Re-evaluation of pheochromocytomas on delayed contrast-enhanced CT: washout enhancement and other imaging features

The purpose of this study was to retrospectively evaluate the enhancement washout and other imaging features of pheochromocytomas on delayed contrast-enhanced CT. Twenty-four patients with 31 pathologically confirmed pheochromocytomas were examined using unenhanced, early and delayed contrast-enhanced CT. The range of their APEW (absolute percentage of enhancement washout) or RPEW (relative PEW) values was analyzed. The other CT features including cystic or necrotic change, calcification, and hemorrhage were also determined by a pathologic correlation. Of the 31 pheochromocytomas, 10 (32%) had APEW values of 60% or less and RPEW values of 40% or less. Fourteen (45%) had APEW values >60% and RPEW values >40%. CT showed cystic or necrotic changes in 11 pheochromocytomas (35%) and calcification (10%) in 3. Nineteen pheochromocytomas showed cystic or necrotic changes on early contrast-enhanced CT, but eight of these lesions showed late enhancement on delayed contrast-enhanced CT, which pathologically corresponded to myxoid degeneration. The unenhanced CT showed hemorrhage in 23 pheochromocytomas, but the pathology examinations showed hemorrhage in 15 lesions. Many pheochromocytomas can be misdiagnosed as adenomas on CT due to the high enhancement washout values. Delayed contrast-enhanced CT can detect myxoid degeneration with late enhancement, which is seen as a cystic or necrotic change on early contrast-enhanced CT.