Indian Journal of Nuclear Medicine
Home | About IJNM | Search | Current Issue | Past Issues | Instructions | Ahead of Print | Online submissionLogin 
Indian Journal of Nuclear Medicine
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 125 Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents     
LETTER TO THE EDITOR
Year : 2017  |  Volume : 32  |  Issue : 1  |  Page : 83-84  

Intense 18F-Fluoro-deoxyglucose uptake in benign adrenal nodule


Division of Clinical PET, Institute of Nuclear Medicine and Allied Sciences, Timarpur, New Delhi, India

Date of Web Publication17-Jan-2017

Correspondence Address:
Taruna Goel
Division of Clinical PET, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Mazumdar Road, Timarpur, Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.198515

Rights and Permissions

How to cite this article:
Goel T, D'souza MM, Haldar A, Ezung SE, Sharma R. Intense 18F-Fluoro-deoxyglucose uptake in benign adrenal nodule. Indian J Nucl Med 2017;32:83-4

How to cite this URL:
Goel T, D'souza MM, Haldar A, Ezung SE, Sharma R. Intense 18F-Fluoro-deoxyglucose uptake in benign adrenal nodule. Indian J Nucl Med [serial online] 2017 [cited 2019 Dec 5];32:83-4. Available from: http://www.ijnm.in/text.asp?2017/32/1/83/198515

Sir,

Adrenal mass is a clinical entity which can occur in 1–5%[1] of adult patients. A critical question to answer is whether it is benign or malignant. Small tumor size and anatomical imaging characteristics based on their lipid content such as unenhanced computed tomography (CT) attenuation <10 Hounsfield units (HU) and decrease in intensity of signal on out-of-phase magnetic resonance imaging are highly predictive of the benign nature of an adrenal mass. However, a fair number of patients in clinical practice can have adrenal tumors with conflicting clinical and imaging features such as small tumor size and high CT attenuation. 18 F-fluoro-deoxyglucose-positron emission tomography (18 F-FDG-PET) has been shown to be excellent in differentiating malignant from benign adrenal tumors, with a reported sensitivity and specificity ranging from 92–100% to 80–100%, respectively.[2],[3]

Here, we report a 60-year-old female, follow-up case of Stage IIIa adenocarcinoma of the esophagus who presented to us for PET/CT study. The patient had already received chemotherapy as the primary treatment and did not have any complaint at present.18 F-FDG PET/CT has performed approximately 60 min, following intravenous injection of 370 MBq of 18 F-FDG. PET/CT scan from skull to mid-thigh was acquired in a whole-body full-ring PET/CT scanner (GE Discovery STE16 camera). Incidentally, the left adrenal gland was found to be showing markedly increased FDG uptake (standardized uptake value maximum [SUVmax] - 7.3, CT attenuation - 40 HU) which raised suspicion for possible malignancy. No abnormal FDG uptake was noted elsewhere in the body. Hence, this increased adrenal gland uptake was followed up with a contrast-enhanced computed tomography (CECT) scan and histopathological examination. CECT scan (done elsewhere) revealed a heterogeneously enhancing soft tissue nodule in the left adrenal gland. Histopathological examination showed predominantly benign adrenal cortical cells with no atypia and malignant cells. The patient had undergone repeat PET/CT study 1 year later which showed no significant change in the left adrenal gland tracer uptake (SUVmax - 7.0) as compared to the previous study [Figure 1] and [Figure 2].
Figure 1: Maximum intensity projection image of WB positron emission tomography/computed tomography scan showing increased fluorodeoxyglucose uptake (standardized uptake value maximum - 7.0) in the left suprarenal region with no other abnormal focus of fluorodeoxyglucose uptake elsewhere

Click here to view
Figure 2: Transaxial computed tomography and fused positron emission tomography/computed tomography images showing intense fluorodeoxyglucose uptake in the left adrenal gland

Click here to view


Most of the studies performed for the evaluation of role of FDG-PET in the diagnosis of nature of adrenal lesions have shown FDG-PET to be useful for differentiating between benign and malignant lesions based on the SUV values.[2],[4] An SUV value of more than 3.1[4] or that of liver [2] is considered as cutoff value for the differentiation between benign and malignant lesions.

Although most of the benign lesions show low SUV values, some studies state that one in five lesions showing SUV > 3.1 can be benign.[5] Dong et al.[6] reported that apart from malignant masses, increased FDG uptake can be seen in benign adrenal lesions such as adrenal hyperplasia, functioning adrenal masses, histoplasmosis, tuberculosis, blastomycosis, myelolipoma, ganglioneuroma, and adrenal hemorrhage. In conclusion, any isolated adrenal gland uptake should always be followed up with histopathological examination. Nonfunctioning benign adrenal lesions should be considered a possible false-positive FDG-PET finding for malignancy while evaluating adrenal incidentalomas, even when intense FDG uptake is revealed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Bovio S, Cataldi A, Reimondo G, Sperone P, Novello S, Berruti A, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest 2006;29:298-302.  Back to cited text no. 1
    
2.
Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A.18 F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med 2001;42:1795-9.  Back to cited text no. 2
    
3.
Kumar R, Xiu Y, Yu JQ, Takalkar A, El-Haddad G, Potenta S, et al. 18 F-FDG PET in evaluation of adrenal lesions in patients with lung cancer. J Nucl Med 2004;45:2058-62.  Back to cited text no. 3
    
4.
Metser U, Miller E, Lerman H, Lievshitz G, Avital S, Even-Sapir E.18 F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med 2006;47:32-7.  Back to cited text no. 4
    
5.
Pitts A, Ih G, Wei M, Dhall D, Nissen NN, Waxman A, et al. Clinical utility of FDG-PET for diagnosis of adrenal mass: A large single-center experience. Hormones (Athens) 2013;12:417-27.  Back to cited text no. 5
    
6.
Dong A, Cui Y, Wang Y, Zuo C, Bai Y.18 F-FDG PET/CT of adrenal lesions. AJR Am J Roentgenol 2014;203:245-52.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed537    
    Printed4    
    Emailed0    
    PDF Downloaded65    
    Comments [Add]    

Recommend this journal