Can MDCT Enhancement Patterns Be Helpful in Differentiating Secretory from Non-Functional Adrenal Adenoma?

Svetlana Kocic; Vladimir Vukomanovic; Aleksandar Djukic; Jovica Saponjski; Dusan Saponjski; Vuk Aleksic; Vesna Ignjatovic; Katarina Vuleta Nedic; Vladan Markovic; Radisa Vojinovic

doi:10.3390/medicina60010072

Can MDCT Enhancement Patterns Be Helpful in Differentiating Secretory from Non-Functional Adrenal Adenoma?

Medicina (Kaunas). 2023 Dec 29;60(1):72. doi: 10.3390/medicina60010072.

Authors

Svetlana Kocic¹, Vladimir Vukomanovic^{2

3}, Aleksandar Djukic^{3

4}, Jovica Saponjski^{5

6}, Dusan Saponjski^{5

6}, Vuk Aleksic⁷, Vesna Ignjatovic^{2

3}, Katarina Vuleta Nedic^{2

3}, Vladan Markovic^{3

8}, Radisa Vojinovic^{3

8}

Affiliations

¹ Department of Radiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia.
² Department of Nuclear Medicine, Faculty of Medical Science, University of Kragujevac, 34000 Kragujevac, Serbia.
³ University Clinical Center Kragujevac, 34000 Kragujevac, Serbia.
⁴ Department of Pathophysiology, Faculty of Medical Science, University of Kragujevac, 34000 Kragujevac, Serbia.
⁵ Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
⁶ University Clinical Center of Serbia, 11000 Belgrade, Serbia.
⁷ Department of Neurosurgery, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia.
⁸ Department of Radiology, Faculty of Medical Science, University of Kragujevac, 34000 Kragujevac, Serbia.

Abstract

Background and Objectives: Primary adrenal tumors (AT) are a heterogeneous group of neoplasms due to their functional heterogeneity, which results in the diverse clinical presentation of these tumors. The purpose of this study was to examine cross-sectional imaging characteristics using multi-detector computed tomography (MDCT) to provide insight into the lesion characterization and functional status of these tumors. The radionuclide imaging using Technetium-99m radiolabeled hydrazinonicotinylacid-d-phenylalanyl¹-tyrosine3-octreotide (^99mTc-HYNIC-TOC), was also used in the diagnostic evaluation of these tumors. Materials and Methods: This cross-sectional study included 50 patients with confirmed diagnoses of AT (21 hormone-secreting and 29 non-functional) at the University Clinical Center, Kragujevac, Serbia, during the 2019-2022 year period. The morphological and dynamic characteristics using MDCT were performed, using qualitative, semi-quantitative, and quantitative analysis. Absolute washout (APW) and relative washout (RPW) values were also calculated. A semi-quantitative analysis of all visual findings with ^99mTc-HYNIC-TOC was performed to compare the tumor to non-tumor tracer uptake. Results: A statistically significant difference was found in the MDCT values in the native phase (p < 0.05), the venous phase (p < 0.05), and the delayed phase (p < 0.001) to detect the existence of adrenal tumors. Most of these functional adrenocortical lesions (n = 44) can be differentiated using the delayed phase (p < 0.05), absolute percentage washout (APW) (p < 0.05), and relative percentage washout (RPW) (p < 0.001). Furthermore, ^99mTc-HYNIC-TOC could have a high diagnostic yield to detect adrenal tumor existence (p < 0.001). There is a positive correlation between radionuclide imaging scan and APW to detect all AT (p < 0.01) and adrenocortical adenomas as well (p < 0.01). Conclusions: The results can be very helpful in a diagnostic algorithm to quickly and precisely diagnose the expansive processes of the adrenal glands, as well as to learn about the advantages and limitations of the mentioned imaging modalities.

Keywords: 99mTc-HYNIC-TOC; adrenal tumor; multidetector computed tomography; scintigraphy.

MeSH terms

Adenoma*
Adrenal Gland Neoplasms* / diagnostic imaging
Adrenocortical Adenoma*
Cross-Sectional Studies
Humans
Tomography, X-Ray Computed

Grants and funding

This research received no external funding.