title: 18F-Fluorodeoxyglucose positron emission tomography for the diagnosis of adrenocortical tumors: a prospective study in 77 operated patients.
abstract: BACKGROUND
  Most adrenal incidentalomas are nonfunctioning adrenocortical adenomas (ACAs). Adrenocortical carcinomas (ACCs) are rare but should be recognized at an early stage.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the usefulness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) to predict malignancy in patients without a previous history of cancer.
  
  
  METHODS
  This was a prospective, multicenter study from 2001 to 2006.
  
  
  METHODS
  The study was conducted at a network of seven university hospitals in Paris.
  
  
  METHODS
  Seventy-seven patients were included. All underwent surgery because of hypersecretory and/or growing benign lesions (n = 18), obvious ACCs (n = 21), or radiologically indeterminate lesions (n = 38).
  
  
  METHODS
  The degree of (18)F-FDG PET uptake [maximum standardized uptake value (maxSUV)] was related to the pathological findings serving as a reference, and its diagnostic value was compared with that of computerized tomography (CT) scan.
  
  
  RESULTS
  Pathology eventually diagnosed 43 ACAs, 22 ACCs, and 12 nonadrenocortical lesions. Using a cutoff value above 1.45 for adrenal to liver maxSUV ratio, the sensitivity and specificity to distinguish ACAs from ACCs were, respectively, 1.00 (95% confidence interval 0.85-1.00) and 0.88 (95% confidence interval 0.75-0.96). Among the 38 indeterminate lesions at CT scan, we could analyze a subgroup of 16 adrenocortical tumors with high unenhanced density (>10 HU) and an inappropriate washout: (18)F-FDG PET correctly predicted the benignity in 13 of 15 ACAs.
  
  
  CONCLUSIONS
  In a multidisciplinary team approach, (18)F-FDG PET helps to manage suspicious CT scan lesions. An adrenal to liver maxSUV ratio less than 1.45 is highly predictive of a benign lesion.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale Unité 567, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Paris, France. lionel.groussin@cch.aphp.fr
authors.forename: Lionel
authors.initials: L
authors.lastname: Groussin
authors.forename: Gérald
authors.initials: G
authors.lastname: Bonardel
authors.forename: Stéphane
authors.initials: S
authors.lastname: Silvéra
authors.forename: Frédérique
authors.initials: F
authors.lastname: Tissier
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Abiven
authors.forename: Rossella
authors.initials: R
authors.lastname: Libé
authors.forename: Marie
authors.initials: M
authors.lastname: Bienvenu
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Alberini
authors.forename: Sylvie
authors.initials: S
authors.lastname: Salenave
authors.forename: Philippe
authors.initials: P
authors.lastname: Bouchard
authors.forename: Jérôme
authors.initials: J
authors.lastname: Bertherat
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
authors.forename: Paul
authors.initials: P
authors.lastname: Legmann
authors.forename: Bruno
authors.initials: B
authors.lastname: Richard
authors.forename: Hervé
authors.initials: H
authors.lastname: Foehrenbach
authors.forename: Xavier
authors.initials: X
authors.lastname: Bertagna
authors.forename: Florence
authors.initials: F
authors.lastname: Tenenbaum
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D048909:Diabetes Complications / Q000000981:diagnostic imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D006728:Hormones / Q000097:blood; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010297:Paris; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D001786:Blood Glucose; D006728:Hormones; D019788:Fluorodeoxyglucose F18