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Ordidge K, Sahdev A. Imaging for patients with endocrine hypertension. ENDOCRINE HYPERTENSION 2023:309-330. [DOI: 10.1016/b978-0-323-96120-2.00013-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Lee HY, Oh YL, Park SY. Hyperattenuating adrenal lesions in lung cancer: biphasic CT with unenhanced and 1-min enhanced images reliably predicts benign lesions. Eur Radiol 2021; 31:5948-5958. [PMID: 33459853 DOI: 10.1007/s00330-020-07648-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate usefulness of biphasic computed tomography (CT) in characterizing hyperattenuating adrenal lesions in lung cancer. METHODS This retrospective study included 239 patients with lung cancer who underwent adrenal CT for hyperattenuating (> 10 Hounsfield unit) adrenal lesions. Adrenal CT comprised unenhanced and 1-min and 15-min enhanced images. We dichotomized adrenal lesions depending on benign or metastatic lesions. Reference standard for benignity was histologic confirmation or ≥ 6-month stability on follow-up CT. Two independent readers analyzed absolute (APW) or relative percentage wash-out (RPW) using triphasic CT, and enhancement ratio (ER) or percentage wash-in (PWI) using biphasic CT (i.e., unenhanced and 1-min enhanced CT). Criteria for benignity were as follows: criteria 1, (a) APW ≥ 60% or (b) RPW ≥ 40%, and criteria 2, (a) ER > 3 and (b) PWI > 200%. We analyzed area under the curve (AUC) and accuracy for benignity, and inter-reader agreement. RESULTS Proportion of benign adrenal lesion was 71.1% (170/239). For criteria 1 and 2, AUCs were 0.872 (95% confidence interval [CI], 0.822-0.911) and 0.886 (95% CI, 0.838-0.923), respectively, for reader 1 (p = 0.566) and 0.816 (95% CI, 0.761-0.863) and 0.814 (95% CI, 0.759-0.862), respectively, for reader 2 (p = 0.955), and accuracies were 87.9% (210/239) and 86.2% (206/239), respectively, for reader 1 (p = 0.479) and 81.2% (194/239) and 80.3% (192/239), respectively, for reader 2 (p = 0.763). Weighted kappa was 0.725 (95% CI, 0.634-0.816) for criteria 1 and 0.736 (95% CI, 0.649-0.824) for criteria 2. CONCLUSION Biphasic CT can reliably characterize hyperattenuating adrenal lesions in patients with lung cancer. KEY POINTS • Criteria from biphasic computed tomography (CT) for diagnosing benign adrenal lesions were enhancement ratio of > 3 and percentage wash-in of > 200%. • In the analysis by two independent readers, area under the curve between criteria 1 and 2 was not significantly different (0.872 and 0.886 for reader 1; 0.816 and 0.814, for reader 2; p > 0.05 for each comparison). • Wash-in characteristics from biphasic CT are helpful to predict benign adrenal lesions in lung cancer.
