Share This Article:

Multi-Detector-Row CT Diagnosis of Adrenal Incidentaloma in Patients with Hepatocellular Carcinoma

Abstract Full-Text HTML Download Download as PDF (Size:435KB) PP. 34-40
DOI: 10.4236/act.2013.21007    3,724 Downloads   6,770 Views   Citations


We investigate the diagnostic reliability of differentiating between lipid-poor adrenal adenomas and metastatic adrenal tumors originating from hepatocellular carcinoma (HCC) using a routine dynamic CT protocol for liver imaging. Eighteen metastatic adrenal tumors originating from HCC and 13 lipid-poor adrenal adenomas were identified. Dynamic CT data were analyzed for CT attenuation of adrenal lesions before and after contrast administration. When a cutoff of 36 HU was set for adrenal lesions at pre-contrast attenuation, the sensitivity and specificity for the diagnosis of metastatic lesions were 94.4%and 92.3%, respectively. Attenuation criteria on pre-contrast CT may help optimize the differentiation between these lesions.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Harada, T., Kamishima, T., Terae, S., Onodera, Y. and Shirato, H. (2013) Multi-Detector-Row CT Diagnosis of Adrenal Incidentaloma in Patients with Hepatocellular Carcinoma. Advances in Computed Tomography, 2, 34-40. doi: 10.4236/act.2013.21007.


