Adrenal Masses: Characterization with Combined Unenhanced and Delayed Enhanced CT

TLDR

The study evaluates the accuracy of a dedicated adrenal CT protocol for characterizing adrenal masses. The protocol uses unenhanced CT followed by contrast and delayed enhanced CT for masses >10 HU, measuring attenuation and washout to classify adenomas versus non‑adenomas, with biopsy or follow‑up confirming indeterminate cases. The protocol correctly identified 96 % of adrenal masses, with 98 % sensitivity and 92 % specificity, accurately distinguishing adenomas from non‑adenomas.

Abstract

To assess the accuracy of a dedicated adrenal computed tomographic (CT) protocol.One hundred sixty-six adrenal masses were evaluated with a protocol consisting of unenhanced CT, and, for those with attenuation values greater than 10 HU, contrast material-enhanced and delayed enhanced CT. Attenuation values and enhancement washout calculations were obtained. An adenoma was diagnosed if a mass had an attenuation value of 10 HU or less at unenhanced CT or a percentage enhancement washout value of 60% or higher.The final diagnosis was adenoma in 127 masses and non-adenoma in 39. Masses measuring more than 10 HU on unenhanced CT scans were confirmed at biopsy (n = 28) or were examined for stability or change in size at follow-up CT performed at a minimum interval of 6 months (n = 33). Thirty-six (92%) of 39 non-adenomas and 124 (98%) of 127 adenomas were correctly characterized. The sensitivity and specificity of this protocol were 98% and 92%, respectively. This protocol correctly characterized 160 (96%) of 166 masses.With a combination of unenhanced and delayed enhanced CT, nearly all adrenal masses can be correctly categorized as adenomas or non-adenomas.