Modern capabilities of contrast-enhanced computed tomography in the diagnosis of adrenal adenomas

BACKGROUND: Adrenal incidentalomas are common, with a detection rate of up to 7% in patients over 70 years of age. Of these, up to 25% are functionally active, leading to the development of severe clinical manifestations. Challenges of insufficient diagnosis and a lack of a personalized approach to the management of such patients persist. To overcome these challenges, the use of CT image analysis is proposed to develop criteria for non-invasive diagnosis, which is a pathway towards improving personalized patient management.

AIM: Analysis of statistically significant correlations between clinical-laboratory parameters and contrast-enhanced (CE) CT imaging features of adrenal adenomas.

MATERIALS AND METHODS: A single-center, non-comparative, cross-sectional retrospective study analyzed preoperative images from four-phase CECT of adrenal adenomas. Hormonal workup included the determination of aldosterone, renin, cortisol levels during an overnight dexamethasone suppression test (DST), adrenocorticotropic hormone (ACTH), 24-hour urinary free cortisol (UFC); potassium and creatinine levels were also assessed. Clinical data included arterial hypertension, impaired carbohydrate metabolism, dyslipidemia, hypokalemia, and renal dysfunction. A comparative and correlation analysis was performed between clinical-laboratory parameters and CECT characteristics.

RESULTS: The study included 254 patients. Hormonal activity was detected in 226 (89.0%) patients; 28 (11.0%) patients had non-functioning adenomas. Hormonally inactive adenomas were characterized by larger size (43.0 mm [32.7; 51.2] vs. 29.0 mm [20; 36], p<0.001), higher native density (41.0 HU [36.0; 47.2] vs. 25.0 HU [12.0; 37.0], p<0.001), and lower venous phase contrast enhancement (141.6% vs. 283.7%, p=0.001). In primary aldosteronism (PA), adenomas were significantly smaller (20.0 mm [16.8; 25.0]) and had lower native density (14.0 HU [4.0; 24.0]) compared to cortisol-producing tumors (34.0 mm [30.0; 38.0], 35.5 HU [30.0; 44.0], p<0.001). The presence of calcifications was more frequently observed in cortisol hypersecretion compared to PA (p=0.011). Correlation analysis revealed negative associations between adenoma size and levels of aldosterone (r=–0.504, p<0.001) and ACTH (r=–0.419, p<0.001), and positive associations with post-DST cortisol levels (r=0.500, p<0.001), renin (r = 0.454, p<0.001), and potassium (r=0.458, p<0.001).

CONCLUSION: CT characteristics of adrenal adenomas vary depending on hormonal activity, type of secretion, and clinical manifestations.

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