The Effect of Radiological Imaging Reports in Clinical Decision-Making in the Management of Adrenal Incidentaloma

Abstract To assess the necessity of additional imaging by comparing the characteristics of adrenal lesions incidentally detected on abdominal, stone protocol, and chest computed tomography (CT) with those obtained from a second imaging modality specifically targeting the adrenal glands. A total of 162 adrenal lesions imaged in 112 patients with adrenal incidentalomas were retrospectively analyzed. Radiology reports were reviewed for adrenal lesion laterality, location, number of lesions, maximum diameter, the number of dimensions specified, lesion density on CT measured in Hounsfield Units (HU), lesion characterization, presence of heterogeneity, and functional status. Cohen’s Kappa test assessed the agreement between the first and second imaging evaluations. Additionally, sensitivity, specificity, positive predictive value, and negative predictive value of the first imaging were calculated using adrenal-specific second imaging as the reference standard. No concordance was found between the initial and follow-up imaging in terms of HU measurements (κ=0.079; p=0.123). However, concordance ranging from weak to excellent was observed regarding bilaterality, localization, lesion count, diameter, and heterogeneity. Based on the second imaging reports as reference, the sensitivity of the initial imaging for diagnosing adenoma and myelolipoma was determined to be 26.49% and 42.85%, respectively. The success rate of adenoma diagnosis was associated with the number of lesions in the adrenal gland (≥2 lesions>single lesion), lesion size (>2 cm>≤ 2 cm), and location (left>right). Nine lesions initially reported as<4 cm on the first imaging were found to be≥4 cm on the second imaging, and seven lesions initially reported as unilateral were noted to be bilateral on the second imaging. In eight patients, adrenal lesions were detected on the first imaging, but the second imaging was reported as normal. A more detailed definition of adrenal incidentalomas, especially in terms of heterogeneity and HU values in the first images in radiology reports, and the use of a standard reporting system will guide clinical practice and provide a cost-effective approach while avoiding unnecessary imaging and radiation.