Key result
An adrenal to liver (T/L) SUVmax ratio >1.53 on 18F-FDG PET/CT was an independent predictor of malignancy in adrenal lesions (OR 126.0), yielding 94% sensitivity and 91% specificity.
Why the study?
Does 18F-FDG PET/CT accurately differentiate malignant from benign adrenal lesions in patients with nonsecreting adrenal masses?
Observational (n=85)
No
Does 18F-FDG PET/CT accurately differentiate malignant from benign adrenal lesions in patients with nonsecreting adrenal masses?
Odds Ratio: 126 (95% CI 10.5–1512.9)
p-value: p=<0.001
The adrenal to liver (T/L) SUVmax ratio derived from 18F-FDG PET/CT is a highly accurate and independent predictor for differentiating malignant from benign adrenal lesions.
Supports FDG PET/CT T/L ratio for adrenal lesion differentiation; hypothesis-generating and requires prospective validation before practice change.
PURPOSE: Prior studies have suggested that (18)F-FDG PET/CT can help characterize adrenal lesions and differentiate adrenal metastases from benign lesions. The aim of this study was to assess the value of (18)F-FDG PET/CT for the differentiation of malignant from benign adrenal lesions. METHODS: This retrospective study included 85 patients (47 men and 38 women, age 63.8 ± 10.8 years) who had undergone (18)F-FDG PET/CT (60 min after injection 300 - 370 MBq (18)F-FDG; Biograph 64 scanner) for evaluation of 102 nonsecreting adrenal masses. For semiquantitative analysis, the maximum standardized uptake value (SUVmax), adrenal to liver (T/L) SUVmax ratio, mean CT attenuation value and tumour diameter were measured in all lesions and compared with the pathological findings. RESULTS: Malignant adrenal tumours (68% of evaluated tumours) had a significantly higher mean SUVmax (13.0 ± 7.1 vs. 3.7 ± 3.0), a higher T/L SUVmax ratio (4.2 ± 2.6 vs. 1.0 ± 0.9), a higher CT attenuation value (31.9 ± 16. 7 HU vs. 0.2 ± 25.8 HU) and a greater diameter (43.6 ± 23.7 mm vs. 25.6 ± 13.3 mm) than benign lesions. The false-positive findings were tuberculosis and benign phaeochromocytoma. Based on ROC analysis, a T/L SUVmax ratio >1.53, an adrenal SUVmax >5.2, an attenuation value >24 HU and a tumour diameter >30 mm were chosen as the optimal cut-off values for differentiating malignant from benign tumours. The areas under the ROC curves for the selected cut-off values were 0.96, 0.96, 0.88 and 0.77, respectively. A multivariate logistic regression model revealed that the T/L SUVmax ratio was an independent prognostic factor for malignancy (p < 0.001); a CT attenuation value of >25 HU and a tumour diameter >30 mm had no additional individual importance in the diagnosis of malignancy. CONCLUSION: Using a T/L SUVmax ratio >1.53 and an adrenal SUVmax >5.2 in (18)F-FDG PET/CT led to high diagnostic sensitivity, specificity and negative predictive value for characterizing adrenal tumours. The diagnostic accuracies of the two parameters were comparable, but T/L SUVmax ratio was an independent predictor of malignancy.
No takes yet. Share an insight, caveat, or question.
Kunikowska et al. (2014) conducted an observational in Adrenal lesions (n=85). 18F-FDG PET/CT (T/L SUVmax ratio >1.53) vs. Benign adrenal lesions was evaluated on Prediction of malignancy in adrenal lesions (OR 126.0, 95% CI 10.5-1512.9, p=<0.001). An adrenal to liver (T/L) SUVmax ratio >1.53 on 18F-FDG PET/CT was an independent predictor of malignancy in adrenal lesions (OR 126.0), yielding 94% sensitivity and 91% specificity.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: