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18F-FDG PET/CT in the Evaluation of Adrenal Masses

Ur Metser, MD1,2, Elka Miller, MD2, Hedva Lerman, MD1, Gennady Lievshitz, MD1, Shmuel Avital, MD3 and Einat Even-Sapir, MD, PhD1

1 Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; 2 Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; and 3 Department of Surgery A, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel



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  		FIGURE 1.  Diagnostic algorithm for characterizing adrenal masses. NCCT = unenhanced CT; CECT = contrast-enhanced CT.

 


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  		FIGURE 2.  Scatter plot of SUVs (y-axis) of all adenomas (B) and all malignant lesions (M).

 


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  		FIGURE 3.  False-positive 18F-FDG PET findings in 59-y-old woman with metastatic colorectal cancer. Coronal 18F-FDG PET/CT images (CT image on left, attenuation-corrected PET image in middle, and fusion image on right) show increased uptake of 18F-FDG (SUV, 4.4) in 2-cm lipid-poor left adrenal adenoma (arrows).

 


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  		FIGURE 4.  ROC analysis for different cutoff values of HU and SUV in differentiating benign from malignant adrenal masses: 99% ({blacksquare}) and 92% ({blacktriangleup}) probabilities for malignancy.

 


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  		FIGURE 5.  53-y-old man with melanoma. Axial PET/CT images (CT image on left, attenuation-corrected PET image in middle, and fusion image on right) show no abnormal uptake of 18F-FDG (SUV, 1.2) in 1.4-cm soft-tissue–attenuating left adrenal mass (38 HU), stable on imaging for 8 mo, suggestive of lipid-poor adenoma (arrows).

 


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  		FIGURE 6.  75-y-old woman with metastatic lung cancer. Axial PET/CT image (CT image on left, attenuation-corrected PET image in middle, and fusion image on right) shows abnormal uptake of 18F-FDG (SUV, 7.8–16.9) in soft-tissue–attenuating masses (28–36 HU) in both adrenal glands, consistent with metastatic deposits (arrows).

 


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  		FIGURE 7.  66-y-old man with disseminated metastatic disease due to lung cancer. Axial PET/CT image shows abnormal uptake of 18F-FDG (SUV, 16.8) in 0.6-cm soft-tissue–attenuating (36 HU) mass in medial portion of left adrenal gland, consistent with metastatic deposit (arrows). Large metastatic deposit is seen in left kidney.

 




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