{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:39:01Z","timestamp":1789666741235,"version":"4.0.1"},"reference-count":55,"publisher":"Elsevier BV","issue":"1","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacr.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of the American College of Radiology"],"published-print":{"date-parts":[[2024,1]]},"DOI":"10.1016\/j.jacr.2023.04.027","type":"journal-article","created":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T20:49:54Z","timestamp":1692996594000},"page":"107-117","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of Size Thresholds on the Diagnosis of Incidental Adrenal Lesions: A Systematic Review and Meta-Analysis"],"prefix":"10.1016","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1630-5138","authenticated-orcid":false,"given":"Mitchell P.","family":"Wilson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubreet","family":"Randhawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0724-9330","authenticated-orcid":false,"given":"Bo","family":"Bao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0060-2170","authenticated-orcid":false,"given":"Roger","family":"Croutze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad H.","family":"Murad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.F.","family":"McInnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Low","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jacr.2023.04.027_bib1","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1007\/BF03344099","article-title":"Prevalence of adrenal incidentaloma in contemporary computerized tomography series","volume":"29","author":"Bovio","year":"2006","journal-title":"J Endocrinol Invest"},{"key":"10.1016\/j.jacr.2023.04.027_bib2","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1530\/EJE-10-1147","article-title":"AME position statement on adrenal incidentaloma","volume":"164","author":"Terzolo","year":"2011","journal-title":"Eur J Endocrinol"},{"key":"10.1016\/j.jacr.2023.04.027_bib3","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1530\/EJE-09-0234","article-title":"Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink?","volume":"161","author":"Cawood","year":"2009","journal-title":"Eur J Endocrinol"},{"key":"10.1016\/j.jacr.2023.04.027_bib4","first-page":"637","article-title":"A survey of adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology","volume":"85","author":"Mantero","year":"2000","journal-title":"J Clin Endocrinol Metab"},{"key":"10.1016\/j.jacr.2023.04.027_bib5","first-page":"926","article-title":"Adrenal cortical carcinoma\u2014a continuing challenge","volume":"94","author":"Henley","year":"1983","journal-title":"Surgery"},{"key":"10.1016\/j.jacr.2023.04.027_bib6","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1148\/radiol.2493070976","article-title":"Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization","volume":"249","author":"Boland","year":"2008","journal-title":"Radiology"},{"key":"10.1016\/j.jacr.2023.04.027_bib7","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.mayocpiqo.2017.11.002","article-title":"Clinical, biochemical, and radiological characteristics of a single-center retrospective cohort of 705 large adrenal tumors","volume":"2","author":"Iniguez-Ariza","year":"2018","journal-title":"Mayo Clin Proc Inn Qual Out"},{"key":"10.1016\/j.jacr.2023.04.027_bib8","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1016\/j.jacr.2017.05.001","article-title":"Management of incidental adrenal masses: a white paper of the ACR incidental findings committee","volume":"14","author":"Mayo-Smith","year":"2017","journal-title":"J Am Coll Radiol"},{"key":"10.1016\/j.jacr.2023.04.027_bib9","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-16-0467","article-title":"Management of adrenal incidentalomas: European Society of Endocrinology clinical practice guideline in collaboration with the European Network for the Study of Adrenal Tumors","volume":"175","author":"Fassnacht","year":"2016","journal-title":"Eur J Endocrinol"},{"issue":"319","key":"10.1016\/j.jacr.2023.04.027_bib10","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1001\/jama.2017.19163","article-title":"Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement","volume":"23","author":"McInnes","year":"2018","journal-title":"JAMA"},{"key":"10.1016\/j.jacr.2023.04.027_bib11","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1002\/jmri.26198","article-title":"Best practices for MRI systematic reviews and meta-analyses","volume":"49","author":"McGrath","year":"2019","journal-title":"J Magn Reson Imaging"},{"key":"10.1016\/j.jacr.2023.04.027_bib12","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.jclinepi.2008.10.012","article-title":"An