Abstract

DISTINGUISHING BENIGN LESION FROM MALIGNANT ADRENAL MASSES BY CT SCAN WITH 15 MINUTES DELAYED PROTOCOL

Author(s): Mayur N. Patel1, Hitesh Kumar K. Rajpura2, Rajendra N. Solanki3, Hemant Patel4

BACKGROUND Adrenal masses are benign, non-hyper functioning adenoma in most of the cases and classified in lipid-rich or lipid-poor adenomas. After injection of contrast with adrenal protocol and delayed washout CT study can differentiate adenomas from other adrenal neoplastic lesions. The aim of this study was to evaluate the effectiveness of MDCT parameters in distinguishing benign from malignant adrenal masses in cancer patients. MATERIALS AND METHODS This study included 64 patients with adrenal masses and was carried out in the period from January 2017 to November 2017. MDCT protocol included pre-contrast scan, dynamic and delayed contrast-enhanced scans assessing the mass size, pre-contrast CT density, histogram, delayed post contrast scan apart from 15-min delayed washout rate, relative percentage washout (RPW) and absolute percentage washout (APW) value. Sensitivities, specificities, accuracies & p-values were calculated for individual and combined parameters. RESULTS Total 64 adrenal masses were evaluated by using CT attenuation values in pre-contrast, venous and 15 min delayed scans, which showed that 15 min delayed images along with APW/RPW can become useful diagnostic tool in differentiating benign adenomas from malignant adrenal neoplastic adenomas with an accuracy of 98.43%. CONCLUSION In adrenal incidentalomas, 15 minutes delayed washout MDCT is mandatory for final diagnosis. Significant accuracy in differentiating adrenal adenomas at APW P60% AND RPW P40%.