title: Diagnostic and prognostic value of 18F-FDG PET/CT in comparison with morphological imaging in primary adrenal gland malignancies - a multicenter experience.
abstract: OBJECTIVE
  To evaluate the diagnostic and prognostic role of fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in comparison to morphological imaging such as computed tomography in primary adrenal malignancies.
  
  
  METHODS
  In this multicenter retrospective study, 68 patients with adrenal malignancy were included. All patients had histologically proven diagnosis of primary adrenal malignancy (adrenocortical carcinoma, malignant pheochromocytoma, neuroblastoma and lymphoma), one whole body (18)F-FDG PET/CT scan and one whole-body contrast enhancement computed tomography (CECT) scan acquired within one month and were followed clinically and by performing morphological tests for at least 12 months.
  
  
  RESULTS
  Overall sensitivity, specificity, accuracy, positive and negative predictive values for CECT and (18)F-FDG PET/CT were respectively, 59%, 100%, 65%, 100%, 27% and 75%, 100%, 82%, 100% and 63%. For adrenocortical carcinomas, (18)F-FDG PET/CT showed a better accuracy (93.4%) than CECT (75%). For neuroblastomas (18)F-FDG PET/CT also showed better accuracy (70.4%) than CECT (66.7%). For malignant pheochromocytomas (18)F-FDG PET/CT and CECT showed the same accuracy (90%). For primary adrenal lymphomas, (18)F-FDG PET/CT showed better accuracy (100%) than CECT (74.41%). Kaplan-Mayer curves showed that "histotypes" and "metastases at the last follow-up" were similarly detected for both disease free survival (DFS) and overall survival (OS), while "global 18F-FDG PET/CT" and "presence of metastases at diagnosis" were significant for DFS. Stratifying the sample by the presence or absence of metastases at diagnosis, standardized uptake value (SUVmax) was a significant prognostic factor for DFS when metastases were absent (Wald test=7.035, P=0.008).
  
  
  CONCLUSIONS
  Our multicenter study demonstrated that (18)F-FDG PET/CT better than CECT diagnosed adrenal malignancies achieving also a good prognostic performance. Therefore management algorithms should include (18)F-FDG PET/CT.
authors.affiliation: Positron Emission Tomography Centre, IRMET S.p.A, Euromedic Inc., Turin, Italy. artor.niccoliasabella@uniba.it.
authors.forename: Angelina
authors.initials: A
authors.lastname: Cistaro
authors.forename: Artor
authors.initials: A
authors.lastname: Niccoli Asabella
authors.forename: Pietro
authors.initials: P
authors.lastname: Coppolino
authors.forename: Natale
authors.initials: N
authors.lastname: Quartuccio
authors.forename: Corinna
authors.initials: C
authors.lastname: Altini
authors.forename: Mariapaola
authors.initials: M
authors.lastname: Cucinotta
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Alongi
authors.forename: Michele
authors.initials: M
authors.lastname: Balma
authors.forename: Silvia
authors.initials: S
authors.lastname: Sanfilippo
authors.forename: Ambra
authors.initials: A
authors.lastname: Buschiazzo
authors.forename: Arnoldo
authors.initials: A
authors.lastname: Piccardo
authors.forename: Margherita
authors.initials: M
authors.lastname: Fanelli
authors.forename: Gianmario
authors.initials: G
authors.lastname: Sambuceti
authors.forename: Jamshed
authors.initials: J
authors.lastname: Bomanji
authors.forename: Sergio
authors.initials: S
authors.lastname: Baldari
authors.forename: Gianni
authors.initials: G
authors.lastname: Bisi
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rubini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D064847:Multimodal Imaging / Q000706:statistics & numerical data; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18