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Affiliation(s)
- Ho Yun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Characterization of adrenal lesions using MDCT wash-out parameters: diagnostic accuracy of several combinations of intermediate and delayed phases. Radiol Med 2018; 123:833-840. [PMID: 29923085 DOI: 10.1007/s11547-018-0911-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of wash-out parameters calculated using multiple intermediate and delayed phases. MATERIALS AND METHODS This prospective study had institutional review board approval and informed consent was obtained from all patients. Between January 2012 and October 2016, 108 consecutive oncologic patients (59 males, 49 females, mean age 52.6 years; 129 diagnosed lesions) underwent multiphasic CT protocol including unenhanced (UE), arterial (AE), portal (PE), 5-min (DE-5) and the 15-min (DE-15) delayed phases of adrenal glands. All images were randomly reviewed in consensus by two radiologists experienced in abdominal CT, unaware of clinical or pathologic data. Location, size and density were recorded. Absolute wash-out, percentage wash-out (PWO) and percentage enhancement wash-out ratio were calculated. The thresholds yielding the best accuracy in differentiating adenomas from nonadenomas were retrospectively determined on the basis of ROC curves. The corresponding diagnostic accuracy values were calculated. Paired sample t test was used to assess differences among imaging parameters within subgroups. Student t test was applied to compare lesions between independent subgroups. p values ≤ 0.05 were considered significant. RESULTS The final diagnosis included 82 adenomas (62 lipid-rich and 20 lipid-poor) and 47 nonadenomas (42 metastases, 3 pheochromocytomas, 2 carcinomas). All the 62 lipid-rich adenomas were correctly diagnosed as benign lesions on the basis of their UE attenuation < 10 HU. The PEAK attenuation was achieved during AE phase for 51/129 lesions (39.5%) and at the time of PE phase in 78/129 lesions (60.5%). The best overall accuracy in diagnosing adenomas (97.6%; 126/129 lesions correctly diagnosed) was obtained using 40% threshold for calculating PWO from PEAK to DE-15 scan. CONCLUSIONS If only an intermediate phase is available, the 15-min delayed scan should be acquired to avoid any drop in diagnostic accuracy. The availability of two intermediate phase may be used to easy CT schedule by obviating the need to acquire a longer delayed phase.
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Pheochromocytoma as a frequent false-positive in adrenal washout CT: A systematic review and meta-analysis. Eur Radiol 2017; 28:1027-1036. [DOI: 10.1007/s00330-017-5076-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/07/2017] [Accepted: 09/12/2017] [Indexed: 12/15/2022]
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Cushing Syndrome: Diagnostic Workup and Imaging Features, With Clinical and Pathologic Correlation. AJR Am J Roentgenol 2017. [PMID: 28639924 DOI: 10.2214/ajr.16.17290] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cushing syndrome (CS) is a constellation of clinical signs and symptoms resulting from chronic exposure to excess cortisol, either exogenous or endogenous. Exogenous CS is most commonly caused by administration of glucocorticoids. Endogenous CS is subdivided into two types: adrenocorticotropic hormone (ACTH) dependent and ACTH independent. CONCLUSION Cushing disease, which is caused by a pituitary adenoma, is the most common cause of ACTH-dependent CS for which pituitary MRI can be diagnostic, with bilateral inferior petrosal sinus sampling useful in equivocal cases. In ectopic ACTH production, which is usually caused by a tumor in the thorax (e.g., small cell lung carcinoma, bronchial and thymic carcinoids, or medullary thyroid carcinoma) or abdomen (e.g., gastroenteropancreatic neuroendocrine tumors or pheochromocytoma), CT, MRI, and nuclear medicine tests are used for localizing the source of ACTH. In ACTH-independent CS, which is caused by various adrenal abnormalities, adrenal protocol CT or MRI is usually diagnostic.
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Asayama Y, Nishie A, Ishigami K, Ushijima Y, Takayama Y, Okamoto D, Fujita N, Ohtsuka T, Yoshizumi T, Aishima S, Oda Y, Honda H. Prognostic significance of contrast-enhanced CT attenuation value in extrahepatic cholangiocarcinoma. Eur Radiol 2016; 27:2563-2569. [DOI: 10.1007/s00330-016-4621-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/01/2016] [Accepted: 09/26/2016] [Indexed: 01/04/2023]
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Hanna S, El-Kalioubie M, Badawy H, Halim M. Optimal diagnosis of adrenal masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Adrenal malignancies can be either primary adrenal tumors or secondary metastases, with metastases representing the most common malignant adrenal lesion. While imaging cannot always clearly differentiate between various adrenal malignancies, presence of certain imaging features, in conjunction with appropriate clinical background and hormonal profile, can suggest the appropriate diagnosis. The second part of the article on adrenal imaging describes adrenal medullary tumors, secondary adrenal lesions, bilateral adrenal lesions, adrenal incidentalomas and provides an algorithmic approach to adrenal lesions based on current imaging recommendations.
