ArticleEuropean journal of endocrinology2021
Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses.
Article in European journal of endocrinology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
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Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Guideline
- American Association of Clinical Endocrinology Consensus Statement on Management of Multiple Endocrine Neoplasia Type 1.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2025Guideline
- Differentiation of Adrenal Adenomas from Non-Adenomatous Lesions: Diagnostic Value of Unenhanced Spectral CT.Tomography (Ann Arbor, Mich.) · 2026Article
- Pitfalls of Adrenal Washout on CT in the Adult Population: A Pictorial Review.Diagnostics (Basel, Switzerland) · 2026Review
- Bilateral Adrenal Metastases From Breast Cancer 14 Years After Remission: Diagnostic Value of "Adrenal Thickening".JCEM case reports · 2026Article
- Habitat-radiomics combining multichannel 2.5D deep learning for differentiating adrenal adenomas from metastases using automatic segmentation: a multicenter study.Frontiers in endocrinology · 2026Article
- Natural history of large adrenal tumors.Frontiers in endocrinology · 2026Article
- Washed up: the end of an era for adrenal incidentaloma CT.Insights into imaging · 2025Review
- Feasibility of extracellular volume fraction derived from single-phase spectral CT for differentiating between adrenal metastases and adenomas.Abdominal radiology (New York) · 2025Article
- Spanish consensus on the diagnosis and management of adrenocortical carcinoma.Endocrine-related cancer · 2025Review
- Adrenocortical carcinoma classified as benign: the limitations of washout values.Endocrinology, diabetes & metabolism case reports · 2025Article
- Whole-lesion CT histogram analysis as an advanced technique in the portal venous phase: differentiating lipid poor adrenal adenomas from pheochromocytomas.Abdominal radiology (New York) · 2025Article
- Review
- An interpretableFrontiers in oncology · 2025Article
- High Diagnostic Accuracy of Arterial Phase CT in Differentiating Pheochromocytoma in Good/Poor Washout Adrenal Masses.Journal of the Endocrine Society · 2024Article
- Androgen and Cortisol Cosecreting Adrenal Adenoma and Tuberculous Lymphadenitis.JCEM case reports · 2024Article
- Prognostic role of quantitative [18F]FDG PET/CT parameters in adrenocortical carcinoma.Endocrine · 2024Article
- Can MDCT Enhancement Patterns Be Helpful in Differentiating Secretory from Non-Functional Adrenal Adenoma?Medicina (Kaunas, Lithuania) · 2023Article
- Endocrine causes of hypertension: literature review and practical approach.Hypertension research : official journal of the Japanese Society of Hypertension · 2023Review
- Article
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveReliable results of wash-out CT in the diagnostic workup of adrenal incidentalomas are scarce. Thus, we evaluated the diagnostic accuracy of delayed wash-out CT and determined thresholds to accurately differentiate adrenal masses.
designRetrospective, single-center cohort study including 216 patients with 252 adrenal lesions who underwent delayed wash-out CT. Definitive diagnoses based on histopathology (n = 92) or comprehensive follow-up.
methodsSize, average attenuation values of the adrenal lesions in all CT scan phases, and absolute and relative percentage wash-out (APW/RPW) were determined by an expert radiologist blinded for clinical data. Adrenal lesions with unenhanced attenuation values >10 Hounsfield units (HU) built a subgroup (n = 142). Diagnostic accuracy was calculated.
resultsThe study group consisted of 171 adenomas, 32 other benign tumors, 11 pheochromocytomas, 9 adrenocortical carcinomas, and 29 other malignant tumors. All (potentially) malignant and 46% of benign lesions showed unenhanced attenuation values >10 HU. In this most relevant subgroup, the established thresholds of 60% for APW and 40% for RPW misclassified 35.9 and 35.2% of the masses, respectively. When we applied optimized cutoffs (APW >83%; RPW >58%) and excluded pheochromocytomas, we missed only one malignant tumor by APW and none by RPW. However, only 11 and 15% of the benign tumors were correctly identified.
conclusionsWash-out CT with the established thresholds for APW and RPW is insufficient to reliably diagnose adrenal masses. Using the proposed cutoff of 58% for RPW, malignant tumors will be correctly identified, but the added value is limited, namely 15% of patients with benign tumors can be prevented from additional imaging or even unnecessary surgery.
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