title: Evaluation of adrenal masses in patients with bronchogenic carcinoma using 18F-fluorodeoxyglucose positron emission tomography.
abstract: OBJECTIVE
  The purpose of this study was to assess the usefulness of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) when differentiating benign from metastatic adrenal masses in patients with bronchogenic carcinoma.
  
  
  METHODS
  For our prospective study, any patient presenting to our institution with pathologically proven bronchogenic carcinoma and an adrenal mass was eligible. Thirty-three adrenal masses (mean size, 3 cm; range, 1-9 cm) in 27 patients were revealed by CT. PET was performed in all 27 patients and interpreted as positive when FDG uptake in the adrenal mass was greater than background activity or negative when FDG uptake in the adrenal mass was equal to or less than background activity. In addition, semiquantitative analysis was performed by computing a standardized uptake ratio. All studies were reviewed independently by three radiologists and then correlated with biopsy and CT findings. Specificity and sensitivity for determining metastatic disease to the adrenal gland were calculated.
  
  
  RESULTS
  FDG uptake was positive (abnormally increased) in 25 adrenal masses. Twenty-three (92%) of the 25 masses were metastatic disease. The mean standardized uptake ratio of these was 6.28 (range, 3.22-14.41). The remaining two masses (8%) that had positive FDG uptake showed no tumor at percutaneous biopsy. The standardized uptake ratio values for these two masses were 3.0 and 3.7. FDG uptake was negative (normal) in eight adrenal masses. All these lesions were benign as proven by biopsy (n = 2) and CT attenuation values of less than 10 H (n = 6). The mean standardized uptake ratio value for these eight lesions classified as benign was 1.77 (range, 0.93-3.70). The sensitivity for detecting metastatic disease was 100%, and the specificity was 80%.
  
  
  CONCLUSIONS
  PET with FDG is an accurate, noninvasive way to differentiate benign from metastatic adrenal masses in patients with bronchogenic carcinoma.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Erasmus
authors.forename: E F
authors.initials: EF
authors.lastname: Patz
authors.forename: H P
authors.initials: HP
authors.lastname: McAdams
authors.forename: J G
authors.initials: JG
authors.lastname: Murray
authors.forename: J
authors.initials: J
authors.lastname: Herndon
authors.forename: R E
authors.initials: RE
authors.lastname: Coleman
authors.forename: P C
authors.initials: PC
authors.lastname: Goodman
mesh_terms: D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D000311:Adrenal Glands / Q000473:pathology; D001707:Biopsy, Needle; D002283:Carcinoma, Bronchogenic / Q000000981:diagnostic imaging* / Q000556:secondary*; D003847:Deoxyglucose / Q000031:analogs & derivatives*; D003937:Diagnosis, Differential; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed
chemical_list: D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D003847:Deoxyglucose