title: Nonfunctional adrenal lesions without loss of signal intensity on MRI: whose problem is it? The patient's? The surgeon's?
abstract: BACKGROUND
  Current indications for adrenalectomy include functional adrenal tumors and potentially malignant tumors based on imaging studies. We evaluated the effectiveness of magnetic resonance imaging (MRI) in obtaining a correct preoperative diagnosis.
  
  
  METHODS
  Fifty-three patients with nonfunctional adrenal lesions were analyzed. Indications for adrenalectomy of nonfunctional adrenal lesions included >6 cm in size and ≤6 cm in size with atypical characteristics on MRI. Lesions with a size of >6 cm, local invasion, irregular margins, and chemical-shift imaging that demonstrated no loss of signal intensity on out-of-phase images were considered suspected of malignancy.
  
  
  RESULTS
  Adrenal lesions of >6 cm in size exhibited an 80-fold increased prediction of malignancy (OR: 80; 95% CI 7.8-813), whereas irregular margins and local invasion exhibited a 45-fold (OR: 45; 95% CI 6.4-312.5) and a 12-fold (OR: 12; 95% CI 4.6-30.6) increased occurrence of malignancy, respectively. The loss of signal intensity did not affect the prediction of malignancy.
  
  
  CONCLUSIONS
  The rate of unnecessary tumor resections that are <6 cm in size can be decreased by performing adrenal biopsies in selected cases or by short-term follow-up to prevent the insufficiency of imaging techniques.
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of General Surgery, Turkey.
authors.forename: Nihat
authors.initials: N
authors.lastname: Aksakal
authors.forename: Alper
authors.initials: A
authors.lastname: Şahbaz
authors.forename: Beyza
authors.initials: B
authors.lastname: Özçınar
authors.forename: Ali
authors.initials: A
authors.lastname: Özemir
authors.forename: Kasım
authors.initials: K
authors.lastname: Çağlayan
authors.forename: Orhan
authors.initials: O
authors.lastname: Ağcaoğlu
authors.forename: Umut
authors.initials: U
authors.lastname: Barbaros
authors.forename: Artür
authors.initials: A
authors.lastname: Salmaslioglu
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Erbil
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D018709:Statistics, Nonparametric