{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T23:14:54Z","timestamp":1793661294270,"version":"4.5.1"},"reference-count":60,"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":"<jats:sec><jats:title>Background<\/jats:title><jats:p>A substantial proportion of all pheochromocytomas is currently detected during the evaluation of an adrenal incidentaloma. Recently, it has been suggested that biochemical testing to rule out pheochromocytoma is unnecessary in case of an adrenal incidentaloma with an unenhanced attenuation value \u226410\u2009Hounsfield Units (HU) at computed tomography (CT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We aimed to determine the sensitivity of the 10\u2009HU threshold value to exclude a pheochromocytoma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective multicenter study with systematic reassessment of preoperative unenhanced CT scans performed in patients in whom a histopathologically proven pheochromocytoma had been diagnosed. Unenhanced attenuation values were determined independently by two experienced radiologists. Sensitivity of the 10\u2009HU threshold was calculated, and interobserver consistency was assessed using the intraclass correlation coefficient (ICC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>214 patients were identified harboring a total number of 222 pheochromocytomas. Maximum tumor diameter was 51 (39\u201374)\u2009mm. The mean attenuation value within the region of interest was 36\u2009\u00b1\u200910\u2009HU. Only one pheochromocytoma demonstrated an attenuation value \u226410\u2009HU, resulting in a sensitivity of 99.6% (95% CI: 97.5\u201399.9). ICC was 0.81 (95% CI: 0.75\u20130.86) with a standard error of measurement of 7.3\u2009HU between observers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The likelihood of a pheochromocytoma with an unenhanced attenuation value \u226410\u2009HU on CT is very low. The interobserver consistency in attenuation measurement is excellent. Our study supports the recommendation that in patients with an adrenal incidentaloma biochemical testing for ruling out pheochromocytoma is only indicated in adrenal tumors with an unenhanced attenuation value &gt;10\u2009HU.<\/jats:p><\/jats:sec>","DOI":"10.1530\/eje-18-0006","type":"journal-article","created":{"date-parts":[[2018,2,22]],"date-time":"2018-02-22T01:45:17Z","timestamp":1519263917000},"page":"431-437","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":66,"title":["Unenhanced CT imaging is highly sensitive to exclude pheochromocytoma: a multicenter study"],"prefix":"10.1093","volume":"178","author":[{"given":"Edward","family":"Buitenwerf","sequence":"first","affiliation":[{"name":"1Departments of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tijmen","family":"Korteweg","sequence":"additional","affiliation":[{"name":"2Departments of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneke","family":"Visser","sequence":"additional","affiliation":[{"name":"1Departments of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte M S C","family":"Haag","sequence":"additional","affiliation":[{"name":"2Departments of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A","family":"Feelders","sequence":"additional","affiliation":[{"name":"3Department of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henri J L M","family":"Timmers","sequence":"additional","affiliation":[{"name":"4Section of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Letizia","family":"Canu","sequence":"additional","affiliation":[{"name":"4Section of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands"},{"name":"5Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harm R","family":"Haak","sequence":"additional","affiliation":[{"name":"6Department of Internal Medicine, M\u00e1xima Medical Center, Eindhoven, The Netherlands"},{"name":"7Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands"},{"name":"8Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H L T","family":"Bisschop","sequence":"additional","affiliation":[{"name":"9Department of Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth M W","family":"Eekhoff","sequence":"additional","affiliation":[{"name":"10Endocrinology Section, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora P M","family":"Corssmit","sequence":"additional","affiliation":[{"name":"11Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanda C","family":"Krak","sequence":"additional","affiliation":[{"name":"12Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise","family":"Rasenberg","sequence":"additional","affiliation":[{"name":"13Department of Radiology, M\u00e1xima Medical Center, Eindhoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janneke","family":"van den Bergh","sequence":"additional","affiliation":[{"name":"14Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaap","family":"Stoker","sequence":"additional","affiliation":[{"name":"15Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel J 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