{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:07:16Z","timestamp":1790701636829,"version":"4.1.0"},"reference-count":73,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2016,8,1]],"date-time":"2016-08-01T00:00:00Z","timestamp":1470009600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Adrenal masses are incidentally discovered in 5% of CT scans. In 2013\/2014, 81 million CT examinations were undertaken in the USA and 5 million in the UK. However, uncertainty remains around the optimal imaging approach for diagnosing malignancy. We aimed to review the evidence on the accuracy of imaging tests for differentiating malignant from benign adrenal masses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A systematic review and meta-analysis was conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials, Science Citation Index, Conference Proceedings Citation Index, and ZETOC (January 1990 to August 2015). We included studies evaluating the accuracy of CT, MRI, or<jats:sup>18<\/jats:sup>F-fluoro-deoxyglucose (FDG)-PET compared with an adequate histological or imaging-based follow-up reference standard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 37 studies suitable for inclusion, after screening 5469 references and 525 full-text articles. Studies evaluated the accuracy of CT (<jats:italic>n<\/jats:italic>=16), MRI (<jats:italic>n<\/jats:italic>=15), and FDG-PET (<jats:italic>n<\/jats:italic>=9) and were generally small and at high or unclear risk of bias. Only 19 studies were eligible for meta-analysis. Limited data suggest that CT density &gt;10HU has high sensitivity for detection of adrenal malignancy in participants with no prior indication for adrenal imaging, that is, masses with \u226410HU are unlikely to be malignant. All other estimates of test performance are based on too small numbers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite their widespread use in routine assessment, there is insufficient evidence for the diagnostic value of individual imaging tests in distinguishing benign from malignant adrenal masses. Future research is urgently needed and should include prospective test validation studies for imaging and novel diagnostic approaches alongside detailed health economics analysis.<\/jats:p><\/jats:sec>","DOI":"10.1530\/eje-16-0461","type":"journal-article","created":{"date-parts":[[2016,6,3]],"date-time":"2016-06-03T02:18:48Z","timestamp":1464920328000},"page":"R51-R64","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":197,"title":["MANAGEMENT OF ENDOCRINE DISEASE: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"175","author":[{"given":"Jacqueline","family":"Dinnes","sequence":"first","affiliation":[{"name":"1Institute of Applied Health Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Bancos","sequence":"additional","affiliation":[{"name":"2Institute of Metabolism and Systems ResearchUniversity of Birmingham, Birmingham, UK"},{"name":"3Division of EndocrinologyMetabolism, Nutrition and Diabetes, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavinia","family":"Ferrante di Ruffano","sequence":"additional","affiliation":[{"name":"1Institute of Applied Health Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Chortis","sequence":"additional","affiliation":[{"name":"2Institute of Metabolism and Systems ResearchUniversity of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Davenport","sequence":"additional","affiliation":[{"name":"1Institute of Applied Health Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Bayliss","sequence":"additional","affiliation":[{"name":"1Institute of Applied Health Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anju","family":"Sahdev","sequence":"additional","affiliation":[{"name":"4Department of ImagingSt Bartholomew\u2019s Hospital, Barts Health, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Guest","sequence":"additional","affiliation":[{"name":"5Department of RadiologyQueen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Fassnacht","sequence":"additional","affiliation":[{"name":"6Department of Internal Medicine IDivision of Endocrinology and Diabetes, University Hospital W\u00fcrzburg, University of W\u00fcrzburg, W\u00fcrzburg, Germany"},{"name":"7Comprehensive Cancer Center MainfrankenUniversity of W\u00fcrzburg, W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J","family":"Deeks","sequence":"additional","affiliation":[{"name":"1Institute of Applied Health Research"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiebke","family":"Arlt","sequence":"additional","affiliation":[{"name":"2Institute of Metabolism and Systems ResearchUniversity of Birmingham, Birmingham, UK"},{"name":"8Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"2016071202381940000_175.2.R51.1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03344099"},{"key":"2016071202381940000_175.2.R51.2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.85.2.637"},{"key":"2016071202381940000_175.2.R51.3","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.07.2799"},{"key":"2016071202381940000_175.2.R51.4","unstructured":"OECD. 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