title: Clinical utility of FDG-PET for diagnosis of adrenal mass: a large single-center experience.
abstract: OBJECTIVE
  To examine the clinical utility of 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) for diagnosing whether an adrenal mass is malignant, in contemporary clinical practice.
  
  
  METHODS
  Retrospective medical record review of patients from 2 databases at a large hospital. The first database consisted of patients who underwent FDG-PET between the years 2009 to 2011 while the second database included patients who had histological diagnosis of adrenal mass between the years 1997 to 2011.
  
  
  RESULTS
  3.4% of 2921 patients had adrenal FDG uptake. Approximately 43% of them did not exhibit corresponding adrenal mass. FDG-PET performance parameters were better if a cutoff of SUV (standardized uptake value) ≥3 was used to define positivity. The imaging characteristics of malignant adrenal masses and pheochromocytoma were similar but differed remarkably compared to those of benign tumors. Serial imaging revealed that the malignant adrenal masses consistently exhibited high CT attenuation, while more than half of them initially exhibited SUV<3 and in some cases FDG uptake indistinguishable from the background. The FDG-PET results were confirmatory in 87% of patients, contributory in 11%, but definitely misleading in 2%.
  
  
  CONCLUSIONS
  FDG-PET is not required for adrenal mass diagnosis in most patients in contemporary practice but may help clinical decision making in specific situations.
authors.affiliation: Division of Endocrinology, 2Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Pitts
authors.forename: Grace
authors.initials: G
authors.lastname: Ih
authors.forename: Meng
authors.initials: M
authors.lastname: Wei
authors.forename: Deepti
authors.initials: D
authors.lastname: Dhall
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Nissen
authors.forename: Alan
authors.initials: A
authors.lastname: Waxman
authors.forename: Run
authors.initials: R
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18