Adrenocortical carcinoma other imaging studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2] Mohammed Abdelwahed M.D[3]

Overview

Adrenal angiography, venography, positron emission tomography and MIBG scan may be used in the diagnosis of adrenocortical carcinoma. The sensitivity of FDG PET/CT was 90% for the diagnosis of metastases as compared with 88% for the diagnostic CT. FDG PET/CT is a useful modality for staging ACC and evaluating local recurrence.

Other Imaging Studies

Other imaging studies that may be used in the diagnosis of adrenocortical carcinoma are:[1]

FDG PET/CT

  • ACC presents as a large, heterogeneous mass with intense FDG uptake.[2]
  • FDG PET/CT had a sensitivity of 100% and specificity of 88% in distinguishing benign from malignant lesions by using cutoff value above 1.45 for adrenal to liver maximum standardized uptake value (SUV).
  • PET/CT cannot distinguish ACC from metastases, lymphoma, or pheochromocytoma due to the high metabolic activity of these tumors.[2]
  • FDG PET/CT is a useful modality for staging ACC and evaluating local recurrence.
  • Increased uptake of FDG may be seen in benign conditions including postoperative changes.
  • No significant difference in accuracy was found between visual analysis, SUV analysis, and standardized uptake ratio (defined as the ratio of adrenal SUV activity to liver SUV activity) analysis.[3]
  • The sensitivity of FDG PET/CT was 90% for the diagnosis of metastases as compared with 88% for the diagnostic CT.
  • FDG PET/CT has low sensitivity for characterization of smaller lesions, particularly for those lesions less than 10 mm in diameter.[4]
  • The intensity of FDG uptake was found to be related to survival in patients with ACC, with a maximum SUV of >10 indicating a poor prognosis.[4]

References

  1. National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/types/adrenocortical/patient/adrenocortical-treatment-pdq#section/_1
  2. 2.0 2.1 Sundin A (2012). "Imaging of adrenal masses with emphasis on adrenocortical tumors.". Theranostics. 2 (5): 516–22. PMC 3364557Freely accessible. PMID 22737189. doi:10.7150/thno.3613. 
  3. Hahner S, Stuermer A, Kreissl M, Reiners C, Fassnacht M, Haenscheid H; et al. (2008). "[123 IIodometomidate for molecular imaging of adrenocortical cytochrome P450 family 11B enzymes."]. J Clin Endocrinol Metab. 93 (6): 2358–65. PMID 18397978. doi:10.1210/jc.2008-0050. 
  4. 4.0 4.1 Mackie GC, Shulkin BL, Ribeiro RC, Worden FP, Gauger PG, Mody RJ; et al. (2006). "Use of [18Ffluorodeoxyglucose positron emission tomography in evaluating locally recurrent and metastatic adrenocortical carcinoma."]. J Clin Endocrinol Metab. 91 (7): 2665–71. PMID 16621901. doi:10.1210/jc.2005-2612. 

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