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The 10 Hounsfield units unenhanced computed tomography attenuation threshold does not apply to cortisol secreting
Claire Chambre1, Emily McMurray1, Camille Baudry1
1Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceINSERM U1016CNRS UMR8104, Institut Cochin, Paris, France Department of EndocrinologyReferral Center for Rare Adrenal Diseases, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 27, rue du Faubourg Saint Jacques, 75014 Paris, FranceDepartment of EndocrinologyDiabetes Mellitus, and Metabolic Diseases, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris XIII University, 93009 Bobigny, FranceMetabolic UnitWestern General Hospital, Edinburgh, UKDepartment of RadiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceUniversité Paris DescartesSorbonne Paris Cité, Paris, FranceDepartment of Digestive and Endocrine SurgeryHormonal BiologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, FranceDepartment of PathologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin
Context:
Computed tomography (CT) unenhanced attenuation value of <10 Hounsfield units (HU) has an excellent specificity (98%) to diagnose lipid-rich adrenocortical adenomas (ACAs) with a weaker sensitivity (71%).
Objective:
To determine from a routine clinical perspective if unenhanced attenuation value is influenced by cortisol secretion in ACAs.
Design:
This was a retrospective study of cases collected between 2009 and 2012.
Setting:
This study was conducted in a tertiary-care university hospital.
Patients:
Seventy-two patients operated on for an ACA (Weiss score ≤ 2) were analysed. Thirty-four patients had an ACA oversecreting cortisol (Cush-ACA). Thirty-eight patients had an ACA without cortisol oversecretion (Non Hyper-ACA).
Main Outcome Measure:
CT unenhanced attenuation value was correlated with the functional status. The Weiss score items were analysed.
Results:
Among the 34 patients with a Cush-ACA a minority (n = 7) had an unenhanced attenuation value under 10 HU. Among the high precontrast density (> 10 HU) Cush-ACAs, washout analysis after contrast administration was consistent with the benign nature of the tumor in ∼ 60% of the cases. Less than 25% clear cells (lipid-rich cells), a Weiss score item, was present in 50% of the Cush-ACAs in favour of a lipid-poor content.
Conclusions:
Unenhanced attenuation value has a poor sensitivity to diagnose an ACA in case of cortisol oversecretion due to poor lipid content. Nevertheless, the accuracy of washout analysis was preserved in the group of Cush-ACAs.
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