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Contrast-enhanced ultrasound may be a useful method in the diagnostic work-up of adrenal incidentaloma with excellent sensitivity for the diagnosis of malignant adrenal mass.

This findings was presented on April 26 at the 12th European Congress of Endocrinology (ECE).

Adrenal masses can usually be diagnosed by ultrasound with high sensitivity and specificity. "Distinguishing between benign and malignant masses, however, is not possible with conventional ultrasound," said Mireen Friedrich-Rust, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany, during a poster presentation on April 26.

The study included 108 with 116 adrenal incidental masses of the adrenal glands. Researchers used Duplex and Doppler ultrasound followed by contrast-enhanced ultrasound (CEUS) to help look for benign or malignant adrenal masses.

The dynamic of contrast enhancement (CE) was analysed using time-intensity curves. The time of CE in the adrenal mass was used to define 4 CEUS patterns: early arterial (I), arterial (II), late (III), and none (IV).

All patients underwent computed tomography ( CT ) or magnetic resonance imaging (MRI) scans as well as a detailed laboratory testing including their hormone profile. If suspicion for a mass was raised, patients underwent a biopsy or surgical removal of the adrenal mass.

The CEUS pattern I and II was observed in all patients with primary or secondary malignant lesions of the adrenal gland (n = 16).

Sensitivity and specificity of CEUS for the diagnosis of the malignant adrenal mass was 100% when using patterns I and II to define malignancy, and 67% when using patterns III and IV.

Overall 38 patients received adrenalectomy out of a total of 40 patients with adrenal masses.

Eight benign phaeochromocytomas, 1 ganglioneuroma, 2 myelolipomas, and 4 adenomas showed perfusion pattern I and II and were therefore misclassified using CEUS.

"In 70% of the surgically removed adrenal masses CEUS and diagnostic imaging using CT and MRI were congruent in terms of characterisation of adenoma versus non-adenoma," according to Dr. Friedrich-Rust. "Contrast-enhanced ultrasound may therefore be a useful method for the diagnostic work-up of adrenal incidentaloma with excellent sensitivity for the diagnosis of malignant adrenal mass."

Source: ECE

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