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Reliability of CT attenuation value for adrenal masses
J Yanagida1, Y Yoshida1, M Otsuki2
1Department of Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Endocrine Connections
|February 6, 2026
Summary
CT attenuation values are reliable for non-radiologists to exclude adrenal malignancy and pheochromocytoma. Measurements by surgeons showed high interobserver reliability, confirming CT attenuation
Area of Science:
- Radiology
- Endocrinology
- Surgical Oncology
Background:
- CT attenuation values aid in adrenal mass diagnosis, with <10 HU often excluding malignancy.
- Reliability of CT attenuation measurements by non-specialists is not well-established.
Purpose of the Study:
- To assess the reliability of CT attenuation measurements by surgeons without specialized radiology training.
- To evaluate the utility of CT attenuation values in differentiating adrenal tumors.
Main Methods:
- Retrospective analysis of 325 adrenal lesions from 313 patients.
- Independent CT attenuation measurements by a general and an endocrine surgeon.
- Interobserver reliability assessed using intraclass and Cohen's kappa coefficients; correlation with endocrine and histopathological diagnoses.
Main Results:
- High interobserver reliability for CT attenuation measurements (ICC=0.938, Kappa=0.851).
- All malignant tumors and pheochromocytomas measured ≥10 HU.
- Cortisol-producing adenomas (CPAs) showed significantly higher CT attenuation than aldosterone-producing adenomas (APAs).
Conclusions:
- CT attenuation measurements are reliable when performed by non-radiologists.
- CT attenuation values are useful for excluding adrenal malignancy and pheochromocytoma.
- Findings support current clinical guidelines for adrenal mass evaluation.
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