nach oben

Abdominal Radiology

Erschienen in:

27.02.2024 | Kidneys, Ureters, Bladder, Retroperitoneum

Validation of the modified CT criteria for identifying non-adenomas

verfasst von: Min Hwan Kwak, Ji-Sup Yun, Ji Na Kim, Young Rae Lee, Chan Kyo Kim, Kyung A. Kang

Erschienen in: Abdominal Radiology | Ausgabe 5/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Although adrenal computed tomography (CT) percentage washout is a potentially powerful imaging technique for differentiating adrenal adenomas from non-adenomas, its application to non-adenomas can be problematic. Recently, modified criteria for diagnosing pheochromocytomas using adrenal CT were developed based on data from 199 patients with surgically proven pheochromocytomas and adenomas. However, these criteria have not been thoroughly validated. The purpose of this study was to validate the performance of the modified criteria for diagnosing non-adenomas including pheochromocytomas.

Methods

The conventional and modified criteria were applied to 266 patients from two cohorts who had surgically proven lipid-poor adenomas (155/266, 58.3%) and non-adenomas (111/266, 41.7%) and underwent adrenal CT. Two radiologists calculated the attenuation on each dynamic phase and percentage washout of adrenal masses. The final assessments based on the conventional and modified criteria were categorized into adenomas or non-adenomas. The diagnostic performance of each criterion for diagnosing non-adenomas was evaluated using the area under the receiver operating characteristic curve (AUC). False negatives and positives were also compared.

Results

The AUC for the diagnosis of non-adenomas was 0.806 for conventional criteria and 0.858 for modified criteria (p = 0.047). The false-negative rate of conventional criteria for the diagnosis of non-adenomas was 29.7%. Use of modified criteria could have reduced the false-negative rate by to 7.2%. The false-positive rate increased from 9% to 21.3% when using the modified criteria.

Conclusion

The utilization of modified criteria has the potential to identify additional non-adenomas that would otherwise be misdiagnosed as adenomas using conventional criteria alone.

Graphical abstract

Nur mit Berechtigung zugänglich

Ctvrtlik F, Koranda P, Tichy T (2014) Adrenal disease: a clinical update and overview of imaging. A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 158:23-34. https://doi.org/https://doi.org/10.5507/bp.2014.010CrossRefPubMed

Johnson PT, Horton KM, Fishman EK (2009) Adrenal mass imaging with multidetector CT: pathologic conditions, pearls, and pitfalls. Radiographics 29:1333-1351. https://doi.org/https://doi.org/10.1148/rg.295095027CrossRefPubMed

Woo S, Suh CH, Kim SY, Cho JY, Kim SH (2018) Pheochromocytoma as a frequent false-positive in adrenal washout CT: A systematic review and meta-analysis. Eur Radiol 28:1027-1036. https://doi.org/https://doi.org/10.1007/s00330-017-5076-5CrossRefPubMed

Patel J, Davenport MS, Cohan RH, Caoili EM (2013) Can established CT attenuation and washout criteria for adrenal adenoma accurately exclude pheochromocytoma? AJR Am J Roentgenol 201:122-127. https://doi.org/https://doi.org/10.2214/AJR.12.9620CrossRefPubMed

Park BK, Kim B, Ko K, Jeong SY, Kwon GY (2006) Adrenal masses falsely diagnosed as adenomas on unenhanced and delayed contrast-enhanced computed tomography: pathological correlation. Eur Radiol 16:642-647. https://doi.org/https://doi.org/10.1007/s00330-005-0017-0CrossRefPubMed

Park BK, Kim CK, Kwon GY, Kim JH (2007) Re-evaluation of pheochromocytomas on delayed contrast-enhanced CT: washout enhancement and other imaging features. Eur Radiol 17:2804-2809. https://doi.org/https://doi.org/10.1007/s00330-007-0695-xCrossRefPubMed

Kang S, Oh YL, Park SY (2021) Distinguishing pheochromocytoma from adrenal adenoma by using modified computed tomography criteria. Abdom Radiol (NY) 46:1082-1090. https://doi.org/https://doi.org/10.1007/s00261-020-02764-4CrossRefPubMed

