Abstract:
BACKGROUND:A substantial proportion of all pheochromocytomas is currently detected during the evaluation of an adrenal incidentaloma. Recently, it has been suggested that biochemical testing to rule out pheochromocytoma is unnecessary in case of an adrenal incidentaloma with an unenhanced attenuation value ≤10 Hounsfield Units (HU) at computed tomography (CT). OBJECTIVES:We aimed to determine the sensitivity of the 10 HU threshold value to exclude a pheochromocytoma. METHODS:Retrospective multicenter study with systematic reassessment of preoperative unenhanced CT scans performed in patients in whom a histopathologically proven pheochromocytoma had been diagnosed. Unenhanced attenuation values were determined independently by two experienced radiologists. Sensitivity of the 10 HU threshold was calculated, and interobserver consistency was assessed using the intraclass correlation coefficient (ICC). RESULTS:214 patients were identified harboring a total number of 222 pheochromocytomas. Maximum tumor diameter was 51 (39-74) mm. The mean attenuation value within the region of interest was 36 ± 10 HU. Only one pheochromocytoma demonstrated an attenuation value ≤10 HU, resulting in a sensitivity of 99.6% (95% CI: 97.5-99.9). ICC was 0.81 (95% CI: 0.75-0.86) with a standard error of measurement of 7.3 HU between observers. CONCLUSION:The likelihood of a pheochromocytoma with an unenhanced attenuation value ≤10 HU on CT is very low. The interobserver consistency in attenuation measurement is excellent. Our study supports the recommendation that in patients with an adrenal incidentaloma biochemical testing for ruling out pheochromocytoma is only indicated in adrenal tumors with an unenhanced attenuation value >10 HU.
journal_name
Eur J Endocrinoljournal_title
European journal of endocrinologyauthors
Buitenwerf E,Korteweg T,Visser A,Haag CMSC,Feelders RA,Timmers HJLM,Canu L,Haak HR,Bisschop PHLT,Eekhoff EMW,Corssmit EPM,Krak NC,Rasenberg E,van den Bergh J,Stoker J,Greuter MJW,Dullaart RPF,Links TP,Kerstens MNdoi
10.1530/EJE-18-0006subject
Has Abstractpub_date
2018-05-01 00:00:00pages
431-437issue
5eissn
0804-4643issn
1479-683Xpii
EJE-18-0006journal_volume
178pub_type
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journal_title:European journal of endocrinology
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