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Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ananya Panda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Chandan J. Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A. K. Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Emad-Eldin S, El-Kalioubie M. Diagnostic value of combined versus individual MRI parameters in distinguishing adenomatous from non-adenomatous adrenal lesions in cancer patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Shi JW, Dai HZ, Shen L, Xu DF. Dual-energy CT: clinical application in differentiating an adrenal adenoma from a metastasis. Acta Radiol 2014; 55:505-12. [PMID: 23969261 DOI: 10.1177/0284185113501660] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Application of dual-energy CT in characterization of adrenal nodules has not been well evaluated. PURPOSE To evaluate the ability of dual-energy CT scan to differentiate an adrenal adenoma from a metastasis. MATERIAL AND METHODS Fifty-five patients presenting 63 adrenal nodules underwent dual-energy CT scan at tube voltages of 80 kVp and 140 kVp. Mean attenuation values were measured for every nodule at 80/140 kVp and at 40/100 keV. Mean attenuation value changes between 140 kVp and 80 kVp (MAVC140-80kVp) and mean attenuation value changes between 100 keV and 40 keV (MAVC100-40keV) were calculated. RESULTS Of the 63 adrenal nodules available for analyses, 42 nodules were classified as adenoma (26 lipid-rich and 16 lipid-poor) and 21 were classified as metastases. MAVC140-80kVp and MAVC100-40keV of all adenomas (including lipid-poor and lipid-rich) were significantly higher than metastases (P < 0.001). According to receiver-operating characteristic (ROC) curve analyses, areas under the ROC curve of MAVC140-80kVp and MAVC100-40keV for diagnosing adrenal adenomas were both of 0.964. When the cut-off points were set at 2.42 HU and 6.95 HU for MAVC140-80kVp and MAVC100-40keV, the two parameters both had a sensitivity of 78.6% and a specificity of 100% in adenoma diagnosis. CONCLUSION Unique energy spectrum information provided by dual-energy CT scan displays a high capacity to distinguish adrenal adenoma from metastasis.
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Affiliation(s)
- Jiang Wei Shi
- Department of Medical Imaging, The First People’s Hospital of Wujiang, Wujiang, PR China
| | - Hong Zhi Dai
- Department of Medical Imaging, The First People’s Hospital of Wujiang, Wujiang, PR China
| | - Li Shen
- Department of Medical Imaging, The First People’s Hospital of Wujiang, Wujiang, PR China
| | - Dong Feng Xu
- Department of Medical Imaging, The First People’s Hospital of Wujiang, Wujiang, PR China
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Markedly increased 18F-FDG uptake in a nonfunctioning adrenal adenoma mimicking malignancy. Clin Nucl Med 2014; 38:e333-5. [PMID: 23486332 DOI: 10.1097/rlu.0b013e318279f389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 63-year-old woman underwent (18)F-FDG PET/CT searching for the cause of a fever of unknown origin. (18)F-FDG PET/CT incidentally detected a focal area of markedly increased radiopharmaceutical uptake in the right adrenal gland; this finding was suspicious for an adrenal malignancy or a functioning adenoma. Nevertheless, histology and laboratory data demonstrated the presence of a nonfunctioning adenoma. This case highlights that nonfunctioning adrenal adenomas should be considered as possible false-positive (18)F-FDG PET/CT findings for malignancy in the evaluation of adrenal incidentalomas, even when marked (18)F-FDG uptake is revealed.
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Characterization of lipid-rich adrenal tumors by FDG PET/CT: Are they hormone-secreting or not? Ann Nucl Med 2013; 28:145-53. [PMID: 24272068 DOI: 10.1007/s12149-013-0793-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 11/12/2013] [Indexed: 10/26/2022]
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.
