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PET/CT for the characterization of adrenal masses in patients with cancer: qualitative vs quantitative accuracy in 150 consecutive patients
American Journal of Roentgenology, 03/31/09

Boland GWL et al. - In a study to evaluate a large cohort of pts with PET/CT to determine whether qualitative (visual) assessment, quantitative standardized uptake value (SUV), or standardized uptake ratio (SUR) techniques should be used when characterizing adrenal masses in pts with cancer, it was shown that PET/CT is a highly accurate method for differentiating benign from malignant adrenal masses particularly when using qualitative, rather than quantitative, PET data. Occasionally benign lesions do show mild to moderate increased FDG uptake vs that of the liver and may mimic some malignant lesions. Without evidence that these lesions are benign by unenhanced CT densitometry or adrenal mass stability or growth from previous CT scans, these lesions should be characterized using contrast-enhanced washout tests and that if those tests are inconclusive, using percutaneous biopsy if early lesion characterization is mandatory.

Methods

The study group was composed of 150 consecutive pts with documented adrenal lesions.
All pts were known to have an underlying primary malignancy and were referred for PET/CT to evaluate the underlying primary and metastatic tumor burden.
Definitive lesion characterization was determined by evaluating all histologic adrenal specimens and all relevant prior and follow-up CT scans, including unenhanced, contrast-enhanced, and delayed contrast-enhanced washout studies.

Results

Of the 139 benign lesions, 109 were considered benign by CT densitometry measurements and 135 by qualitative PET data.
Qualitative PET characterized 28 of 30 benign lesions that were considered indeterminate by unenhanced CT.
All 26 malignant lesions were characterized by PET: All showed qualitative and quantitative signal intensity greater than the liver.
By combining unenhanced and qualitative CT data with the retrospective PET data, the analysis yielded a sensitivity of 100% for detection of malignancy, a specificity of 99%, a positive predictive value (PPV) of 93%, a negative predictive value (NPV) of 100%, and an accuracy of 99% (Table 1).
For detection of benignity, sensitivity, specificity, PPV, NPV, and accuracy were 99%, 100%, 100%, 93%, and 99%, respectively.

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