Diagnostic Accuracy of Contrast Enhanced Computed Tomography Scan in Characterizing the Adrenal Masses as Adenomas or Non-Adenomas by Taking Histopathology as a Gold Standard
DOI:
https://doi.org/10.70749/ijbr.v3i4.2369Keywords:
Adrenal Masses, Contrast-enhanced Computed Tomography, Histopathology, Diagnostic AccuracyAbstract
Background: Adrenal masses are a source of diagnostic challenge with distinction of adenomas from non-adenomatous masses serving to guide management. Although readily available and well established as a tool of first choice is contrast-enhanced computed tomography, its sensitivity and specificity compared to histopathological examination require reassessment. Objective: To determine the diagnostic accuracy of contrast-enhanced CT in characterizing the adrenal masses as adenomas or non-adenomas by taking histopathology as gold standard. Study Design: Cross-sectional validation study. Duration and Place of Study: The study was conducted between March 2024 and August 2024 in the Department of Radiology, Liaquat University of Medical and Health Sciences, Jamshoro. Methodology: A total of 118 patients aged 20–85 years with adrenal masses >1 cm and attenuation values above 10 Hounsfield units on unenhanced computed tomography were enrolled. Contrast-enhanced computed tomography was performed 60 seconds after intravenous contrast administration and interpreted by a senior radiologist. Imaging findings were compared with histopathology, which served as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. Results: The mean patient age was 51.13 ± 11.63 years, with females comprising 65.3% of the cohort. Computed tomography demonstrated a sensitivity of 86.7%, specificity of 93.2%, positive predictive value of 65.0%, negative predictive value of 98.0%, and overall diagnostic accuracy of 92.4%. Stratified analyses confirmed consistent diagnostic performance across gender and body mass index groups. Conclusion: Contrast-enhanced computed tomography is a reliable and effective diagnostic modality for evaluating adrenal masses, with high specificity and accuracy when compared with histopathology.
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1. Paloka, R., Gopireddy, D. R., Virarkar, M., Galgano, S. J., Morani, A., Adimula, P., Singareddy, A., & Montanarella, M. (2022). Multimodality imaging of adrenal gland pathologies: A comprehensive pictorial review. Journal of Clinical Imaging Science, 12, 62.
https://doi.org/10.25259/jcis_92_2022
2. Bracci, B., De Santis, D., Del Gaudio, A., Faugno, M. C., Romano, A., Tarallo, M., Zerunian, M., Guido, G., Polici, M., Polidori, T., Pucciarelli, F., Matarazzo, I., Laghi, A., & Caruso, D. (2022). Adrenal lesions: A review of imaging. Diagnostics, 12(9), 2171.
https://doi.org/10.3390/diagnostics12092171
3. Agrawal, N., Awasthi, A., Mahata, R., & Chakraborty, P. P. (2021). Continuous and progressive ‘wash-in’ without ‘wash-out’ of contrast in adrenal mass: A useful feature of ganglioneuroma. BMJ Case Reports, 14(5), e241661.
https://doi.org/10.1136/bcr-2021-241661
4. Viëtor, C. L., Creemers, S. G., Van Kemenade, F. J., Van Ginhoven, T. M., Hofland, L. J., & Feelders, R. A. (2021). How to differentiate benign from malignant Adrenocortical tumors? Cancers, 13(17), 4383.
https://doi.org/10.3390/cancers13174383
5. Han, Z., Wu, M., Wei, P., Zhu, H., Zhang, X., Ding, Z., & Zhang, M. (2022). Differential diagnostic value of plain CT scan in adrenal adenoma and non-adenoma: A two-center control study of mean attenuation value, minimum attenuation value, and CT histogram. Frontiers in Endocrinology, 13.
https://doi.org/10.3389/fendo.2022.1007870
6. Park, S. S., & Kim, J. H. (2023). Recent updates on the management of adrenal Incidentalomas. Endocrinology and Metabolism, 38(4), 373-380.
