title: Clinical utility of noncontrast computed tomography attenuation value (hounsfield units) to differentiate adrenal adenomas/hyperplasias from nonadenomas: Cleveland Clinic experience.
abstract: Radiological characterization of an adrenal tumor as adenoma may decrease the need for follow-up imaging studies, biopsies, and unnecessary adrenalectomies. We retrospectively reviewed 299 adrenalectomies in 290 patients at Cleveland Clinic Foundation over a recent 5-yr period to assess the value of noncontrast Hounsfield units (HU) in characterizing whether an adrenal mass is adenoma or nonadenoma. The mean (+/- SD) HU value for the adrenocortical adenoma/hyperplasia group was 16.2 +/- 13.6 and significantly lower (P < 0.0001) than primary adrenocortical cancers (36.9 +/- 4.1), metastases (39.2 +/- 15.2), and pheochromocytomas (38.6 +/- 8.2). The sensitivity and specificity for 10- and 20-HU cutoff values to differentiate adenomas/hyperplasias from nonadenomas were 40.5 and 100% and 58.2 and 96.9%, respectively. The size of the adrenal tumor had less value with only 40.7 and 81.3% sensitivity and 94.7 and 61.4% specificity for 2- and 4-cm cutoff values. A combination of less than or equal to 4-cm adrenal mass size and noncontrast computed tomography HU less than or equal to 20 had 42.1% sensitivity and 100% specificity. Our study, the largest with surgical histopathology as the gold standard for diagnosis, supports a noncontrast computed tomography attenuation value of 10 HU as a safe cutoff value to differentiate adrenal adenomas/hyperplasias from nonadenomas.
authors.affiliation: Department of Endocrinology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. hamraha@ccf.org
authors.forename: Amir H
authors.initials: AH
authors.lastname: Hamrahian
authors.forename: Adriana G
authors.initials: AG
authors.lastname: Ioachimescu
authors.forename: Erick M
authors.initials: EM
authors.lastname: Remer
authors.forename: Gaspar
authors.initials: G
authors.lastname: Motta-Ramirez
authors.forename: Hari
authors.initials: H
authors.lastname: Bogabathina
authors.forename: Howard S
authors.initials: HS
authors.lastname: Levin
authors.forename: Sethu
authors.initials: S
authors.lastname: Reddy
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
authors.forename: Emmanuel L
authors.initials: EL
authors.lastname: Bravo
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging*; D000308:Adrenocortical Hyperfunction / Q000000981:diagnostic imaging*; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed