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.
03 - 07 May 2008
European Society of Endocrinology