18F-FDG-PET/CT Evaluation of Indeterminate Adrenal Masses in Noncancer Patients

J Clin Endocrinol Metab. 2021 Apr 23;106(5):1448-1459. doi: 10.1210/clinem/dgab005.


Context: Adrenal tumors in noncancer patients are common.

Objective: Evaluate performance of 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG-PET/CT) in distinguishing between benign and malignant adrenal tumors.

Design: Retrospective chart review 2010-2019.

Setting: Academic institution.

Patients: One hundred and seventeen noncancer patients, defined as having no history of cancer or with cancer in remission for ≥5 years, completed 18F-FDG-PET/CT to evaluate adrenal masses, with pathologic diagnoses or imaging follow-up (≥12 months).

Intervention: 18F-FDG-PET/CT of 117 indeterminate adrenal masses.

Main outcome measures: Receiver operator characteristic curve of the ratios of adrenal lesion standardized uptake value (SUV)max to liver SUVmean and of adrenal lesion SUVmax to aortic arch blood pool SUVmean were constructed.

Results: Seventy benign and 47 malignant masses (35 adrenocortical carcinomas [ACCs], 12 adrenal metastases) were identified. Malignant masses had higher median liver SUV and blood pool SUV ratios than benign masses (6.2 and 7.4 vs 1.4 and 2.0, P < .001). Median liver and blood pool SUV ratios of ACC (6.1 and 7.3, respectively) and metastases (6.7 and 7.7, respectively) were higher than those of than adenomas (1.4 and 2.2, P < .05 for all comparisons). Optimal liver SUV ratio to discern between benign and malignant masses was 2.5, yielding 85% sensitivity, 90% specificity, and 7 false negative results (including 3 ACCs). Optimal blood pool SUV ratio was 3.4, yielding 83% sensitivity, 90% specificity, and 8 false negative results (including 4 ACCs).

Conclusion: When used in conjunction with other clinical assessments, 18F-FDG-PET/CT can be a valuable tool in evaluating adrenal masses in noncancer patients.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adrenal Gland Neoplasms / diagnosis*
  • Adrenal Gland Neoplasms / pathology
  • Adrenal Glands / diagnostic imaging*
  • Adrenal Glands / pathology
  • Adult
  • Aged
  • Cohort Studies
  • Diagnosis, Differential
  • Early Detection of Cancer / methods
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Male
  • Middle Aged
  • Positron Emission Tomography Computed Tomography / methods*
  • Retrospective Studies
  • United States


  • Fluorodeoxyglucose F18