Groussin Lionel, Bonardel Gérald, Silvéra Stéphane, Tissier Frédérique, Coste Joël, Abiven Gwenaelle, Libé Rossella, Bienvenu Marie, Alberini Jean-Louis, Salenave Sylvie, Bouchard Philippe, Bertherat Jérôme, Dousset Bertrand, Legmann Paul, Richard Bruno, Foehrenbach Hervé, Bertagna Xavier, Tenenbaum Florence
Institut National de la Santé et de la Recherche Médicale Unité 567, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Paris, France.
J Clin Endocrinol Metab. 2009 May;94(5):1713-22. doi: 10.1210/jc.2008-2302. Epub 2009 Feb 3.
Most adrenal incidentalomas are nonfunctioning adrenocortical adenomas (ACAs). Adrenocortical carcinomas (ACCs) are rare but should be recognized at an early stage.
The objective of the study was to evaluate the usefulness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) to predict malignancy in patients without a previous history of cancer.
This was a prospective, multicenter study from 2001 to 2006.
The study was conducted at a network of seven university hospitals in Paris.
Seventy-seven patients were included. All underwent surgery because of hypersecretory and/or growing benign lesions (n = 18), obvious ACCs (n = 21), or radiologically indeterminate lesions (n = 38).
The degree of (18)F-FDG PET uptake [maximum standardized uptake value (maxSUV)] was related to the pathological findings serving as a reference, and its diagnostic value was compared with that of computerized tomography (CT) scan.
Pathology eventually diagnosed 43 ACAs, 22 ACCs, and 12 nonadrenocortical lesions. Using a cutoff value above 1.45 for adrenal to liver maxSUV ratio, the sensitivity and specificity to distinguish ACAs from ACCs were, respectively, 1.00 (95% confidence interval 0.85-1.00) and 0.88 (95% confidence interval 0.75-0.96). Among the 38 indeterminate lesions at CT scan, we could analyze a subgroup of 16 adrenocortical tumors with high unenhanced density (>10 HU) and an inappropriate washout: (18)F-FDG PET correctly predicted the benignity in 13 of 15 ACAs.
In a multidisciplinary team approach, (18)F-FDG PET helps to manage suspicious CT scan lesions. An adrenal to liver maxSUV ratio less than 1.45 is highly predictive of a benign lesion.
大多数肾上腺偶发瘤为无功能肾上腺皮质腺瘤（ACA）。肾上腺皮质癌（ACC）虽罕见，但应早期识别。
本研究旨在评估18F-氟脱氧葡萄糖正电子发射断层扫描（18F-FDG PET）对无癌症既往史患者肾上腺病变恶性程度的预测价值。
这是一项2001年至2006年的前瞻性多中心研究。
研究在巴黎七所大学医院组成的网络中进行。
纳入77例患者。所有患者均因分泌亢进和/或生长的良性病变（n = 18）、明确的ACC（n = 21）或放射学上不确定的病变（n = 38）而接受手术。
18F-FDG PET摄取程度[最大标准化摄取值（maxSUV）]与作为参考的病理结果相关，并将其诊断价值与计算机断层扫描（CT）进行比较。
病理最终诊断出43例ACA、22例ACC和12例非肾上腺皮质病变。以肾上腺与肝脏maxSUV比值大于1.45为临界值，区分ACA与ACC的敏感性和特异性分别为1.00（95%置信区间0.85 - 1.00）和0.88（95%置信区间0.75 - 0.96）。在CT扫描显示的38例不确定病变中，我们分析了16例肾上腺皮质肿瘤亚组，这些肿瘤平扫密度高（>10 HU）且廓清不适当：18F-FDG PET正确预测了15例ACA中13例的良性性质。
在多学科团队方法中，18F-FDG PET有助于处理CT扫描可疑病变。肾上腺与肝脏maxSUV比值小于1.45高度提示为良性病变。
