Endocrinol Metab.  2014 Mar;29(1):5-11. 10.3803/EnM.2014.29.1.5.

Differential Diagnosis of Adrenal Mass Using Imaging Modality: Special Emphasis on F-18 Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography

• Lee HJ
• Lee J

• KMID: 2169345
• DOI: http://doi.org/10.3803/EnM.2014.29.1.5

Abstract

Adrenal incidentalomas are adrenal masses serendipitously detected during an imaging study performed for reasons unrelated to suspicion of adrenal disease. The incidence of adrenal incidentalomas has increased because of the widespread use of various imaging modalities. In oncology patients with adrenal incidentalomas, the characterization of the adrenal masses is challenging because nearly 50% of incidental adrenal masses are metastatic lesions that need special medical attention. Although unenhanced computed tomography (CT) densitometry, chemical shift magnetic resonance imaging (MRI), delayed contrast-enhanced CT and CT histogram analysis have been used as sensitive and specific modalities for differentiating benign from malignant adrenal masses, F-18 fluoro-2-deoxy-D-glucose positron emission tomography (F-18 FDG PET)/CT is a highly accurate imaging modality compared to CT or MRI, especially when these two imaging modalities are combined. In addition, a semiquantitative analysis using standardized uptake value ratio further improves the diagnostic accuracy of F-18 FDG PET/CT in differentiating benign from malignant adrenal masses. Thus, F-18 FDG PET/CT is very helpful for determining the best therapeutic management, especially for assessing the need for surgery.

Keyword

Adrenal incidentalomas; Fluorodeoxyglucose F18; Integrated positron emission tomography-computed tomography; Multidetector computed tomography; Magnetic resonance imaging

MeSH Terms

Densitometry
Diagnosis, Differential*
Electrons*
Fluorodeoxyglucose F18
Humans
Incidence
Magnetic Resonance Imaging
Multidetector Computed Tomography
Positron-Emission Tomography
Positron-Emission Tomography and Computed Tomography
Tomography, X-Ray Computed
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 (A) A 63-year-old man with lung cancer underwent F-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET)/computed tomography (CT). F-18 FDG PET/CT showed focal FDG uptake (maximum standardized uptake value, SUVmax 5.9) in the left adrenal mass (arrows) that was 2.7 cm in diameter. The SUVratio (SUVmax of the adrenal mass divided by SUVmax of the segment 8 of the liver) and Houndsfield unit (HU) of the adrenal mass were 1.7 and 5.5, respectively. On unenhanced abdominal CT, the adrenal mass was misinterpreted as benign, but this mass was considered metastatic based on the F-18 FDG PET/CT finding. After adrenalectomy, this adrenal mass proved to be metastatic. (B) A 50-year-old man with esophageal cancer underwent F-18 FDG PET/CT. F-18 FDG PET/CT showed focal FDG uptake (SUVmax 3.8) in the left 1.4-cm adrenal mass (arrows). SUVratio and HU of the adrenal mass were 0.9 and 23.0, respectively. On unenhanced abdominal CT, this adrenal mass was misinterpreted as a malignancy, but the mass was considered benign based on the F-18 FDG PET/CT finding. It was stable in size for the next 9 months and proved to be benign.

• 

  Fig. 2 A 57-year-old man with left adrenal mass underwent F-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET)/computed tomography (CT) and I-131 metaiodobenzylguanidine (MIBG) scintigraphy. (A) F-18 FDG PET/CT showed a 4.0-cm hypermetabolic mass with maximum standardized uptake value of 4.1 (arrows). (B) I-131 MIBG scintigraphy also showed focal tracer uptake in the left adrenal gland (arrows). After adrenalectomy, this adrenal mass proved to be a pheochromocytoma.

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