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]

Overview

Adrenal angiography,venography, positron emission tomography and MIBG may be used in the diagnosis of adrenocortical carcinoma.

Other Imaging Studies

Other Imaging studies that may be used in diagnosis of adrenocortical carcinoma are:

• Adrenal angiography
• Adrenal venography
• PET scan (positron emission tomography scan)
• MIBG scan
• Bone scans are used to visualize bone metastasis

ACC typically presents as a large, heterogeneous mass

with intense FDG uptake greater than liver background

(Figure 4). In a study of 77 patients with surgically proven

diagnosis of ACA or ACC, [18F]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). In the same study using a cutoff value of 3.4

for adrenal maximum SUV, the sensitivity was 100% and

specificity70%(108). Assessment of morphological characteristics

such as tumor size, heterogeneity, and irregular

margins as well as attenuation value and metabolic activity

is likely to improve accuracy. [18F]FDG PET/CT, however,

cannot distinguish ACC from metastases, lymphoma,

or pheochromocytoma, which also exhibit high

metabolic activity (109). In a meta-analysis of published

data to determine the diagnostic utility of [18F]FDG

PET/CT for distinguishing benign from malignant adrenal

tumors, [18F]FDG PET/CT had sensitivity of 97% and

specificity of 91% (109). No significant difference in accuracy

was found between visual analysis, SUV analysis,

and standardized uptake ratio (defined as ratio of adrenal

SUV activity to liver SUV activity) analysis.

[18F]FDG PET/CT is a useful modality for stagingACC

and evaluating local recurrence. In a study on 22 patients

with ACC, sensitivity of [18F]FDG PET/CT was 90% for

diagnosis of metastases as compared with 88% for diagnostic

CT. However, they should be considered complementary

imaging modalities because 12% and 10% of

lesions were seen only by [18F]FDG PET/CT or CT, respectively

(110). [18F]FDG PET/CT has low sensitivity for

characterization of smaller lesions, particularly for those lesions less than 10 mm in diameter (111). Intensity of

FDGuptake was found to be related to survival in patients

with ACC, with a maximum SUV of _10 indicating poor

prognosis (111). In a study of 12 patients with previously

resectedACC,[18F]FDGPET/CTcorrectly identified local

tumor recurrence in all patients (112). [18F]FDG is not a

tumor-specific tracer, and increased uptake may be seen in

benign conditions including postoperative changes.

Functional imaging by positron emission tomography

(PET) with [18F]fluorodeoxyglucose (FDG) and [11C]me-tomidate (MTO) or [123I]MTO (where available) may be

used to confirm diagnosis of a malignant lesion or establish

the adrenocortical origin of a tumor. NP59 ([131I]-

iodocholesterol) scans are no longer available.