TY - JOUR
T1 - CT characteristics of pheochromocytoma - Relevance for the evaluation of adrenal incidentaloma
AU - Canu, Letizia
AU - Van Hemert, Janna A W
AU - Kerstens, Michiel
AU - Hartman, Robert
AU - Khanna, Aakanksha
AU - Kraljevic, Ivana
AU - Kastelan, Darko
AU - Badiu, Corin
AU - Ambroziak, Urszula
AU - Tabarin, Antoine
AU - Haissaguerre, Magalie
AU - Buitenwerf, Edward
AU - Visser, Anneke
AU - Mannelli, Massimo
AU - Arlt, Wiebke
AU - Chortis, Vasileios
AU - Bourdeau, Isabelle
AU - Gagnon, Nadia
AU - Buchy, Marie
AU - Borson-Chazot, Francoise
AU - Deutschbein, Timo
AU - Fassnacht, Martin
AU - Hubalewska Dydejczyk, H Alicja
AU - Motyka, Marcin
AU - Rzepka, Wewlina
AU - Casey, Ruth T.
AU - Challis, Benjamin
AU - Quinkler, Marcus
AU - Vroonen, Laurent
AU - Spyroglou, Ariadni
AU - Beuschlein, Felix
AU - Lamas, Cristina
AU - Young, William F
AU - Bancos, Irina
AU - Timmers, Henri J
PY - 2018/10/31
Y1 - 2018/10/31
N2 - Background
Up to 7% of all adrenal incidentalomas (AIs) are pheochromocytomas (PCCs). In the evaluation of AI, it is generally recommended to exclude PCC by measurement plasma free or 24h urinary fractionated metanephrines. However, recent studies suggest to abstain from biochemical exclusion of PCC in cases of lesions with computed tomography (CT) characteristics of an adrenocortical adenoma (ACA).
Aim
To determine the proportion of PCCs with ACA-like attenuation or contrast washout on CT.
Methods
For this multicenter retrospective study, two central investigators independently analyzed the CT reports of 533 patients with 548 histologically confirmed PCCs. Data on tumor size, unenhanced Hounsfield Units (HU), absolute percentage washout (APW) and relative percentage washout (RPW) were collected besides clinical parameters.
Results
Among the 376 PCCs for which unenhanced attenuation data were available, 374 had an attenuation of >10 HU (99.5%). In the two exceptions (0,5%), unenhanced attenuation was exactly 10 HU, which lies just within the range of ≤10 HU that would suggest a diagnosis of ACA. Of 76 PCCs with unenhanced HU >10 and available washout data, 22 (28,9%) had a high APW and/or RPW, suggestive of ACA.
Conclusion
Based on the lack of PCCs with an unenhanced attenuation of <10 HU, and the low proportion (0,5%) of PCCs with an attenuation of =10 HU, it seems reasonable to abstain from biochemical testing for PCC in AIs with an unenhanced attenuation ≤10 HU. The assessment of contrast washout, however, is unreliable to rule out PCC.
AB - Background
Up to 7% of all adrenal incidentalomas (AIs) are pheochromocytomas (PCCs). In the evaluation of AI, it is generally recommended to exclude PCC by measurement plasma free or 24h urinary fractionated metanephrines. However, recent studies suggest to abstain from biochemical exclusion of PCC in cases of lesions with computed tomography (CT) characteristics of an adrenocortical adenoma (ACA).
Aim
To determine the proportion of PCCs with ACA-like attenuation or contrast washout on CT.
Methods
For this multicenter retrospective study, two central investigators independently analyzed the CT reports of 533 patients with 548 histologically confirmed PCCs. Data on tumor size, unenhanced Hounsfield Units (HU), absolute percentage washout (APW) and relative percentage washout (RPW) were collected besides clinical parameters.
Results
Among the 376 PCCs for which unenhanced attenuation data were available, 374 had an attenuation of >10 HU (99.5%). In the two exceptions (0,5%), unenhanced attenuation was exactly 10 HU, which lies just within the range of ≤10 HU that would suggest a diagnosis of ACA. Of 76 PCCs with unenhanced HU >10 and available washout data, 22 (28,9%) had a high APW and/or RPW, suggestive of ACA.
Conclusion
Based on the lack of PCCs with an unenhanced attenuation of <10 HU, and the low proportion (0,5%) of PCCs with an attenuation of =10 HU, it seems reasonable to abstain from biochemical testing for PCC in AIs with an unenhanced attenuation ≤10 HU. The assessment of contrast washout, however, is unreliable to rule out PCC.
U2 - 10.1210/jc.2018-01532
DO - 10.1210/jc.2018-01532
M3 - Article
SN - 0021-972X
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
ER -