Session: MON 37-82-Pheochromocytoma & Paraganglioma
Poster Board MON-53
Objective: To identify additional radiological features that can help to differentiate adrenal PHEOs from non-PHEOs
Methods: We retrospectively studied 112 patients with pathologically proven adrenal PHEO and 125 patients with lipid poor, non-PHEO adrenal masses from 1997-2012.
Results: The median (range) pre-contrast (Pr-C) attenuation for PHEOs (n=66) was 35 HU (17 - 59) compared to 27 HU (10 - 57) in lipid poor non-PHEOs (n=125) (P<0.001). Post-contrast (Po-C) images performed at the porto-venous phase were available in 18 PHEOs and 34 lipid poor non-PHEOs as part of adrenal CT protocol. The median (range) of Po-C attenuation among PHEOs and non-PHEOs was 88 HU (31 - 137) and 34 HU (17 - 134) respectively (P = 0.037). Median difference between Po-C HU and Pr-C HU (Delta) in PHEOs was 53 HU (14-105) compared to 43 HU (0-95) in non-PHEOs (P =0.315). While hemorrhage was more common among lipid poor non-PHEOs (18% vs 5%; P = 0.027), necrosis and hypervascularity were more common among the PHEOs (61% vs 19%; P <0.001) and (57% vs 28%; P = 0.001) respectively.
Discussion: All PHEOs in our series had a Pr-C attenuation >16 HU. A Po-C HU> 30 had 100% sensitivity and 26% specificity for diagnosis of PHEO.
Conclusion: Our data further confirms that PHEO work up for AI with a Pr-C attenuation value <10 HU is not needed. There is considerable overlap in Po-C attenuation values between PHEOs and non-PHEOs. A Po-C >30HU had limited specificity in excluding PHEO. Radiological features of necrosis and hypervascularity, when present, favors a diagnosis of PHEO.
Disclosure: CF: Speaker Bureau Member, Vivus USA. AHH: Consultant, Corcept. Nothing to Disclose: SK, AP, MC, ER, EB
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