Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-01-2006 | Original Article

FDG-PET and CT characterization of adrenal lesions in cancer patients

Authors: Suman Jana, Tong Zhang, David M. Milstein, Carmen R. Isasi, M. Donald Blaufox

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 1/2006

Abstract

Purpose

Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) may differentiate benign from malignant adrenal lesions. In this study, standardized uptake values (SUVs), visual interpretation, and computed tomography (CT) data were correlated with the final diagnosis to determine the contribution of adrenal FDG-PET in patients with known non-adrenal cancer.

Methods

Ninety-two patients with adrenal lesions on CT underwent FDG-PET. Eighty adrenals in 74 patients met the inclusion criteria (PET scan within 4 weeks of CT plus >1 year of follow-up after PET scan with repeat CT or biopsy for final diagnosis). CT was considered positive for metastases (CT+) based on two of the following three criteria: >4 cm, Hounsfield units (HU) >30, and delayed contrast enhancement. Lesions with <2 cm, with HU <20, and showing no enhancement were considered benign (CT−). Remaining lesions were considered indeterminate (CT-Ind). Visually, adrenal uptake exceeding liver uptake was considered PET positive (PET+). Diagnosis of metastases was based on biopsy or interval CT growth (unchanged >1 year=benign). SUV_max and SUV_avg were calculated from a 4×4 pixel region of interest drawn from CT, PET, and fused images. A receiver operator curve (ROC) determined the SUV with the best sensitivity and specificity.

Results

Overall, PET was 93% sensitive and 96% specific for metastases. A SUV_max of 3.4 was 95% sensitive and 86% specific. A SUV_avg of 3.1 was 95% sensitive and 90% specific. There was no significant difference between visual interpretation and SUV (SUV_max or SUV_avg). Among CT+ and CT− lesions, PET was 100% sensitive and 96% specific; CT was 86% sensitive and 100% specific. In the CT-Ind group, PET was 88% sensitive and 96% specific.

Conclusion

PET accurately characterized adrenal lesions. Visual interpretation was as accurate as SUV. FDG-PET was most useful in the 52.5% of cancer patients with inconclusive adrenal lesions on CT.

Dunnick NR, Korobkin M. Imaging of Adrenal Incidentalomas: current status. AJR Am J Roentgenol 2002;179:559–68PubMed

Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma: analysis of 1000 autopsied cases. Cancer 1950;3:74–85PubMed

Zornoza J, Bracken R, Wallace S. Radiologic features of adrenal metastases. Urology 1976;8:295–9CrossRefPubMed

Falk THM, Sandler MP. Classification of silent adrenal masses: time to get practical. J Nucl Med 1994;35:1152–4PubMed

Gross MD, Shapiro B. Clinical review 50: clinically silent adenal masses. J Clin Endocrinol Metab 1993;77:885–8

Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev 1995;16:460–84CrossRefPubMed

Higgins JC. Diagnosis of renal and adrenal incidentalomas. Clinics in Family Practice 2002;4(3):505CrossRef

Barzon L, Boscara M. Diagnosis and management of adrenal incidentalomas. J Urol 2000;163(2):398–422

Cook DM, Loriaux LD. The incidental adrenal mass. Am J Med 1996;101(1) 88–94CrossRefPubMed

10.

Ooi TC. Adrenal incidentalomas: in detection, not significance. CMAJ 1997;157(7):903–4PubMed

11.

Herrera MF, Grant CS, van Heerden JA, Sheedy PF, Ilstrup DM. Incidentally discovered adrenal tumors: an institutional perspective. Surgery 1991;110(6):1014–21PubMed

12.

Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A. ¹⁸F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med 2001;42:1795–99PubMed

13.

Boland GW, Goldberg MA, Lee MJ, Mayo-Smith WW, Dixon J, McNicholas MM, et al. Indeterminate adrenal mass in patients with cancer: evaluation at PET with 2-[F-18]-fluoro-2-deoxyglucose. Radiology 1995;194:131–4PubMed

14.

Erasmus JJ, Patz EF Jr, McAdams HP, Murray JG, Herndon J, Coleman RE, et al. Evaluation of adrenal masses in patients with bronchogenic carcinoma using¹⁸F- fluorodeoxyglucose positron emission tomography. AJR Am J Roentgenol 1997;168:1357–60PubMed

15.

Maurea S, Mainolfi C, Bazzicalupo L, Panico MR, Imparato C, Alfano B, et al. Imaging of adrenal tumors using FDG PET: comparison of benign and malignant lesions. AJR Am J Roentgenol 1999;173:25–9PubMed

16.

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;179:415–8PubMed

17.

Korobkin M, Brodeur FJ, Yutzy GG, Francis IR, Quint LE, Dunnick NR, et al. Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. AJR Am J Roentgenol 1996;166:531–6PubMed

18.

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;171:201–4PubMed

19.

Bagheri B, Maurer AH, Cone L, Doss M, Adler L. Characterization of the normal adrenal gland with¹⁸F-FDG PET/CT. J Nucl Med 2004;45:1340–3PubMed

20.

