{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T12:48:42Z","timestamp":1790426922911,"version":"4.1.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"5","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,5]]},"abstract":"Context<\/jats:title>The recent recommendations of the European Endocrine Society states that the performance of computed tomography (CT) to characterize \u2018true' adrenal incidentalomas (AIs) remains debatable.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine relevant thresholds for usual CT parameters for the diagnosis of benign tumors using robust reference standard among a large series of \u2018true\u2019 AIs recruited in an endocrinological setting.<\/jats:p><\/jats:sec>Design<\/jats:title>Retrospective study of 253 AIs in 233 consecutive patients explored in a single university hospital: 183 adenomas, 33 pheochromocytomas, 23 adrenocortical carcinomas, 5 other malignant tumors and 9 other benign tumors. Reference standard was histopathology in 118 AIs, biological diagnosis of pheochromocytoma in 2 AIs and size stability after at least 1 year of follow-up in 133 AIs.<\/jats:p><\/jats:sec>Methods<\/jats:title>Sensitivity, specificity and positive and negative predictive values were estimated for various thresholds of size, unenhanced attenuation (UA), relative and absolute wash-out (RPW, APW) of contrast media. 197 scans were reviewed independently in a blinded fashion by two expert radiologists to assess inter-observer reproducibility of measurements.<\/jats:p><\/jats:sec>Results<\/jats:title>Criteria associated with a 100% positive predictive value for the diagnosis of benign AI were: a combination of size and UA: 30\u2009mm and 20\u2009HU or 40\u2009mm and 15\u2009HU, respectively; RPW >53%; and APW >78%. Non-adenomatous AIs with rapid contrast wash-out were exclusively benign pseudocysts and pheochromocytomas, suggesting that classical thresholds of 60% and 40% for APW and RPW, respectively, can be safely used for patients with normal metanephrine values. Inter-observer reproducibility of all parameters was excellent (intra-class correlation coefficients: 0.96\u20130.99).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Our study, the largest conducted in AIs recruited in an endocrinological setting, suggests safe thresholds for quantitative CT parameters to avoid false diagnoses of benignity.<\/jats:p><\/jats:sec>","DOI":"10.1530\/eje-17-1056","type":"journal-article","created":{"date-parts":[[2018,2,22]],"date-time":"2018-02-22T01:45:17Z","timestamp":1519263917000},"page":"439-446","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":52,"title":["Diagnostic accuracy of computed tomography to identify adenomas among adrenal incidentalomas in an endocrinological population"],"prefix":"10.1093","volume":"178","author":[{"given":"M","family":"Marty","sequence":"first","affiliation":[{"name":"1Departments of Endocrinology, Diabetes and Nutrition"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Gaye","sequence":"additional","affiliation":[{"name":"2Departments of Radiology, CHU Haut-Leveque and University of Bordeaux, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Perez","sequence":"additional","affiliation":[{"name":"3Public Health Department, Clinical Epidemiology Unit INSERM, CIC 1401 and Bordeaux University Hospital, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Auder","sequence":"additional","affiliation":[{"name":"2Departments of Radiology, CHU Haut-Leveque and University of Bordeaux, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M L","family":"Nunes","sequence":"additional","affiliation":[{"name":"1Departments of Endocrinology, Diabetes and Nutrition"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Ferriere","sequence":"additional","affiliation":[{"name":"1Departments of Endocrinology, Diabetes and Nutrition"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Haissaguerre","sequence":"additional","affiliation":[{"name":"1Departments of Endocrinology, Diabetes and Nutrition"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Tabarin","sequence":"additional","affiliation":[{"name":"1Departments of Endocrinology, Diabetes and Nutrition"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"ref251","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1530\/EJE-10-1147","article-title":"AME position statement on adrenal incidentaloma","volume":"164","year":"2011","journal-title":"European Journal of Endocrinology"},{"key":"ref421","doi-asserted-by":"crossref","first-page":"4346","DOI":"10.1210\/jc.2013-1844","article-title":"Normotensive incidentally discovered pheochromocytomas display specific biochemical, cellular, and molecular characteristics","volume":"98","year":"2013","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref151","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1148\/radiol.10091386","article-title":"Incidental adrenal lesions: accuracy of characterization with contrast-enhanced washout multidetector CT \u2013 10-minute delayed imaging protocol revisited in a large patient cohort","volume":"256","year":"2010","journal-title":"Radiology"},{"key":"ref241","first-page":"51","article-title":"DinnesJBancosIFerrante di Management of endocrine disease : imaging for the diagnosis of malignancy in incidentally discovered adrenal masses : a systematic review and meta - 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