossRef Brady MJ, Thomas J, Wong TZ, Franklin KM, Ho LM, Paulson EK. Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer: a proposal for an efficient diagnostic algorithm. Radiology. 2009;250:523–30.PubMedCrossRef
Metadaten
Titel
Characterization of lipid-rich adrenal tumors by FDG PET/CT: Are they hormone-secreting or not?
verfasst von
Kentaro Takanami
Tomohiro Kaneta
Ryo Morimoto
Fumitoshi Satoh
Yasuhiro Nakamura
Kei Takase
Shoki Takahashi
Publikationsdatum
01.02.2014
Verlag
Springer Japan
Erschienen in
Annals of Nuclear Medicine / Ausgabe 2/2014
Print ISSN: 0914-7187
Elektronische ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-013-0793-6

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