Prinz R, Brooks M, Churchill R, Graner JL, Lawrence AM, Paloyan E, et al. Incidental asymptomatic adrenal masses detected by computed tomographic scanning. JAMA 1982;248:701CrossRefPubMed

21.

Paulsen SD, Nghiem HV, Korobkin M, Caoili EM, Higgins EJ. Changing role of imaging-guided percutaneous biopsy of adrenal masses: evaluation of 50 adrenal biopsies. AJR Am J Roentgenol 2004;182:1033–7PubMed

22.

Bernardino ME, Walther MM, Phillips VM, Graham SD Jr, Sewell CW, Gedgaudas-McClees K, et al. CT-guided adrenal biopsy: accuracy, safety and indications. AJR Am J Roentgenol 1985;144(1):67–9PubMed

23.

Silverman SG, Mueller PR, Pinkney LP, Koenker RM, Seltzer SE. Predictive value of image-guided adrenal biopsy: analysis of results of 101 biopsies. Radiology 1993;187(3):715–8PubMed

24.

Welch TJ, Sheedy PF, Stephens DH, Johnson CM, Swensen SJ. Percutaneous adrenal biopsy: review of a 10-year experience. Radiology 1994;193:341–4PubMed

25.

Ettinghausen SE, Burt ME. Prospective evaluation of unilateral adrenal masses in patients with operable non-small-cell lung cancer. J Clin Oncol 1991;9:1462–6PubMed

26.

Mody MK, Kazerooni EA, Korobkin M. Percutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications. J Comput Assist Tomogr 1995;19(3):434–9PubMed

27.

Xarli VP, Steele AA, Davis PJ, Buescher ES, Rios CN, Garcia-Bunnel R. Adrenal hemorrhage in the adult. Medicine (Baltimore) 1978;47:211–21

28.

Szolar DH, Kammerhuber F. Quantitative CT evaluation of adrenal gland masses: a step forward in the differentiation between adenomas and nonadenomas? Radiology 1997;202:517–21PubMed

29.

Mitchell DG, Crovello M, Matteucci T, Petersen RO, Miettinen MM. Benign adrenocortical masses: diagnosis with chemical shift MR imaging. Radiology 1992;185:345–51PubMed

30.

Mayo-Smith WW, Lee MJ, McNicholas MMJ, Hahn PF, Boland GW, Saini S. Characterization of adrenal masses (<5 cm) by use of chemical shift MR imaging: observer performance versus quantitative measures. AJR Am J Roentgenol 1995;165:91–5PubMed

31.

Kreft BP, Muller-Miny H, Sommer T, Steudel A, Vahlensieck M, Novak D, et al. Diagnostic value of MR imaging in comparison to CT in the detection and differential diagnosis of renal masses. ROC analysis. Eur Radiol 1997;7:542–7CrossRefPubMed

32.

Outwater EK, Siegelman ES, Huang AB, Birnbaum R. Adrenal masses: correlation between CT attenuation value and chemical shift ratio at MR imaging with in-phase and opposed-phase sequences. Radiology 1996;200:749–52PubMed

33.

Korobkin M, Lombardi TJ, Aisen AM, Francis IR, Quint LE, Dunnick NR, et al. Characterization of adrenal masses with chemical shift and gadolinium-enhanced MR imaging. Radiology 1995;197:411–8PubMed

34.

Jana S, Abdel-Dayem HM. Role of nuclear medicine in evaluating treatment response in oncology. Nuclear Medicine Annual 2004;1–59

35.

Erasmus JJ, McAdams HP, Patz EF Jr, Coleman RE, Ahuja V, Goodman PC. Evaluation of primary pulmonary carcinoid tumors using FDG PET. AJR Am J Roentgenol 1998;170:1369–73PubMed

36.

Hedeland H, Ostberg G, Hokfelt B. On the prevalence of adrenocortical adenomas in an autopsy material in relation to hypertension and diabetes. Acta Med Scand 1968;184(3):211–4PubMed

37.

Pauling M, Williamson B. Adrenal involvement in non-Hodgkin lymphoma. AJR Am J Roentgenol 1983;141: 303–5PubMed

Title: FDG-PET and CT characterization of adrenal lesions in cancer patients
Authors: Suman Jana
Tong Zhang
David M. Milstein
Carmen R. Isasi
M. Donald Blaufox
Publication date: 01-01-2006
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 1/2006
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-005-1915-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

FDG-PET and CT characterization of adrenal lesions in cancer patients

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2006

The sentinel lymph node concept. 2005. A.J. Schauer, W. Becker, M. Reiser, K. Possinger (Eds). Springer Verlag, Heidelberg Berlin New York. Hardcover, 565 pp., 420 figs., 228 tables. ISBN 3-540-41041-4. Price €199.95, SFR 338.50, GBP 154.00, US $ 249.00

Myocardial ischaemia and metabolic memory

Memory-provoked rCBF-SPECT as a diagnostic tool in Alzheimer’s disease?

18F-FDG PET in the management of endometrial cancer

Cellular uptake of 99mTcN-NOET in human leukaemic HL-60 cells is related to calcium channel activation and cell proliferation

Diagnostic and prognostic value of non-invasive imaging in known or suspected coronary artery disease