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Contrast-Enhanced Sonography of Adrenal Masses: Differentiation of Adenomas and Nonadenomatous Lesions

¹ Medizinische Klinik I, Klinikum der Johann Wolfgang Goethe Universität, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
² Department of Radiology, Saarland University Hospital, Homburg, Germany.
³ Department of Pathology, Saarland University Hospital, Homburg, Germany.
⁴ Faculty of Medicine, Internal Medicine–Biomathematics, Saarland University, Homburg, Germany.

OBJECTIVE. The aim of this proof-of-principle study was to evaluate contrast-enhanced sonography in the characterization of adrenal masses.

SUBJECTS AND METHODS. Thirty-five consecutively registered patients with newly detected adrenal masses underwent hormonal evaluation and duplex and Doppler sonography followed by contrast-enhanced sonography and CT or MRI. The dynamics of contrast enhancement were analyzed with time–intensity curves. CT and MRI were used as the reference methods for the diagnosis of adenoma and myelolipoma. Metastasis was diagnosed with fine-needle biopsy, and all other adrenal masses were diagnosed at adrenalectomy. Fisher's exact test was used to evaluate the criteria for diagnosis of malignant adrenal masses.

RESULTS. Size greater than 4 cm and hypervascularization were found significantly more often in malignant than in benign lesions (71% vs 21% for size; 57% vs 7% for hypervascularization). At contrast-enhanced sonography, early arterial or arterial contrast enhancement and rapid washout were seen in all patients with primary or secondary malignant lesions of the adrenal gland and in only 22% of patients with benign adrenal masses (p < 0.05). All primary malignant lesions were confirmed at histologic examination. In 32 of 35 patients (91%), findings at CT or MRI were congruent with those at contrast-enhanced sonography in regard to characterization of adenoma versus nonadenomatous lesion (p < 0.001). In two of the 35 cases, however, all imaging methods favored the diagnosis of nonadenomatous lesion, but the histologic result after adrenalectomy was adrenal adenoma. The sensitivity and specificity of contrast-enhanced sonography in the diagnosis of malignant adrenal mass were 100% and 82%.

CONCLUSION. Contrast-enhanced sonography can be used to differentiate adenomas and nonadenomatous lesions with a sensitivity comparable with that of CT and MRI and may be a cost-effective method for preselection of patients with adrenal masses.

Keywords: adenoma • adrenal gland • contrast-enhanced sonography • incidentaloma • nonadenomatous • sonography

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