Lanoix J, Djelouah M, Chocardelle L, Deguelte S, Delemer B, Dohan A, Soyer P, Barat M, Hoeffel C (2022) Differentiation between heterogeneous adrenal adenoma and non-adenoma adrenal lesion with CT and MRI. Abdom Radiol (NY) 47:1098-1111. https://doi.org/https://doi.org/10.1007/s00261-022-03409-4CrossRefPubMed

Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR (1998) Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. AJR Am J Roentgenol 171:201-204. https://doi.org/https://doi.org/10.2214/ajr.171.1.9648789CrossRefPubMed

10.

Motta-Ramirez GA, Remer EM, Herts BR, Gill IS, Hamrahian AH (2005) Comparison of CT findings in symptomatic and incidentally discovered pheochromocytomas. AJR Am J Roentgenol 185:684-688. https://doi.org/https://doi.org/10.2214/ajr.185.3.01850684CrossRefPubMed

11.

Fassnacht M, Tsagarakis S, Terzolo M, Tabarin A, Sahdev A, Newell-Price J, Pelsma I, Marina L, Lorenz K, Bancos I (2023) European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. European Journal of Endocrinology 189:G1-G42CrossRefPubMed

12.

Vilar L, da Conceição Freitas M, Canadas V, Albuquerque JL, Botelho CA, Egito CS, Arruda MJ, Moura L, Coelho CE, Casulari LA (2008) Adrenal incidentalomas: diagnostic evaluation and long-term follow-up. Endocrine practice 14:269-278CrossRefPubMed

13.

Hong AR, Kim JH, Park KS, Kim KY, Lee JH, Kong SH, Lee SY, Shin CS, Kim SW, Kim SY (2017) Optimal follow-up strategies for adrenal incidentalomas: reappraisal of the 2016 ESE-ENSAT guidelines in real clinical practice. European journal of endocrinology 177:475-483CrossRefPubMed

14.

Marty M, Gaye D, Perez P, Auder C, Nunes M, Ferriere A, Haissaguerre M, Tabarin A (2018) Diagnostic accuracy of computed tomography to identify adenomas among adrenal incidentalomas in an endocrinological population. European Journal of Endocrinology 178:439-446CrossRefPubMed

15.

Bancos I, Taylor AE, Chortis V, Sitch AJ, Lang K, Prete A, Gilligan LC, Biehl M, Deeks JJ, Arlt W (2020) Urine metabolomic phenotyping for detection of adrenocortical carcinoma: still a long way to go–Authors' reply. The Lancet Diabetes & Endocrinology 8:877-878CrossRef

16.

Duh Q-Y (2020) Understanding the epidemiology of adrenal tumours. The Lancet Diabetes & Endocrinology 8:871-873CrossRef

17.

Schloetelburg W, Ebert I, Petritsch B, Weng AM, Dischinger U, Kircher S, Buck AK, Bley TA, Deutschbein T, Fassnacht M (2022) Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses. European Journal of Endocrinology 186:183-193CrossRef

18.

Park SY, Park BK, Park JJ, Kim CK (2016) Differentiation of adrenal hyperplasia from adenoma by use of CT densitometry and percentage washout. American Journal of Roentgenology 206:106-112CrossRefPubMed

19.

Doppman J, Gill Jr J, Miller D, Chang R, Gupta R, Friedman T, Choyke P, Feuerstein I, Dwyer A, Jicha D (1992) Distinction between hyperaldosteronism due to bilateral hyperplasia and unilateral aldosteronoma: reliability of CT. Radiology 184:677-682CrossRefPubMed

20.

Lattin Jr GE, Sturgill ED, Tujo CA, Marko J, Sanchez-Maldonado KW, Craig WD, Lack EE (2014) From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics 34:805-829CrossRefPubMed

21.

