Key result
Among 16 patients with ultimately benign adrenal lesions, 131I-norcholesterol categorized only 2 as concerning, compared to 11 by unenhanced CT and 9 by 18F-FDG PET-CT.
Why the study?
The study aimed to assess the value of F-FDG PET-CT and I-norcholesterol scintigraphy in the noninvasive characterization of high-risk adrenal lesions using surgical pathology as the gold standard.
Does combined imaging with 18F-FDG PET-CT and 131I-norcholesterol scintigraphy accurately characterize indeterminate adrenal lesions compared to surgical pathology?
Observational (n=16)
No
Does combined imaging with 18F-FDG PET-CT and 131I-norcholesterol scintigraphy accurately characterize indeterminate adrenal lesions compared to surgical pathology?
In patients with high-risk adrenal masses, conventional CT and FDG PET lack specificity for benign lesions, whereas 131I-norcholesterol scintigraphy may provide additional diagnostic value.
Answers are grounded in this paper and cite their sources.
May prompt caution interpreting CT and FDG PET for adrenal masses; leaves open additive value of 131I-norcholesterol scintigraphy.
PURPOSE: To assess the value of F-FDG PET-computed tomography (CT) and I-norcholesterol scintigraphy in noninvasive characterization of high-risk adrenal lesions using surgical pathology as the gold standard. METHODS: We retrospectively reviewed clinical cases referred to the adrenal multidisciplinary team in a tertiary centre over the last 6 years. Inclusion criteria were the presence of indeterminate adrenal lesions and performance of combined imaging with 2-deoxy-2-[fluorine-18] fluoro- D-glucose Positron emission tomography/ computed tomography and I-norcholesterol scans. The accuracy of CT, PET-CT and I-norcholesterol findings was assessed by comparison with the postoperative histopathological outcome. RESULTS: Sixteen patients fulfilled the inclusion criteria. Ten underwent unilateral adrenalectomy, and six had clinical follow-up. The number of cases categorized as concerning on the basis of unenhanced CT, F-FDG PET-CT and I-norcholesterol was 11, 9 and 2, respectively. The mean diameter of adrenal lesions was 4.5 ± 1.9 cm. Average SUVmax of the FDG-avid adrenal lesions was 5.0 ± 2.0 (range 3.5-9.7). Fourteen adrenal masses showed I-norcholesterol uptake. All adrenal masses turned out to be benign lesions. CONCLUSION: Conventional CT and FDG PET parameters are not adequately specific for determination of a benign lesion in this selected cohort of high-risk patients. Use of I-norcholesterol in this patient cohort may provide additional value.
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Riaz et al. (2020) conducted an observational in indeterminate adrenal lesions (n=16). 18F-FDG PET-CT and 131I-norcholesterol scintigraphy was evaluated on Accuracy of CT, PET-CT and I-norcholesterol findings compared with postoperative histopathological outcome. Among 16 patients with ultimately benign adrenal lesions, 131I-norcholesterol categorized only 2 as concerning, compared to 11 by unenhanced CT and 9 by 18F-FDG PET-CT.
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