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Evans PD, Miller CM, Marin D, Stinnett SS, Wong TZ, Paulson EK, Ho LM. FDG-PET/CT characterization of adrenal nodules: diagnostic accuracy and interreader agreement using quantitative and qualitative methods. Acad Radiol 2013; 20:923-9. [PMID: 23830599 DOI: 10.1016/j.acra.2013.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 02/13/2013] [Accepted: 02/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine interreader agreement and diagnostic accuracy across varying levels of reader experience using qualitative and quantitative methods of evaluating adrenal nodules using ((18)F)-fluorodeoxyglucose-positron emission tomography/computed tomography. METHODS 132 adrenal nodules (96 adenomas, 36 metastases) were retrospectively identified in 105 patients (49 men and 56 women, mean age 66 years, age range 45-85 years) with a history of lung cancer who underwent ((18)F)-fluorodeoxyglucose-positron emission tomography/computed tomography. For each nodule, three readers independently performed one qualitative and two quantitative measurements: visual assessment, standardized uptake value (SUVmax), and standard uptake ratio (SUVratio). Interreader agreement was calculated using percent agreement with κ statistic for qualitative analysis and intraclass correlation coefficient (ICC) for quantitative analysis. Accuracy, sensitivity, and specificity for distinguishing benign from malignant adrenal nodules were calculated for each method. RESULTS Percent agreement between readers for visual (qualitative) assessment was 92% to 96% and κ statistic was 0.79 to 0.90 (95% confidence limits 0.66-0.99). ICC for SUVmax was 92% to 99% (95% CL 0.8-1.0), and ICC for SUVratio was 89% to 99% (95% CL 0.74-0.99). For diagnosis of malignancy, mean sensitivity and specificity for visual assessment were 80% and 97%, respectively. Mean sensitivity and specificity for SUVmax were 91% and 81%, respectively; for SUVratio, 90% and 80%. Mean diagnostic accuracy was 93%, 83%, and 84% for visual assessment, SUVmax, and SUVratio, respectively. CONCLUSION Excellent interreader agreement is seen for quantitative and qualitative methods of distinguishing benign from malignant adrenal nodules. Qualitative analysis demonstrated higher accuracy but lower sensitivity compared with quantitative analysis.
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Can Established CT Attenuation and Washout Criteria for Adrenal Adenoma Accurately Exclude Pheochromocytoma? AJR Am J Roentgenol 2013; 201:122-7. [DOI: 10.2214/ajr.12.9620] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Korivi BR, Elsayes KM. Cross-sectional imaging work-up of adrenal masses. World J Radiol 2013; 5:88-97. [PMID: 23671745 PMCID: PMC3650209 DOI: 10.4329/wjr.v5.i3.88] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/12/2012] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
Advances in medical imaging with current cross-section modalities enable non-invasive characterization of adrenal lesions. Computed tomography (CT) provides characterization with its non-contrast and wash-out features. Magnetic resonance imaging (MRI) is helpful in further characterization using chemical shift imaging (CSI) and MR spectroscopy. For differentiating between benign and malignant masses, positron emission tomography (PET) imaging is useful with its qualitative analysis, as well as its ability to detect the presence of extra-adrenal metastases in cancer patients. The work-up for an indeterminate adrenal mass includes evaluation with a non-contrast CT. If a lesion is less than 10 Hounsfield Units on a non-contrast CT, it is a benign lipid-rich adenoma and no further work-up is required. For the indeterminate adrenal masses, a lipid-poor adenoma can be differentiated from a metastasis utilizing CT wash-out features. Also, MRI is beneficial with CSI and MR spectroscopy. If a mass remains indeterminate, PET imaging may be of use, in which benign lesions demonstrate low or no fluorodeoxyglucose activity. In the few cases in which adrenal lesions remain indeterminate, surgical sampling such as percutaneous biopsy can be performed.
