title: Diffusion tensor imaging in the differentiation of adrenal adenomas and metastases.
abstract: OBJECTIVE
  To determine the utility of diffusion tensor imaging for the differentiation of adrenal adenomas and metastases.
  
  
  METHODS
  Thirty-three patients with a mean age of 59 years were included in this study. Each subject presented with a single adrenal lesion (19 adenomas, 14 metastases). Magnetic resonance imaging (MRI) was performed in the coronal plane using a 3 Tesla MRI and a six-channel phased array SENSE torso coil. T1-weighted in-phase and opposed-phase, T2-weighted turbo spin-echo, and single-shot echo-planar diffusion tensor imaging (DTI) sequences were used for image acquisition. To determine apparent diffusion coefficients (ADC) and fractional anisotropy (FA) values of adrenal lesions, coronal T2-weighted images were used as anatomical references and to localize regions of interest on DTI images. The signal intensity (SI) indices were obtained from in-phase/opposed-phase images by a radiologist blinded to the DTI findings. The DTI parameters were determined by a different radiologist. The SI indices and the differences in FA and ADCs between adenomas and metastases were compared. Analyses of receiver operating characteristics (ROC) were performed to determine the area under the curve (AUC).
  
  
  RESULTS
  The SI index of adenomas was found to be significantly higher than the value determined for metastases. Moreover, the median FA value of adrenal adenomas was found to be significantly higher than that of metastases. No statistically significant difference was observed in the ADCs between adenomas and metastases. Furthermore, no significant correlation was found among the SI index and the measured DTI parameters. Based on ROC analyses, the AUC was found to be 0.936 in FA measurements with a 95% confidence interval. The cutoff value obtained from this analysis was 0.40 with maximum sensitivity and specificity values of 74% and 88%, respectively.
  
  
  CONCLUSIONS
  Although no significant difference was observed in the ADCs between adrenal adenomas and metastases, the FA values differed significantly. The FA values may have the potential to differentiate between adrenal adenomas and metastases, which is a possibility that should be validated by further research.
authors.affiliation: Department of Radiology, Yeditepe University School of Medicine, İstanbul, Turkey.
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Işık
authors.forename: Bengi
authors.initials: B
authors.lastname: Gürses
authors.forename: Neslihan
authors.initials: N
authors.lastname: Taşdelen
authors.forename: Ozgür
authors.initials: O
authors.lastname: Kılıçkesmez
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Fırat
authors.forename: Cetin
authors.initials: C
authors.lastname: Ordu
authors.forename: Nevzat
authors.initials: N
authors.lastname: Gürmen
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016880:Anisotropy; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric