Mohammed F Mohammed1,2, Khaled Y ElBanna1,3, David Ferguson1, Alison Harris1, Faisal Khosa1. 1. 1 Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada. 2. 2 Medical Imaging Department, Abdominal Imaging Section, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard, Health Affairs, Riyadh, Saudi Arabia. 3. 3 Department of Medical Imaging, Sunnybrook Hospital, Toronto, ON, Canada.
Abstract
OBJECTIVE: Our objective was to investigate whether the quantitative measurement of venous phase enhancement on CT can distinguish a pheochromocytoma from an adrenal adenoma. MATERIALS AND METHODS: A pathology database was retrospectively appraised over a period of 7 years and revealed 43 histopathologically proven adrenal adenomas and 34 pheochromocytomas. The lesion densities were measured on the 60-second venous phase CT on all adrenal lesions to assess venous phase enhancement values. RESULTS: Venous phase enhancement of 85 HU or greater afforded a sensitivity, specificity, positive predictive value, and negative predictive value of 88.2%, 83.7%, 81.1%, and 90%, respectively (p < 0.0001). The positive likelihood ratio was 5.42. Venous phase enhancement of ≥ 85 HU was detected in 30 (88.2%) pheochromocytomas (p < 0.001) and in seven (16.3%) adenomas. Venous phase enhancement of < 85 HU was detected in four (11.8%) pheochromocytomas and in 36 (83.7%) adenomas. Of the pheochromocytomas imaged with a triphasic protocol (n = 15), 66.7% (n = 10) met both absolute and relative percentage washout criteria for the diagnosis of a lipid-poor adenoma (p > 0.1). CONCLUSION: A significant subset of pheochromocytomas mimics adenomas on absolute or relative percentage washout calculations. However, nodules with venous phase enhancement of 85 HU or more are much more likely to be pheochromocytomas than adenomas, regardless of whether the lesion shows absolute or relative percentage washout compatible with a lipid-poor adenoma. The typical values of absolute and relative percentage washout of adrenal adenoma should be interpreted along with the venous phase enhancement value to avoid potential misdiagnoses.
OBJECTIVE: Our objective was to investigate whether the quantitative measurement of venous phase enhancement on CT can distinguish a pheochromocytoma from an adrenal adenoma. MATERIALS AND METHODS: A pathology database was retrospectively appraised over a period of 7 years and revealed 43 histopathologically proven adrenal adenomas and 34 pheochromocytomas. The lesion densities were measured on the 60-second venous phase CT on all adrenal lesions to assess venous phase enhancement values. RESULTS: Venous phase enhancement of 85 HU or greater afforded a sensitivity, specificity, positive predictive value, and negative predictive value of 88.2%, 83.7%, 81.1%, and 90%, respectively (p < 0.0001). The positive likelihood ratio was 5.42. Venous phase enhancement of ≥ 85 HU was detected in 30 (88.2%) pheochromocytomas (p < 0.001) and in seven (16.3%) adenomas. Venous phase enhancement of < 85 HU was detected in four (11.8%) pheochromocytomas and in 36 (83.7%) adenomas. Of the pheochromocytomas imaged with a triphasic protocol (n = 15), 66.7% (n = 10) met both absolute and relative percentage washout criteria for the diagnosis of a lipid-poor adenoma (p > 0.1). CONCLUSION: A significant subset of pheochromocytomas mimics adenomas on absolute or relative percentage washout calculations. However, nodules with venous phase enhancement of 85 HU or more are much more likely to be pheochromocytomas than adenomas, regardless of whether the lesion shows absolute or relative percentage washout compatible with a lipid-poor adenoma. The typical values of absolute and relative percentage washout of adrenal adenoma should be interpreted along with the venous phase enhancement value to avoid potential misdiagnoses.
Authors: Filip Ctvrtlik; Zbynek Tudos; Paulina Szasz; Zuzana Sedlackova; Igor Hartmann; Jan Schovanek; Zdenek Frysak; Iva Macova; Tomas Zelinka; Milan Hora; Eva Kocova; Jaroslav Pacovsky; Michal Krsek; Viera Lehotska; Emilia Mojtova; Josef Molnar; Vladimir Vanek; Karel Pacak; Jan Baxa Journal: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub Date: 2019-09-23 Impact factor: 1.245
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