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Ojili V, Tirumani SH, Chintapalli KN, Gunabushanam G. Non-Invasive Diagnosis of Abdomino-Pelvic Masses: Role of Multimodality Imaging. J Clin Imaging Sci 2013; 3:6. [PMID: 23607075 PMCID: PMC3625888 DOI: 10.4103/2156-7514.106621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/18/2012] [Indexed: 11/04/2022] Open
Abstract
Recent advances in radiology have greatly increased the ability to make highly accurate diagnosis. Biopsy of many commonly seen lesions is no longer performed as the radiological findings are pathognomonic. This gives rise to the concept of ‘virtual biopsy’, a term coined on the lines of other imaging techniques such as virtual colonoscopy. Virtual biopsy is not a new imaging technique but a new concept which refers to the use of existing imaging modalities to evaluate the morphological features of tumors and arriving at a non-invasive diagnosis with a high degree of confidence obviating the need for true biopsy. Elements of virtual biopsy have already been incorporated into some evidence-based guidelines, and it is expected that with further technological advancements, an increasing number of tumors may be diagnosed and managed accordingly. A wider acceptance of virtual biopsy could further reduce the need for invasive biopsies and its attendant costs and risks. In this review article, we use index cases to further emphasize this concept.
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Affiliation(s)
- Vijayanadh Ojili
- Department of Radiology, University of Texas Health Sciences Centre at San Antonio, San Antonio, TX 78229, USA
| | - Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Kedar N. Chintapalli
- Department of Radiology, University of Texas Health Sciences Centre at San Antonio, San Antonio, TX 78229, USA
| | - Gowthaman Gunabushanam
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut, 06520-8042, USA
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Siegelman ES. Adrenal MRI: Techniques and clinical applications. J Magn Reson Imaging 2012; 36:272-85. [DOI: 10.1002/jmri.23601] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Foti G, Faccioli N, Mantovani W, Malleo G, Manfredi R, Mucelli RP. Incidental adrenal lesions: Accuracy of quadriphasic contrast enhanced computed tomography in distinguishing adenomas from nonadenomas. Eur J Radiol 2011; 81:1742-50. [PMID: 21602008 DOI: 10.1016/j.ejrad.2011.04.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 04/19/2011] [Accepted: 04/25/2011] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the accuracy in distinguishing adrenal adenomas from nonadenomas by means of quadriphasic CT exam, including unenhanced (UE), arterial enhanced (AE), portal enhanced (PE) and 5-min delayed enhanced (DE) CT scans. METHODS This retrospective study had institutional review board approval; the need for informed consent was waived. From September 2007 to September 2009, 104 adrenal masses were evaluated in 87 patients (49 M, 38 F, mean age 58.4 years) undergoing UE, AE (35-s delay), PE (80-s delay) and DE (5-min delay) CT scans. The mean adrenal attenuation during all imaging phases was measured by two readers. The accuracy values of absolute unenhanced attenuation (UE), absolute wash-out (AWO), relative percentage wash-out (RPWO) and percentage enhancement wash-out (PEW) were assessed by using receiver operator curves (ROC) analysis. The overall accuracy of the quadriphasic protocol and other triphasic protocols were evaluated. A value of p≤0.05 was considered significant. RESULTS The accuracy in characterizing adrenal lesions was 86.5% (90/104) for UE attenuation (≤10 HU threshold), 90.1% (82/91) for RPWO (≥30% threshold), 85.7% (78/91) for AWO (≥12 HU threshold) and 83.5% (76/91) for PEW (≥30% threshold), respectively. Quadriphasic CT (accuracy 97.1%, 101/104) performed better than triphasic CT including only AE scan (efficiency 90.0%, 94/104; p=0.011) and triphasic CT including only PE scan (efficiency 96.1%, 100/104; p=0.025). CONCLUSION Quadriphasic CT protocol including 5-min DE scan may be used to characterize incidentally detected adrenal masses. RPWO represented the best wash-out parameter for characterizing adrenal lesions.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale Scuro 10, 37134 Verona, Italy.
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