evidence-based practice guideline for the peer review of electronic search strategies","volume":"62","author":"Sampson","year":"2009","journal-title":"J Clin Epidemiol"},{"key":"10.1016\/j.jacr.2023.04.027_bib13","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.ejrad.2017.05.032","article-title":"Treatment of multiple test readers in diagnostic accuracy systematic reviews-meta-analyses of imaging studies","volume":"93","author":"McGrath","year":"2017","journal-title":"Eur J Radiol"},{"key":"10.1016\/j.jacr.2023.04.027_bib14","doi-asserted-by":"crossref","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"Whiting","year":"2011","journal-title":"Ann Intern Med"},{"key":"10.1016\/j.jacr.2023.04.027_bib15","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s12874-016-0196-1","article-title":"Modelling multiple thresholds in meta-analysis of diagnostic test accuracy studies","volume":"16","author":"Steinhauser","year":"2016","journal-title":"BMC Med Res Method"},{"key":"10.1016\/j.jacr.2023.04.027_bib16","doi-asserted-by":"crossref","first-page":"501","DOI":"10.3349\/ymj.2018.59.4.501","article-title":"Characteristics of adrenal incidentalomas in a large, prospective computed tomography-based multicenter study: the COAR study in Korea","volume":"59","author":"Ahn","year":"2018","journal-title":"Yonsei Med J"},{"key":"10.1016\/j.jacr.2023.04.027_bib17","doi-asserted-by":"crossref","first-page":"212","DOI":"10.4103\/1947-2714.157482","article-title":"Adrenal mass in patients who underwent abdominal computed tomography examination","volume":"7","author":"Al-Thani","year":"2015","journal-title":"N Am J Med Sci"},{"key":"10.1016\/j.jacr.2023.04.027_bib18","doi-asserted-by":"crossref","first-page":"669","DOI":"10.4158\/EP-2018-0616","article-title":"Large adrenal incidentalomas require a dedicated diagnostic procedure","volume":"25","author":"Amodru","year":"2019","journal-title":"Endocr Pract"},{"key":"10.1016\/j.jacr.2023.04.027_bib19","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1055\/s-0029-1237704","article-title":"Long term follow-up of patients with adrenal incidenalomas\u2014a single center experience and review of the literature","volume":"118","author":"Anagnostis","year":"2010","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"10.1016\/j.jacr.2023.04.027_bib20","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1055\/s-0035-1548823","article-title":"Complete evaluation of adrenal tumours in a tertiary care institution in Thuringia, Germany","volume":"123","author":"Askitis","year":"2015","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"10.1016\/j.jacr.2023.04.027_bib21","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/s002689900441","article-title":"Can adrenal incidentalomas be safely observed?","volume":"22","author":"Barry","year":"1998","journal-title":"World J Surg"},{"key":"10.1016\/j.jacr.2023.04.027_bib22","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1111\/j.1365-2796.1995.tb00889.x","article-title":"Incidentally detected adrenal tumors (incidentalomas): histological heterogeneity and differentiated therapeutic approach","volume":"237","author":"Bencsik","year":"1995","journal-title":"J Intern Med"},{"key":"10.1016\/j.jacr.2023.04.027_bib23","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1007\/s00268-008-9550-8","article-title":"Adrenal incidentalomas: experience in a developing country","volume":"32","author":"Bhargav","year":"2008","journal-title":"World J Surg"},{"key":"10.1016\/j.jacr.2023.04.027_bib24","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.urolonc.2009.03.027","article-title":"Adrenal incidentalomas: experience from a retrospective study in a Chinese population","volume":"29","author":"Bin","year":"2011","journal-title":"Urol Oncol"},{"key":"10.1016\/j.jacr.2023.04.027_bib25","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.surg.2014.06.042","article-title":"A new risk stratification algorithm for the management of patients with adrenal incidentalomas","volume":"156","author":"Birsen","year":"2014","journal-title":"Surgery"},{"key":"10.1016\/j.jacr.2023.04.027_bib26","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1530\/eje.1.02110","article-title":"Adrenal incidentaloma\u2014follow-up results from a Swedish prospective study","volume":"154","author":"Bulow","year":"2006","journal-title":"Eur J Endocrinol"},{"key":"10.1016\/j.jacr.2023.04.027_bib27","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/S0003-3944(01)00650-2","article-title":"Which adrenal incidentalomas are to be operated?","volume":"126","author":"Chapuis","year":"2001","journal-title":"Ann