| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
CLINICAL INVESTIGATIONS |
Medicina Nucleare e Radiodiagnostica, Istituto Nazionale dei Tumori, Napoli; and Centro per la Medicina Nucleare del Consiglio Nazionale delle Ricerche, Università Federico II, Napoli, Italy
The aim of this study was to evaluate the role of radionuclide imaging in the characterization of nonhypersecreting adrenal masses. Methods: A total of 54 patients (19 men, 35 women; mean age, 50 ± 16 y) with nonhypersecreting unilateral adrenal tumors that had been originally detected on CT or MRI underwent adrenal scintigraphy using different radiotracers. None of the patients showed specific symptoms of adrenal hypersecretion. Screening tests for excess cortical and medullary products showed normal adrenal hormone levels. Radionuclide studies (n = 73) included 131I-norcholesterol (n = 24), 131I-metaiodobenzylguanidine (MIBG) (n = 23), and 18F-FDG PET (n = 26) scans. Results: Histology after surgery (n = 31) or adrenal biopsy (n = 23) was obtained. Adrenal lesions were represented by 19 adenomas, 4 cysts, 1 myelolipoma, 1 neurinoma, 2 ganglioneuromas, 5 pheochromocytomas, 4 pseudotumors, 6 carcinomas, 2 sarcomas, and 10 metastases (size range, 1.5- to 5-cm diameter; mean, 4.9 ± 3.1 cm). For norcholesterol imaging, diagnostic sensitivity, specificity, and accuracy were 100%, 71%, and 92%, respectively; the positive predictive value (PPV) of the norcholesterol scan to characterize an adrenal mass as an adenoma was 89%, whereas the corresponding negative predictive value (NPV) to rule out this type of tumor was 100%. For MIBG imaging, diagnostic sensitivity, specificity, and accuracy were 100%, 94%, and 96%, respectively; the PPV of the MIBG scan to characterize an adrenal mass as a medullary chromaffin tissue tumor was 83%, whereas the corresponding NPV to rule out this type of tumor was 100%. For FDG PET, diagnostic sensitivity, specificity, and accuracy were 100%, 100%, and 100%, respectively; the PPV of FDG PET to characterize an adrenal mass as a malignant tumor was 100%, whereas the corresponding NPV to rule it out was 100%. Furthermore, in 7 patients with malignant adrenal tumors, FDG whole-body scanning revealed extra-adrenal tumor sites (n = 29), allowing an accurate diagnosis of the disease’s stage using a single-imaging technique. Conclusion: In patients with nonhypersecreting adrenal masses, radionuclide adrenal imaging, using specific radiopharmaceuticals such as norcholesterol, MIBG, and FDG, may provide significant functional information for tissue characterization. Norcholesterol and MIBG scans are able to detect benign tumors such as adenoma and pheochromocytoma, respectively. Conversely, FDG PET allows for recognition of malignant adrenal lesions. Therefore, adrenal scintigraphy is recommended for tumor diagnosis and, hence, for appropriate treatment planning, particularly when CT or MRI findings are inconclusive for lesion characterization.
Key Words: adrenals • tumors • norcholesterol • MIBG • FDG
Related articles in JNM:
This article has been cited by other articles:
|
|
 |
|
  L. Groussin, G. Bonardel, S. Silvera, F. Tissier, J. Coste, G. Abiven, R. Libe, M. Bienvenu, J.-L. Alberini, S. Salenave, et al. 18F-Fluorodeoxyglucose Positron Emission Tomography for the Diagnosis of Adrenocortical Tumors: A Prospective Study in 77 Operated Patients J. Clin. Endocrinol. Metab., May 1, 2009; 94(5): 1713 - 1722. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. W. L. Boland, M. A. Blake, P. F. Hahn, and W. W. Mayo-Smith Incidental Adrenal Lesions: Principles, Techniques, and Algorithms for Imaging Characterization Radiology, December 1, 2008; 249(3): 756 - 775. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Libe, A. Fratticci, and J. Bertherat Adrenocortical cancer: pathophysiology and clinical management Endocr. Relat. Cancer, March 1, 2007; 14(1): 13 - 28. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S-C Chan, T-C Yen, and K-K Ng Upper pole of a duplex kidney mimicking adrenal incidentaloma in 18F-fluoro-2-deoxy-D-glucose positron emission tomography: a pitfall in diagnosis Br. J. Radiol., August 1, 2006; 79(944): e50 - e52. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Blake, J. M. A. Slattery, M. K. Kalra, E. F. Halpern, A. J. Fischman, P. R. Mueller, and G. W. Boland Adrenal Lesions: Characterization with Fused PET/CT Image in Patients with Proved or Suspected Malignancy--Initial Experience Radiology, March 1, 2006; 238(3): 970 - 977. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Pacak, G. Eisenhofer, and D. S. Goldstein Functional Imaging of Endocrine Tumors: Role of Positron Emission Tomography Endocr. Rev., August 1, 2004; 25(4): 568 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Bagheri, A. H. Maurer, L. Cone, M. Doss, and L. Adler Characterization of the Normal Adrenal Gland with 18F-FDG PET/CT J. Nucl. Med., August 1, 2004; 45(8): 1340 - 1343. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Mansmann, J. Lau, E. Balk, M. Rothberg, Y. Miyachi, and S. R. Bornstein The Clinically Inapparent Adrenal Mass: Update in Diagnosis and Management Endocr. Rev., April 1, 2004; 25(2): 309 - 340. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. H. Kann, B. Wirkus, T. Behr, K.-J. Klose, and S. Meyer Endosonographic Imaging of Benign and Malignant Pheochromocytomas J. Clin. Endocrinol. Metab., April 1, 2004; 89(4): 1694 - 1697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. La Cava, A. Imperiale, C. Olianti, G. R. Gheri, C. Ladu, M. Mannelli, and A. Pupi SPECT Semiquantitative Analysis of Adrenocortical 131I-6{beta}-Iodomethyl-Norcholesterol Uptake to Discriminate Subclinical and Preclinical Functioning Adrenal Incidentaloma J. Nucl. Med., July 1, 2003; 44(7): 1057 - 1064. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Lawson Role of Molecular Imaging in Management of Nonhypersecreting Adrenal Masses J. Nucl. Med., June 1, 2001; 42(6): 893 - 894. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| JOURNAL OF NUCLEAR MEDICINE TECHNOLOGY | THE JOURNAL OF NUCLEAR MEDICINE |
