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01-02-2014 | Original Article

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

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

Published in: Annals of Nuclear Medicine | Issue 2/2014

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.

Korobkin M. CT characterization of adrenal masses: the time has come. Radiology. 2000;217:629–32.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

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

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

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

Tsushima Y, Ishizaka H, Matsumoto M. Adrenal masses: differentiation with chemical shift, fast low-angle shot MR imaging. Radiology. 1993;186:705–9.PubMed

Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology. 2004;231:305–32.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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med. 2007;48:932–45.PubMedCrossRef

20.

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.

Young WF Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007;356:601–10.PubMedCrossRef

22.

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.

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.

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.

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.

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.

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.

Boland GW. Adrenal imaging: why, when, what, and how? Part 2. What technique? AJR Am J Roentgenol. 2011;196:W1–5.PubMedCrossRef

29.

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.

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.

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.

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.

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.

Terzolo M, Pia A, Reimondo G. Subclinical Cushing’s syndrome: definition and management. Clin Endocrinol (Oxford). 2012;76:12–8.CrossRef

35.

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.

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.

Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med. 2004;45:1431–4.PubMed

38.

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

Title: Characterization of lipid-rich adrenal tumors by FDG PET/CT: Are they hormone-secreting or not?
Authors: Kentaro Takanami
Tomohiro Kaneta
Ryo Morimoto
Fumitoshi Satoh
Yasuhiro Nakamura
Kei Takase
Shoki Takahashi
Publication date: 01-02-2014
Publisher: Springer Japan
Published in: Annals of Nuclear Medicine / Issue 2/2014
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-013-0793-6

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Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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