Imaging of aldosterone-secreting adenomas: a prospective comparison of computed tomography and magnetic resonance imaging in 27 patients with suspected primary aldosteronism.
We have compared prospectively the sensitivity, specificity and accuracy of CT and MRI in a series of 27 consecutive patients (age 23-76 yrs, 17 females, 10 males) with clinically suspected primary aldosteronism. We found 13 patients with a unilateral aldosterone-producing adenoma (11 on the left and 2 on the right side), 6 with idiopathic hyper-aldosteronism and 8 with primary hypertension, which in two cases was associated with a nonfunctioning adrenal adenoma. The diagnosis of aldosterone-producing adenoma was confirmed at surgery and pathology in all cases. Idiopathic hyper-aldosteronism was diagnosed on the basis of the results of dexamethasone-suppressed adrenal scintigraphy and/or selective adrenal vein sampling. MRI correctly identified all cases of aldosterone-producing adenoma, but gave false positive results in five cases: one had idiopathic hyper-aldosteronism with bilateral nodular hyperplasia and four primary hypertension, which in two patients was associated with a nonfunctioning adrenal adenoma. Therefore, the sensitivity of MRI was 100%, its specificity 64% and overall diagnostic accuracy 81%. In comparison, CT correctly recognized only eight of the 13 patients with aldosterone-producing adenoma and gave false positive results in three primary hypertensives, including the two patients with a nonfunctioning adrenal adenoma. Therefore, its sensitivity, specificity and accuracy were 62, 77 and 69%, respectively. Based on these results, it could be anticipated that about four of every ten patients with aldosterone-producing adenoma would not be correctly diagnosed by CT.(ABSTRACT TRUNCATED AT 250 WORDS)
Rossi
G P
GP
Department of Clinical Medicine, University of Padova, Italy.
Chiesura-Corona
M
M
Tregnaghi
A
A
Zanin
L
L
Perale
R
R
Soattin
S
S
Pelizzo
M R
MR
Feltrin
G P
GP
Pessina
A C
AC
D000236:Adenoma / Q000175:diagnosis* / Q000378:metabolism*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D000311:Adrenal Glands / Q000098:blood supply; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood / Q000378:metabolism*; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014680:Veins
D000450:Aldosterone; D003907:Dexamethasone