Chir"},{"key":"10.1016\/j.jacr.2023.04.027_bib28","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1159\/000314959","article-title":"Clinical analysis of 249 cases of adrenal tumors in a Chinese hospital","volume":"85","author":"Chen","year":"2010","journal-title":"Urol Int"},{"key":"10.1016\/j.jacr.2023.04.027_bib29","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1055\/s-0029-1211219","article-title":"Incidentally discovered adrenal masses: a functional and morphological study","volume":"101","author":"Corsello","year":"1993","journal-title":"Exp Clin Endocrinol"},{"key":"10.1016\/j.jacr.2023.04.027_bib30","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2214\/AJR.17.18543","article-title":"Incidentally detected bilateral adrenal nodules in patients without cancer: Is further workup necessary?","volume":"210","author":"Corwin","year":"2018","journal-title":"AJR Am J Roentgenol"},{"key":"10.1016\/j.jacr.2023.04.027_bib31","doi-asserted-by":"crossref","first-page":"e126","DOI":"10.1016\/j.juro.2016.02.2442","article-title":"Incidental adrenal mass: Do our results support the guidelines?","volume":"195","author":"Dinis","year":"2016","journal-title":"J Urol"},{"key":"10.1016\/j.jacr.2023.04.027_bib32","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1159\/000111147","article-title":"Malignant and unclear histological findings in incidentalomas","volume":"40","author":"Duenschede","year":"2008","journal-title":"Eur Surg Res"},{"key":"10.1016\/j.jacr.2023.04.027_bib33","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4158\/EP.ep.14.3.279","article-title":"Adrenal incidentalomas, 2003-2005: experience after publication of the National Institutes of Health consensus statement","volume":"14","author":"Eldeiry","year":"2008","journal-title":"Endocr Pract"},{"key":"10.1016\/j.jacr.2023.04.027_bib34","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1067\/msy.2000.109965","article-title":"Management of incidentally discovered adrenal masses and risk of malignancy","volume":"128","author":"Favia","year":"2000","journal-title":"Surgery"},{"key":"10.1016\/j.jacr.2023.04.027_bib35","doi-asserted-by":"crossref","first-page":"E173","DOI":"10.1111\/ans.13868","article-title":"Predicting malignancy in adrenal incidentaloma and evaluation of a novel risk stratification algorithm","volume":"88","author":"Foo","year":"2018","journal-title":"ANZ J Surg"},{"key":"10.1016\/j.jacr.2023.04.027_bib36","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.2214\/AJR.07.3565","article-title":"Contrast-enhanced sonography of adrenal masses: differentiation of adenomas and nonadenomatous lesions","volume":"191","author":"Freidrich-Rust","year":"2008","journal-title":"AJR Am J Roentgenol"},{"key":"10.1016\/j.jacr.2023.04.027_bib37","first-page":"60","article-title":"Surgery of the incidentally discovered mass of the adrenal gland (incidentaloma)","volume":"37","author":"Fronticelli","year":"1995","journal-title":"Panminerva Med"},{"key":"10.1016\/j.jacr.2023.04.027_bib38","first-page":"20020","article-title":"Clinical features of 99 patients with huge (size >\/= 6 cm) adrenal incidentaloma","volume":"9","author":"Gao","year":"2016","journal-title":"Int J Clin Exp Med"},{"key":"10.1016\/j.jacr.2023.04.027_bib39","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.surg.2010.05.001","article-title":"Adrenal incidentaloma: Does an adequate workup rule out surprises?","volume":"148","author":"Grogan","year":"2010","journal-title":"Surgery"},{"key":"10.1016\/j.jacr.2023.04.027_bib40","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1007\/BF03347425","article-title":"Adrenal incidentaloma: surgical update","volume":"30","author":"Guerrieri","year":"2007","journal-title":"J Endocrinol Invest"},{"key":"10.1016\/j.jacr.2023.04.027_bib41","first-page":"1014","article-title":"Incidentally discovered adrenal tumors: an institutional perspective","volume":"110","author":"Herrera","year":"1991","journal-title":"Surgery"},{"key":"10.1016\/j.jacr.2023.04.027_bib42","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/BF03348745","article-title":"Jockenhovel F, Kuck W, Hauffa B, et al. Conservative and surgical management of incidentally discovered adrenal tumors (incidentalomas)","volume":"15","year":"1992","journal-title":"J Endocrinol Invest"},{"key":"10.1016\/j.jacr.2023.04.027_bib43","doi-asserted-by":"crossref","first-page":"e238","DOI":"10.1097\/SLA.0000000000004048","article-title":"Modern assessment of cancer risk in adrenal incidentalomas: analysis of 2219 patients","volume":"275","author":"Kahramangil","year":"2022","journal-title":"Ann