[1] F. Bosch and N. Munoz, “Hepatocellular Carcinoma in the World: Epidemiologic Questions,” In: E. Tabor, A. DiBisceglie and R. Purcell, Eds., Etiology, Pathology and Treatment of Hepatocellular Carcinoma in America. Advances in Applied Technology Series, Gulf, Houston, 1991, p. 35.
[2] C. Muir, J. Waterhouse, T. Mack, J. Powell and S. Whelan, “Cancer Incidence in Five Continents,” International Agency for Research on Cancer, Lyon, 1987.
[3] N. Munoz and X. Bosch, “Epidemiology of Hepatocellular Carcinoma,” In: K. Okuda and K. G. Ishak, Eds., Neoplasms of the Liver, Springer, Tokyo, 1989, p. 3.
[4] K. Okuda, “Epidemiology of Primary Liver Cancer,” In: T. Tobe, Ed., Primary Liver Cancer in Japan, Springer-Verlag, Tokyo, 1992, p. 3. doi:10.1007/978-4-431-68177-9_1
[5] K. Okuda, T. Ohtsuki, H. Obata, M. Tomimatsu, N. Okazaki, H. Hasegawa, Y. Nakajima and K. Ohnishi, “Natural History of Hepatocellular Carcinoma and Prognosis in Relation to Treatment. Study of 850 Patients,” Cancer, Vol. 56, No. 4, 1985, pp. 918-928. doi:10.1002/1097-0142(19850815)56:4<918::AID-CNCR2820560437>3.0.CO;2-E
[6] J. W. Marsh, I. Dvorchik, M. Subotin, V. Balan, J. Rakela, E. P. Popechitelev, V. Subbotin, A. Casavilla, B. I. Carr, J. J. Fung and S. Iwatsuki, “The Prediction of Risk of Recurrence and Time to Recurrence of Hepatocellular Carcinoma after Orthotopic Liver Transplantation: A Pilot Study,” Hepatology, Vol. 26, No. 2, 1997, pp. 444-450. doi:10.1002/hep.510260227
[7] T. Nakashima, K. Okuda, M. Kojiro, A. Jimi, R. Yamaguchi, K. Sakamoto and T. Ikari, “Pathology of Hepatocellular Carcinoma in Japan. 232 Consecutive Cases Autopsied in Ten Years,” Cancer, Vol. 51, No. 5, 1983, pp. 863-877. doi:10.1002/1097-0142(19830301)51:5<863::AID-CNCR2820510520>3.0.CO;2-D
[8] L. Barzon, N. Sonino, F. Fallo, G. Palu and M. Boscaro, “Prevalence and Natural History of Adrenal Incidentalomas,” European Journal of Endocrinology, Vol. 149, No. 4, 2003, pp. 273-285. doi:10.1530/eje.0.1490273
[9] Mayo-Smith WW, Boland GW, Noto RB and Lee MJ, "State-of-the-Art Adrenal Imaging." Radiographics, Vol. 21, 2001, pp. 995-1012.
[10] M. Korobkin, F. J. Brodeur, G. G. Yutzy, I. R. Francis, L. E. Quint, N. R. Dunnick and E. A. Kazerooni, “Differentiation of Adrenal Adenomas from Nonadenomas Using CT Attenuation Values,” AJR American Journal of Roentgenology, Vol. 166, No. 3, 1996, pp. 531-536.
[11] E. M. Caoili, M. Korobkin, I. R. Francis, R. H. Cohan, J. F. Platt, N. R. Dunnick and K. I. Raghupathi, “Adrenal Masses: Characterization with Combined Unenhanced and Delayed Enhanced CT,” Radiology, Vol. 222, No. 3, 2002, pp. 629-633. doi:10.1148/radiol.2223010766
[12] W. W. Mayo-Smith, “CT Characterization of Adrenal Masses,” Radiology, Vol. 226, No. 1, 2003, pp. 289-290. doi:10.1148/radiol.2261020528
[13] S. Katyal, J. H. Oliver, M. S. Peterson, J. V. Ferris, B. S. Carr and R. L. Baron, “Extrahepatic Metastases of Hepatocellular Carcinoma,” Radiology, Vol. 216, No. 3, 2000, pp. 698-703.
[14] T. Ichikawa, S. M. Erturk and T. Araki, “Multiphasic Contrast-Enhanced Multidetector-Row CT of Liver: Contrast-Enhancement Theory and Practical Scan Protocol with a Combination of Fixed Injection Duration and Patients’ Body-Weight-Tailored Dose of Contrast Material,” European Journal of Radiology, Vol. 58, No. 2, 2006, pp. 165-176. doi:10.1016/j.ejrad.2005.11.037
[15] D. H. Szolar, M. Korobkin, P. Reittner, A. Berghold, T. Bauernhofer, H. Trummer, H. Schoellnast, K. W. Preidler and H. Samonigg, “Adrenocortical Carcinomas and Adrenal Pheochromocytomas: Mass and Enhancement Loss Evaluation at Delayed Contrast-Enhanced CT,” Radiology, Vol. 234, No. 2, 2005, pp. 479-485. doi:10.1148/radiol.2342031876
[16] S. H. Park, M. J. Kim, J. H. Kim, J. S. Lim and K. W. Kim, “Differentiation of Adrenal Adenoma and Nonadenoma in Unenhanced CT: New Optimal Threshold Value and the Usefulness of Size Criteria for Differentiation,” Korean Journal of Radiology, Vol. 8, No. 4, 2007, pp. 328-335. doi:10.3348/kjr.2007.8.4.328
[17] F. Ctvrtlik, M. Herman, V. Student, V. Ticha and J. Minarik, “Differential Diagnosis of Incidentally Detected Adrenal Masses Revealed on Routine Abdominal CT,” European Journal of Radiology, Vol. 69, No. 2, 2009, pp. 243-252. doi:10.1016/j.ejrad.2007.11.041
[18] C. S. Pena, G. W. Boland, P. F. Hahn, M. J. Lee and P. R. Mueller, “Characterization of Indeterminate (Lipid-Poor) Adrenal Masses: Use of Washout Characteristics at Contrast-Enhanced CT,” Radiology, Vol. 217, No. 3, 2000, pp. 798-802.
[19] G. M. Israel, M. Korobkin, C. Wang, E. N. Hecht and G. A. Krinsky, “Comparison of Unenhanced CT and Chemical Shift MRI in Evaluating Lipid-Rich Adrenal Adenomas,” AJR American Journal of Roentgenology, Vol. 183, No. 1, 2004, pp. 215-219.
[20] B. K. Park, B. Kim, K. Ko, S. Y. Jeong and G. Y. Kwon, “Adrenal Masses Falsely Diagnosed as Adenomas on Un-Enhanced and Delayed Contrast-Enhanced Computed Tomography: Pathological Correlation,” European Radiology, Vol. 16, No. 3, 2006, pp. 642-647. doi:10.1007/s00330-005-0017-0

comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.