The possibility of computed tomography in differential diagnostics of heterogeneous adenomas and adrenocortical cancer: a cross-sectional study

Introduction: Differential diagnostics of large heterogeneous adenomas presents difficulties due to the heterogeneous structure of the tumor. Of greatest interest is the differential diagnostics of heterogeneous adenomas with adrenocortical carcinoma (ACC).

Objective: Development of CT criteria for differential diagnosis of large heterogeneous adenomas and ACC, assessment of the presence of micro- and macrostructural fat as a sign of a benign process.

Materials and Methods: Retrospectively evaluated preoperative contrast-enhanced CT data in 67 patients with heterogeneous adrenal masses operated with histological verification of adenomas and ACC. The patients were divided into groups: 1 — heterogeneous and high-density adenomas n=40, 2 — ACC n=27. The following CT parameters were assessed: maximum size, contours, micro- and macrostructural fat/calcifications, minimum/maximum density in the native phase, density in the arterial/venous/delayed phases of the most and least dense areas, absolute and relative washout coefficient, presence of necrosis. Statistics: For statistical analysis, the Mann–Whitney test and the c2 test were applied. The diagnostic value of CT parameters was assessed using ROC analysis and logistic regression, with 95% confidence intervals calculated by nonparametric bootstrapping.

Results: When comparing the parameters by groups, it was shown that such parameters as the largest size, minimum density in the native phase, density of the least dense areas in the arterial/venous/delayed phases were lower in the adenoma group than in the ACC group. The presence of micro- and macrostructural fat was characteristic of the adenoma group, and the presence of necrosis was characteristic of the ACC group.

Discussion: The obtained results are consistent with previously published studies and clinical guidelines, refining the threshold values for large heterogeneous tumors, which confirms the feasibility of a comprehensive assessment of structural and densitometric features to improve the accuracy of differential diagnosis in clinical practice.

Conclusions: The above parameters can be used as CT criteria for differential diagnosis of heterogeneous adenomas with ACC.

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