{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:39:06Z","timestamp":1780468746412,"version":"3.54.1"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,9,5]],"date-time":"2017-09-05T00:00:00Z","timestamp":1504569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Evidence on the diagnostic performance of adrenal imaging is limited. We aimed to assess the diagnostic performance of unenhanced computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) and <jats:sup>18<\/jats:sup>F\u2010fluorodeoxyglucose (<jats:sup>18<\/jats:sup>FDG) positron emission tomography (<jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>)\/<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> imaging in a high\u2010risk population for adrenal malignancy using an optimal reference standard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Imaging studies of patients with adrenal nodules who underwent adrenal biopsy and\/or adrenalectomy between 1994 and 2014 were reviewed and compared to the reference standard of histology. Eighty % of patients presented with known or suspected extra\u2010adrenal malignancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Unenhanced abdominal <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> was performed in 353 patients with adrenal lesions; median size was 3 (0.7\u201015) cm and median radiodensity was 33 (\u221221\u201078) Hounsfield units (<jats:styled-content style=\"fixed-case\">HU<\/jats:styled-content>). Radiodensity of &gt;10\u00a0HU diagnosed malignancy with a sensitivity of 100%, specificity of 33%, positive predictive value (<jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content>) of 72% and negative predictive value (<jats:styled-content style=\"fixed-case\">NPV<\/jats:styled-content>) of 100%. <jats:sup>18<\/jats:sup><jats:styled-content style=\"fixed-case\">FDG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> was performed in 89 patients; median tumour size was 2.1 (0.7\u20109.2) cm. Maximum standardized uptake (<jats:styled-content style=\"fixed-case\">SUV<\/jats:styled-content> max) was higher in malignant lesions when compared to benign lesions (median=10 [2.3\u201029.4] vs 3.7 [1.4\u201024.5], respectively, <jats:italic>P<\/jats:italic>&lt;.0001). Similarly, median <jats:styled-content style=\"fixed-case\">SUV<\/jats:styled-content> max lesion to <jats:styled-content style=\"fixed-case\">SUV<\/jats:styled-content> max liver ratio (<jats:styled-content style=\"fixed-case\">ALR<\/jats:styled-content>) in malignant lesions was higher than in benign lesions (median=3 [0.74\u201013.4] vs 1.2 [0.5\u20106.6], respectively, <jats:italic>P<\/jats:italic>&lt;.0001). <jats:sup>18<\/jats:sup><jats:styled-content style=\"fixed-case\">FDG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">CT ALR<\/jats:styled-content> &gt;1.8 diagnosed malignancy with a sensitivity of 87%, specificity of 84%, <jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content> of 85% and <jats:styled-content style=\"fixed-case\">NPV<\/jats:styled-content> of 86%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Noncontract <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> radiodensity of \u226410\u00a0HU excludes malignancy even in a high\u2010risk population. For indeterminate adrenal lesions, given a superior specificity, <jats:sup>18<\/jats:sup><jats:styled-content style=\"fixed-case\">FDG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> could be considered as a second stage imaging study.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.13448","type":"journal-article","created":{"date-parts":[[2017,8,17]],"date-time":"2017-08-17T08:13:08Z","timestamp":1502957588000},"page":"30-36","source":"Crossref","is-referenced-by-count":51,"title":["Diagnostic performance of unenhanced computed tomography and <sup>18<\/sup>F\u2010fluorodeoxyglucose positron emission tomography in indeterminate adrenal tumours"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4868-0423","authenticated-orcid":false,"given":"Danae A","family":"Delivanis","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Bancos","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas D","family":"Atwell","sequence":"additional","affiliation":[{"name":"Department of Radiology Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant D","family":"Schmit","sequence":"additional","affiliation":[{"name":"Department of Radiology Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick W","family":"Eiken","sequence":"additional","affiliation":[{"name":"Department of Radiology Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neena","family":"Natt","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Erickson","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyridoula","family":"Maraka","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition Mayo Clinic Rochester MN USA"},{"name":"Department of Endocrinology and Metabolism Center for Osteoporosis and Metabolic Bone Diseases University of Arkansas for Medical Sciences and the Central Arkansas Veterans Health Care System Little Rock AR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William 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