https://doi.org/10.3803/enm.2023.1779
7. Chen, J., He, Y., Zeng, X., Zhu, S., & Li, F. (2022). Distinguishing between metastatic and benign adrenal masses in patients with extra-adrenal malignancies. Frontiers in Endocrinology, 13.
https://doi.org/10.3389/fendo.2022.978730
8. Barat, M., Cottereau, A., Gaujoux, S., Tenenbaum, F., Sibony, M., Bertherat, J., Libé, R., Gaillard, M., Jouinot, A., Assié, G., Hoeffel, C., Soyer, P., & Dohan, A. (2022). Adrenal mass characterization in the era of quantitative imaging: State of the art. Cancers, 14(3), 569.
https://doi.org/10.3390/cancers14030569
9. Kim, C. K., Kang, K. A., Oh, Y. L., & Park, S. Y. (2023). Role of computed tomography in predicting adrenal adenomas with cortisol hypersecretion. The British Journal of Radiology, 96(1149).
https://doi.org/10.1259/bjr.20221032
10. Seow, J. H., Stella, D. L., Welman, C. J., Somasundaram, A. J., & Gerstenmaier, J. F. (2025). Washed up: The end of an era for adrenal incidentaloma CT. Insights into Imaging, 16(1).
https://doi.org/10.1186/s13244-025-02015-4
11. Schloetelburg, W., Ebert, I., Petritsch, B., Weng, A. M., Dischinger, U., Kircher, S., Buck, A. K., Bley, T. A., Deutschbein, T., & Fassnacht, M. (2022). Adrenal wash-out CT: Moderate diagnostic value in distinguishing benign from malignant adrenal masses. European Journal of Endocrinology, 186(2), 183-193.
https://doi.org/10.1530/eje-21-0650
12. Yokoyama, K., Matsuki, M., Isozaki, T., Ito, K., Imokawa, T., Ozawa, A., Kimura, K., Tsuchiya, J., & Tateishi, U. (2025). Advances in multimodal imaging for adrenal gland disorders: Integrating CT, MRI, and nuclear medicine. Japanese Journal of Radiology, 43(6), 903-926.
https://doi.org/10.1007/s11604-025-01732-6
13. Shankaranandh, R. (2012). Characterization of Adrenal Masses with Contrast enhanced CT–Washout Study (Doctoral dissertation, Madras Medical College, Chennai).
14. Choudhury, H., ., R., Agarwal, S., Duara, B., Gogoi, M., Talukdar, B. J., Das, B., & Dey, S. (2025). Characterisation of adrenal masses with contrast enhanced computed TomographyAdrenal protocol: A cross-sectional study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH.
https://doi.org/10.7860/jcdr/2025/76559.20623
15. Wang, X., Li, K., Sun, H., Zhao, J., Zheng, L., Zhang, Z., Bai, R., & Zhang, G. (2016). Differentiation between adrenal adenomas and nonadenomas using dynamic contrast-enhanced computed tomography. OncoTargets and Therapy, 9, 6809-6817.
https://doi.org/10.2147/ott.s112003
16. Shivapur, A. A., Patil, A. S., Goudar, P. S., Patil, S. D., & Hattiholi, V. V. (2021). Prevalence and characterization of adrenal incidentalomas on computed tomography-a hospital-based retrospective study.
https://ajms.alameenmedical.org/ArticlePDFs/13%20AJMS%20V14.N2.2021%20p%20159-168.pdf
17. Elsayes, K. M., Emad-Eldin, S., Morani, A. C., & Jensen, C. T. (2018). Practical approach to adrenal imaging. Urologic Clinics of North America, 45(3), 365-387.
https://doi.org/10.1016/j.ucl.2018.03.005
18. Park, S. H., Kim, M., Kim, J. H., Lim, J. S., & Kim, K. W. (2007). 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, 8(4), 328.
https://doi.org/10.3348/kjr.2007.8.4.328
19. Chen, Y., Zhang, Y., Zhang, X., & Wang, X. (2025). Characterization of adrenal glands on computed tomography with a 3D V-net-based model. Insights into Imaging, 16(1).
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