Diagnostic performance of18-F-FDG-PET-CT in adrenal lesions using histopathology as reference standard.
To determine the diagnostic performance of PET-CT in differentiating benign and malignant adrenal lesions when evaluating PET parameters individually as well as in combination with CT parameters, using histopathology as the reference standard.



18F-FDG-PET-CT scans of patients undertaken within 6 months prior to pathologic evaluation of their adrenal lesion(s) were evaluated. PET assessments consisted individually of maximum standardized uptake value of the adrenal lesion (A-SUVmax) and its ("normalized") ratio to the liver (R-SUVmax). The diagnostic performances of these two PET parameters were also assessed when combined with the Hounsfield density from the non-contrast CT component of the PET-CT (A-HU). Diagnostic performance was assessed by area under the curve (AUC) of the receiver operating characteristics. Multiple logistic regression analysis was used to evaluate the individual and combined parameters.



The study cohort consisted of 61 adrenal lesions (59 patients). Malignant lesions (n = 52) had significantly higher median PET and CT parameters than benign lesions: A-SUVmax(11.4 vs. 6.1), R-SUVmax(3.3 vs. 1.7), and A-HU (37 vs. 24) [all p < 0.023]. AUC for the PET parameters individually was almost identical: 0.75 for A-SUVmaxand 0.74 for R-SUVmax. On univariate analysis, thresholds of A-SUVmax>3.47 and R-SUVmax>0.83 yielded maximum accuracy (both 87%). The combination of these PET parameters individually with A-HU improved both AUC and accuracy (0.81% and 93%, respectively).



The individual PET parameters A-SUVmaxand R-SUVmaxhave similar diagnostic performance for differentiating malignant and benign adrenal lesions; their performance and accuracy improve when combined with the CT component (A-HU).
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4008, USA. emrealtinmakas@gmail.com.|Department of Medical Imaging, St .Michael's Hospital, University of Toronto, Toronto, ON, M5B 1W8, Canada. emrealtinmakas@gmail.com.
Emre
E
Altinmakas
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4008, USA.
Brian P
BP
Hobbs
Hunan Cancer Hospital, PET-CT Center, Changsha, 410013, China.
Hui
H
Ye
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4008, USA.
Elizabeth G
EG
Grubbs
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4008, USA.
Nancy D
ND
Perrier
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4008, USA.
Victor G
VG
Prieto
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4008, USA.
Jeffrey E
JE
Lee
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4008, USA.
Chaan S
CS
Ng
D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies
D019788:Fluorodeoxyglucose F18
18F-FDG-PET–CT; Adrenal lesions; Characterization