Schieda N, Siegelman ES (2017) Update on CT and MRI of Adrenal Nodules. AJR Am J Roentgenol 208:1206-1217. https://doi.org/https://doi.org/10.2214/AJR.16.17758CrossRefPubMed

22.

Korobkin M, Brodeur FJ, Yutzy GG, Francis IR, Quint LE, Dunnick NR, Kazerooni EA (1996) Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. AJR. American journal of roentgenology 166:531-536CrossRefPubMed

23.

Lee MJ, Hahn PF, Papanicolaou N, Egglin TK, Saini S, Mueller PR, Simeone JF (1991) Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size, and observer analysis. Radiology 179:415-418CrossRefPubMed

24.

Kim MJ, Kang KA, Kim CK, Park SY (2023) Inter-method agreement between wash-in and wash-out computed tomography for characterizing hyperattenuating adrenal lesions as adenomas or non-adenomas. European Radiology 33:2218-2226CrossRefPubMed

25.

Kang S, Oh YL, Park SY (2021) Distinguishing pheochromocytoma from adrenal adenoma by using modified computed tomography criteria. Abdominal Radiology 46:1082-1090CrossRefPubMed

26.

Park SY, Park BK, Park JJ, Kim CK (2015) CT sensitivities for large (≥ 3 cm) adrenal adenoma and cortical carcinoma. Abdominal imaging 40:310-317CrossRefPubMed

27.

Sun MR, Ngo L, Genega EM, Atkins MB, Finn ME, Rofsky NM, Pedrosa I (2009) Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes—correlation with pathologic findings. Radiology 250:793-802CrossRefPubMed

28.

Jakobsson U, Westergren A (2005) Statistical methods for assessing agreement for ordinal data. Scand J Caring Sci 19:427-431. https://doi.org/https://doi.org/10.1111/j.1471-6712.2005.00368.xCrossRefPubMed

29.

Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P, Keiser HR, Goldstein DS, Eisenhofer G (2002) Biochemical diagnosis of pheochromocytoma: which test is best? Jama 287:1427-1434CrossRefPubMed

30.

Schieda N, Alrashed A, Flood TA, Samji K, Shabana W, McInnes MD (2016) Comparison of Quantitative MRI and CT Washout Analysis for Differentiation of Adrenal Pheochromocytoma From Adrenal Adenoma. AJR Am J Roentgenol 206:1141-1148. https://doi.org/https://doi.org/10.2214/AJR.15.15318CrossRefPubMed

31.

Mohammed MF, ElBanna KY, Ferguson D, Harris A, Khosa F (2018) Pheochromocytomas Versus Adenoma: Role of Venous Phase CT Enhancement. AJR Am J Roentgenol 210:1073-1078. https://doi.org/https://doi.org/10.2214/AJR.17.18472CrossRefPubMed

32.

Szolar DH, Korobkin M, Reittner P, Berghold A, Bauernhofer T, Trummer H, Schoellnast H, Preidler KW, Samonigg H (2005) Adrenocortical carcinomas and adrenal pheochromocytomas: mass and enhancement loss evaluation at delayed contrast-enhanced CT. Radiology 234:479-485. https://doi.org/https://doi.org/10.1148/radiol.2342031876CrossRefPubMed

33.

Blake MA, Kalra MK, Maher MM, Sahani DV, Sweeney AT, Mueller PR, Hahn PF, Boland GW (2004) Pheochromocytoma: an imaging chameleon. Radiographics 24 Suppl 1:S87-99. https://doi.org/https://doi.org/10.1148/rg.24si045506CrossRefPubMed

34.

Park BK, Kim CK, Kim B, Kwon GY (2007) Adrenal tumors with late enhancement on CT and MRI. Abdom Imaging 32:515-518. https://doi.org/https://doi.org/10.1007/s00261-006-9156-2CrossRefPubMed

35.

Zhang YM, Lei PF, Chen MN, Lv XF, Ling YH, Cai PQ, Gao JM (2016) CT findings of adrenal schwannoma. Clin Radiol 71:464-470. https://doi.org/https://doi.org/10.1016/j.crad.2016.01.010CrossRefPubMed

36.

