Adrenocortical carcinoma other imaging studies: Difference between revisions

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*MIBG scan
*MIBG scan
*[[Bone scan]]s are used to visualize bone [[metastasis]]
*[[Bone scan]]s are used to visualize bone [[metastasis]]
ACC typically presents as a large, heterogeneous mass


with intense FDG uptake greater than liver background
==== FDG PET/CT ====
 
* ACC presents as a large, heterogeneous mass with intense [[FDG]] uptake.<ref name="pmid22737189" />
(Figure 4). In a study of 77 patients with surgically proven
* [[FDG]] [[PET scan|PET/CT]] had a [[Sensitivity (tests)|sensitivity]] of 100% and [[Specificity (tests)|specificity]] of 88% in distinguishing [[benign]] from [[malignant]] lesions by using cutoff value above 1.45 for [[Adrenal gland|adrenal]] to [[liver]] maximum standardized uptake value (SUV).  
 
* [[PET scan|PET/CT]] cannot distinguish ACC from [[Metastasis|metastases]], [[lymphoma]], or [[pheochromocytoma]] due to the high metabolic activity of these tumors.<ref name="pmid22737189">{{cite journal| author=Sundin A| title=Imaging of adrenal masses with emphasis on adrenocortical tumors. | journal=Theranostics | year= 2012 | volume= 2 | issue= 5 | pages= 516-22 | pmid=22737189 | doi=10.7150/thno.3613 | pmc=3364557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22737189  }}</ref>
diagnosis of ACA or ACC, [18F]FDG PET/CT had a sensitivity
* [[FDG]] [[PET scan|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.
of 100% and specificity of 88% in distinguishing
* No significant difference in [[Accuracy and precision|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.<ref name="pmid18397978">{{cite journal| author=Hahner S, Stuermer A, Kreissl M, Reiners C, Fassnacht M, Haenscheid H et al.| title=[123 I]Iodometomidate for molecular imaging of adrenocortical cytochrome P450 family 11B enzymes. | journal=J Clin Endocrinol Metab | year= 2008 | volume= 93 | issue= 6 | pages= 2358-65 | pmid=18397978 | doi=10.1210/jc.2008-0050 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18397978  }}</ref>
 
* The sensitivity of [[FDG]] [[PET scan|PET/CT]] was 90% for the diagnosis of [[metastases]] as compared with 88% for diagnostic [[Computed tomography|CT]].  
benign from malignant lesions by using cutoff value above
* [[FDG]] [[PET scan|PET/CT]] has low [[sensitivity]] for characterization of smaller lesions, particularly for those lesions less than 10 mm in diameter.<ref name="pmid16621901">{{cite journal| author=Mackie GC, Shulkin BL, Ribeiro RC, Worden FP, Gauger PG, Mody RJ et al.| title=Use of [18F]fluorodeoxyglucose positron emission tomography in evaluating locally recurrent and metastatic adrenocortical carcinoma. | journal=J Clin Endocrinol Metab | year= 2006 | volume= 91 | issue= 7 | pages= 2665-71 | pmid=16621901 | doi=10.1210/jc.2005-2612 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16621901  }}</ref>
 
* 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.<ref name="pmid16621901" />
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.


==References==
==References==

Revision as of 17:49, 20 September 2017

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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:[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 diagnostic CT.
  • FDG PET/CT has low sensitivity for characterization of smaller lesions, particularly for those lesions less than 10 mm in diameter.[4]
  • 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. doi:10.7150/thno.3613. PMC 3364557. PMID 22737189.
  3. Hahner S, Stuermer A, Kreissl M, Reiners C, Fassnacht M, Haenscheid H; et al. (2008). "[123 I]Iodometomidate for molecular imaging of adrenocortical cytochrome P450 family 11B enzymes". J Clin Endocrinol Metab. 93 (6): 2358–65. doi:10.1210/jc.2008-0050. PMID 18397978.
  4. 4.0 4.1 Mackie GC, Shulkin BL, Ribeiro RC, Worden FP, Gauger PG, Mody RJ; et al. (2006). "Use of [18F]fluorodeoxyglucose positron emission tomography in evaluating locally recurrent and metastatic adrenocortical carcinoma". J Clin Endocrinol Metab. 91 (7): 2665–71. doi:10.1210/jc.2005-2612. PMID 16621901.

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