Surg"},{"key":"10.1016\/j.jacr.2023.04.027_bib44","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1046\/j.1365-2265.1997.d01-1751.x","article-title":"Incidentally discovered adrenal mass (incidentaloma): investigation and management of 208 patients","volume":"46","author":"Kasperlik-Zeluska","year":"1997","journal-title":"Clin Endocrinol (Oxf)"},{"key":"10.1016\/j.jacr.2023.04.027_bib45","doi-asserted-by":"crossref","first-page":"20","DOI":"10.3803\/EnM.2013.28.1.20","article-title":"Clinical characteristics for 348 patients with adrenal incidentaloma","volume":"28","author":"Kim","year":"2013","journal-title":"Endocrinol Metab (Seoul)"},{"key":"10.1016\/j.jacr.2023.04.027_bib46","first-page":"3324","article-title":"Clinical value of tumor size in the evaluation of adrenal incidentalomas","volume":"97","author":"Li","year":"2017","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"10.1016\/j.jacr.2023.04.027_bib47","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1001\/archsurg.2009.59","article-title":"Limited value of adrenal biopsy in the evaluation of adrenal neoplasm: a decade of experience","volume":"144","author":"Mazzalgia","year":"2009","journal-title":"Arch Surg"},{"key":"10.1016\/j.jacr.2023.04.027_bib48","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1159\/000093915","article-title":"Indications and results of surgery for incidentally found adrenal tumors","volume":"77","author":"Meyer","year":"2006","journal-title":"Urol Int"},{"issue":"Suppl 1","key":"10.1016\/j.jacr.2023.04.027_bib49","doi-asserted-by":"crossref","first-page":"S126","DOI":"10.1016\/j.ijsu.2014.05.029","article-title":"Imaging of adrenal incidentaloma: our experience","volume":"12","author":"Reginelli","year":"2014","journal-title":"Int J Surg"},{"key":"10.1016\/j.jacr.2023.04.027_bib50","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1007\/BF01659129","article-title":"Incidentalomas of the adrenal gland: 36 operated patients and review of the literature","volume":"17","author":"Siren","year":"1993","journal-title":"World J Surg"},{"key":"10.1016\/j.jacr.2023.04.027_bib51","first-page":"221","article-title":"Clinical and histopathological evaluation of the adrenal incidentaloma","volume":"48","author":"Sworczak","year":"2001","journal-title":"Neoplasma"},{"key":"10.1016\/j.jacr.2023.04.027_bib52","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1590\/s1677-5538.ibju.2018.0235","article-title":"Limited significance of repeated long-term radiological and hormonal examination in nonfunctioning adrenal incidentalomas","volume":"45","author":"Tasaki","year":"2019","journal-title":"Int Braz J Urol"},{"key":"10.1016\/j.jacr.2023.04.027_bib53","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12893-016-0154-1","article-title":"Management of adrenal incidentaloma: The role of adrenalectomy may be underestimated","volume":"16","author":"Ye","year":"2016","journal-title":"BMC Surg"},{"key":"10.1016\/j.jacr.2023.04.027_bib54","doi-asserted-by":"crossref","first-page":"13","DOI":"10.7812\/TPP\/15-037","article-title":"Evaluation of small adrenal incidental nodules: Is imaging follow-up necessary?","volume":"20","author":"Young","year":"2016","journal-title":"Perm J"},{"key":"10.1016\/j.jacr.2023.04.027_bib55","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s40200-016-0224-z","article-title":"Likelihood ratio of computed tomography characteristics for diagnosis of malignancy in adrenal incidentaloma: systematic review and meta-analysis","volume":"15","author":"Sabet","year":"2016","journal-title":"J Diabetes Metab Disord"}],"container-title":["Journal of the American College of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1546144023006348?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1546144023006348?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:44:38Z","timestamp":1763703878000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1546144023006348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":55,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["S1546144023006348"],"URL":"https:\/\/doi.org\/10.1016\/j.jacr.2023.04.027","relation":{},"ISSN":["1546-1440"],"issn-type":[{"value":"1546-1440","type":"print"}],"subject":[],"published":{"date-parts":[[2024,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Impact of Size Thresholds on the Diagnosis of Incidental Adrenal Lesions: A Systematic Review and Meta-Analysis","name":"articletitle","label":"Article Title"},{"value":"Journal of the American College of Radiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jacr.2023.04.027","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2023 American College of Radiology","name":"copyright","label":"Copyright"}]}}