ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 S30.2

Contrast-enhanced ultrasound of adrenal mass: differentiation between benign and malignant lesions

Mireen Friedrich-Rust1, Guenther Schneider2, Rainer M Bohle3, Stefan Zeuzem1 & Jörg Bojunga1

1Department Medicine I, Goethe-University, Frankfurt am Main, Germany; 2Department of Radiology, Saarland Univeristy, Homburg/Saar, Germany; 3Department of Pathology, Saarland University, Homburg/Saar, Germany.

Background: Adrenal masses can be detected by ultrasound with high sensitivity and specificity. However, a differentiation between benign and malignant adrenal masses is presently not possible. Contrast-enhanced ultrasound has been studied intensively with excellent results for the characterization of liver lesions.

The aim of the present study was to evaluate the value of contrast-enhanced ultrasound for the characterization of adrenal mass in a proof of principle study.

Methods: Thirty-five patients with adrenal incidentaloma received an ultrasound of the adrenal mass, including Duplex and Doppler ultrasound, followed by contrast-enhanced ultrasound. The dynamic of contrast-enhancement was analyzed using time-intensity curves. In addition, all patients received CT or MRI and a detailed laboratory testing including hormone profile. In susceptive cases adrenalectomy was performed.

Results: Early arterial contrast-enhancement and rapid wash-out was seen on contrast-enhanced ultrasound in all patients with primary or secondary malignant lesions of the adrenal gland (n=6). All primary malignant lesions were confirmed by histology. In 91% (32/35) of examined patients MRT/CT and contrast-enhanced ultrasound were congruent concerning the characterization of adnoma versus non-adenoma. However, in three of these cases all imaging methods suspected non-adenoma, but histology found adrenal adenoma after adrenalectomy. The sensitivity and specificity of contrast-enhanced ultrasound for the diagnosis of malignant adrenal mass was 100% and 79%, respectively.

Discussion: The present proof of principle study shows that contrast-enhanced ultrasound can be used to differentiate between adenoma and non-adenoma as good as CT or MRI and could be a cost-effective method for pre-selection of patients with adrenal incidentaloma.

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