Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019, 163(3):212-219

Characteristic CT features of pheochromocytomas - probability model calculation tool based on a multicentric study

Filip Ctvrtlik^a, Zbynek Tudos^a, Paulina Szasz^a, Zuzana Sedlackova^a, Igor Hartmann^b, Jan Schovanek^c, Zdenek Frysak^c, Iva Macova^d, Tomas Zelinka^e, Milan Hora^f, Eva Kocova^g, Jaroslav Pacovsky^h, Michal Krsekⁱ, Viera Lehotska^j, Emilia Mojtova^k, Josef Molnar^l, Vladimir Vanek^l, Karel Pacak^m, Jan Baxaⁿ

^a Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

^b Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

^c Department of Internal Medicine III - Nephrology, Rheumatology, and Endocrinology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

^d Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic

^e Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic

^f Department of Urology, Faculty Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Czech Republic

^g Department of Radiology, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic

^h Department of Urology, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic

ⁱ Second Department of Internal Medicine, Third Faculty of Medicine, Charles University and Royal Vinohrady Teaching Hospital, Prague, Czech Republic

^j Second Radiology Department, Faculty of Medicine, Comenius University in Bratislava and St. Elizabeth Cancer Institute, Bratislava, Slovakia

^k Department of Endocrinology, Slovak Medical University and St. Elizabeth Cancer Institute, Bratislava, Slovakia

^l Department of Algebra and Geometry, Faculty of Science, Palacky University Olomouc, Czech Republic

^m Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

ⁿ Department of Imaging Methods, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Czech Republic

Objectives: The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model.

Methods: This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign").

Results: Pheochromocytomas have a significantly more spherical shape (P<0.001), whereas an elliptical shape significantly reduces the probability of a pheochromocytoma (odds ratio = 0.015), as does another shape (odds ratio = 0.006). A “ring sign” is also more frequent in pheochromocytomas compared to other adrenal tumors (P=0.001, odds ratio = 6.49). A sharp necrosis also increases the probability of a pheochromocytoma more than unsharp necrosis (odds ratio 231.6 vs. 20.2). The probability calculation model created on the basis of the results confirms a high sensitivity and specificity (80% and 95%).

Conclusion: This study confirms the value of anatomical features in the assessment of adrenal masses with the ability to significantly improve the identification of pheochromocytomas. Advanced assessment of the tumor shape was defined and a original comprehensive calculating tool of the pheochromocytoma probability was created on the basis of the results presented here and could be used in clinical routine.

Keywords: helical computed tomography, adrenocortical adenoma, pheochromocytoma, adrenocortical carcinoma, metastasis

Received: July 16, 2019; Revised: September 5, 2019; Accepted: September 9, 2019; Published: September 23, 2019  Show citation