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Unenhanced CT imaging is highly sensitive to exclude pheochromocytoma: a multicenter study
Edward Buitenwerf1, Tijmen Korteweg2, Anneke Visser3
1Departments of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands e.buitenwerf@umcg.nl.
A 10 Hounsfield Unit (HU) threshold on CT scans effectively rules out pheochromocytoma in adrenal incidentalomas. This finding supports avoiding biochemical testing for adrenal tumors with low HU values.
Area of Science:
- Endocrinology
- Radiology
- Oncology
Background:
- Pheochromocytomas are often discovered incidentally in adrenal glands.
- Current guidelines suggest biochemical testing may be unnecessary for adrenal incidentalomas with unenhanced CT attenuation values ≤10 Hounsfield Units (HU).
Purpose of the Study:
- To evaluate the sensitivity of the 10 HU threshold for excluding pheochromocytoma in adrenal incidentalomas.
- To assess the reliability of CT attenuation measurements between radiologists.
Main Methods:
- Retrospective analysis of preoperative unenhanced CT scans from patients with histopathologically confirmed pheochromocytomas.
- Independent measurement of unenhanced attenuation values by two radiologists.
- Calculation of sensitivity and interobserver consistency (Intraclass Correlation Coefficient - ICC).
Main Results:
- 222 pheochromocytomas in 214 patients were analyzed.
- Only one pheochromocytoma had an attenuation value ≤10 HU, yielding a sensitivity of 99.6% for the 10 HU threshold.
- Excellent interobserver agreement (ICC = 0.81) was observed for attenuation measurements.
Conclusions:
- The probability of pheochromocytoma in adrenal incidentalomas with CT attenuation ≤10 HU is very low.
- The 10 HU threshold is a reliable tool for excluding pheochromocytoma.
- Biochemical testing for pheochromocytoma is recommended only for adrenal tumors with unenhanced CT attenuation >10 HU.
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