Kodama Y, Ng CS, Wu TT, Ayers GD, Curley SA, Abdalla EK, Vauthey JN, Charnsangavej C (2007) Comparison of CT methods for determining the fat content of the liver. American Journal of Roentgenology 188:1307-1312CrossRefPubMed

37.

Motta-Ramirez GA, Remer EM, Herts BR, Gill IS, Hamrahian AH (2005) Comparison of CT findings in symptomatic and incidentally discovered pheochromocytomas. AMERICAN JOURNAL OF ROENTGENOLOGY-NEW SERIES- 185:684CrossRef

38.

Terzolo M, Stigliano A, Chiodini I, Loli P, Furlani L, Arnaldi G, Reimondo G, Pia A, Toscano V, Zini M (2011) AME position statement on adrenal incidentaloma. European journal of endocrinology 164:851-870CrossRefPubMed

Titel: Validation of the modified CT criteria for identifying non-adenomas
verfasst von: Min Hwan Kwak
Ji-Sup Yun
Ji Na Kim
Young Rae Lee
Chan Kyo Kim
Kyung A. Kang
Publikationsdatum: 27.02.2024
Verlag: Springer US
Erschienen in: Abdominal Radiology / Ausgabe 5/2024
Print ISSN: 2366-004X
Elektronische ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-024-04206-x

Automated prostate gland segmentation in challenging clinical cases: comparison of three artificial intelligence methods

Pelvis

Comparison between pelvic MRI, CT, and PET/CT in baseline staging and radiation planning of anal squamous cell carcinoma

Hollow Organ GI

Diagnostic performance of hepatic CT and chemical-shift MRI to discriminate lipid-poor adrenal adenomas from hepatocellular carcinoma metastases

Kidneys, Ureters, Bladder, Retroperitoneum

Transitioning from interventional radiology: ideas for the inevitable

Practice

Multiparametric assessment of microvascular invasion in hepatocellular carcinoma using gadoxetic acid-enhanced MRI

Hepatobiliary

Performance of VI-RADS in predicting muscle-invasive bladder cancer after transurethral resection: a single center retrospective analysis

Kidneys, Ureters, Bladder, Retroperitoneum

Neu im Fachgebiet Radiologie

Stumme Schlaganfälle − ein häufiger Nebenbefund im Kopf-CT?

12.01.2025
Computertomografie
Nachrichten

In 4% der in der Notfallambulanz initiierten zerebralen Bildgebung sind „alte“ Schlaganfälle zu erkennen. Gar nicht so selten handelt es sich laut einer aktuellen Studie dabei um unbemerkte Insulte. Bietet sich hier womöglich die Chance auf ein effektives opportunistisches Screening?

Die elektronische Patientenakte kommt: Das sollten Sie jetzt wissen

12.01.2025
Elektronische Patientenakte
Nachrichten

Am 15. Januar geht die „ePA für alle“ zunächst in den Modellregionen an den Start. Doch schon bald soll sie in allen Praxen zum Einsatz kommen. Was ist jetzt zu tun? Was müssen Sie wissen? Wir geben in einem FAQ Antworten auf 21 Fragen.

Stören weiße Wände und viel Licht die Bildqualitätskontrolle?

09.01.2025
Mammografie
Nachrichten

Wenn es darum geht, die technische Qualität eines Mammogramms zu beurteilen, könnten graue Wandfarbe und reduzierte Beleuchtung im Bildgebungsraum von Vorteil sein. Darauf deuten zumindest Ergebnisse einer kleinen Studie hin.

PMBCL mit CMR: Radiatio kann ohne Risiko weggelassen werden

08.01.2025
Non-Hodgkin-Lymphome
Nachrichten

Patienten mit primär mediastinalem B-Zell-Lymphom (PMBCL), die nach der Induktionstherapie eine komplette metabolische Remission (CMR) erreichen und keine konsolidierende Bestrahlung erhalten, müssen offenbar keine Überlebensnachteile fürchten.

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Validation of the modified CT criteria for identifying non-adenomas