title: Differentiation between benign and malignant adrenal mass using contrast-enhanced ultrasound.
abstract: OBJECTIVE
  Adrenal masses can be detected by ultrasound with high sensitivity and specificity. The aim of the present study was to evaluate CEUS in a large patient population using CEUS patterns identified in a previous pilot study.
  
  
  METHODS
  116 adrenal masses were evaluated by ultrasound, including CEUS with the contrast agent Sonovue®. The dynamic of contrast enhancement (CE) was analyzed using time-intensity curves. The time of the first CE in the adrenal mass was used to define four CEUS patterns: pattern I = early arterial CE, pattern II = arterial CE, pattern III = late CE, pattern IV = no CE. In addition, all patients received CT/MRI and hormonal testing. In suspicious cases biopsy or adrenalectomy was performed.
  
  
  RESULTS
  CEUS patterns I&II were seen in all patients with primary or secondary malignant lesions of the adrenal gland (n = 16). The sensitivity and specificity of CEUS for the diagnosis of malignant adrenal mass were 100 % (CI [75;100]) and 67 % (CI [56;75]), respectively. Overall histology was available as a reference method for 40 adrenal masses. In 68 % of histologically diagnosed adrenal masses, MRI/CT and CEUS were congruent concerning the characterization of malignant versus benign adrenal mass.
  
  
  CONCLUSIONS
  Contrast-enhanced ultrasound may be a useful method in the diagnostic work-up of adrenal mass with excellent sensitivity for the diagnosis of malignancy.
authors.affiliation: Department of Internal Medicine 1, J. W. Goethe-University Hospital. Mireen.Friedrich-Rust@kgu.de
authors.forename: M
authors.initials: M
authors.lastname: Friedrich-Rust
authors.forename: T
authors.initials: T
authors.lastname: Glasemann
authors.forename: A
authors.initials: A
authors.lastname: Polta
authors.forename: K
authors.initials: K
authors.lastname: Eichler
authors.forename: K
authors.initials: K
authors.lastname: Holzer
authors.forename: S
authors.initials: S
authors.lastname: Kriener
authors.forename: E
authors.initials: E
authors.lastname: Herrmann
authors.forename: J
authors.initials: J
authors.lastname: Nierhoff
authors.forename: D
authors.initials: D
authors.lastname: Bon
authors.forename: W O
authors.initials: WO
authors.lastname: Bechstein
authors.forename: T
authors.initials: T
authors.lastname: Vogl
authors.forename: S
authors.initials: S
authors.lastname: Zeuzem
authors.forename: J
authors.initials: J
authors.lastname: Bojunga
mesh_terms: D000236:Adenoma; D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging*; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D000311:Adrenal Glands / Q000000981:diagnostic imaging; D018246:Adrenocortical Adenoma / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000000981:diagnostic imaging; D010743:Phospholipids; D010865:Pilot Projects; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D036542:Tomography, Spiral Computed; D014463:Ultrasonography; D014741:Video Recording
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride