Diagnostic Performance of Hepatic CT and Chemical-shift MRI to Discriminate Lipid-poor Adrenal Adenomas from Hepatocellular Carcinoma Metastases

Overview

Journal Abdom Radiol (NY)

Publisher Springer

Specialties Gastroenterology
Radiology

Date 2024 Mar 8

PMID 38456897

Authors

Yasunori Nagayama

Hidetaka Hayashi

Narumi Taguchi

Ryuya Yoshida

Ryota Harai

Masafumi Kidoh

Seitaro Oda

Takeshi Nakaura

Toshinori Hirai

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the diagnostic performance of multiphase hepatic CT parameters (non-contrast attenuation, absolute and relative washout ratios [APW and RPW, respectively], and relative enhancement ratio [RER]) and chemical-shift MRI (CS-MRI) for discriminating lipid-poor adrenal adenomas (with non-contrast CT attenuation > 10 HU) from metastases in patients with hepatocellular carcinoma (HCC).

Methods: This retrospective study included HCC patients with lipid-poor adrenal lesions who underwent multiphase hepatic CT between January 2010 and December 2021. For each adrenal lesion, non-contrast attenuation, APW, RPW, RER, and signal-intensity index (SI-index) were measured. Each parameter was compared between adenomas and metastases. The area under the receiver operating characteristic curves (AUCs) and sensitivities to achieve 100% specificity for adenoma diagnoses were determined.

Results: 104 HCC patients (78 men; mean age, 71.8 ± 9.6 years) with 63 adenomas and 48 metastases were identified; CS-MRI was performed in 66 patients with 49 adenomas and 21 metastases within one year of CT. Lipid-poor adenomas showed lower non-contrast attenuation (22.9 ± 7.1 vs. 37.9 ± 9.4 HU) and higher APW (40.5% ± 12.8% vs. 23.7% ± 17.4%), RPW (30.0% ± 10.2% vs. 12.4% ± 9.6%), RER (329% ± 152% vs. 111% ± 43.0%), and SI-index (43.3 ± 20.7 vs. 10.8 ± 13.4) than HCC metastases (all p < .001). AUC for non-contrast attenuation, APW, RPW, RER, and SI-index were 0.894, 0.786, 0.904, 0.969, and 0.902, respectively. The sensitivities to achieve 100% specificity were 7.9%, 25.4%, 30.2%, 63.5%, and 24.5%, respectively. Combined RER and APW achieved the highest sensitivity of 73.0%.

Conclusion: Multiphase hepatic CT allows for better discrimination between lipid-poor adrenal adenomas and metastases relative to CS-MRI, especially when combined with RER and washout parameters.

References

Villanueva A . Hepatocellular Carcinoma. N Engl J Med. 2019; 380(15):1450-1462. DOI: 10.1056/NEJMra1713263. View

Marrero J, Kulik L, Sirlin C, Zhu A, Finn R, Abecassis M . Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018; 68(2):723-750. DOI: 10.1002/hep.29913. View

Chernyak V, Fowler K, Kamaya A, Kielar A, Elsayes K, Bashir M . Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients. Radiology. 2018; 289(3):816-830. PMC: 6677371. DOI: 10.1148/radiol.2018181494. View

Lee Y, Wang J, Zhu Y, Agopian V, Tseng H, Yang J . Diagnostic Criteria and LI-RADS for Hepatocellular Carcinoma. Clin Liver Dis (Hoboken). 2021; 17(6):409-413. PMC: 8340355. DOI: 10.1002/cld.1075. View

Katyal S, Oliver 3rd J, Peterson M, Ferris J, Carr B, BARON R . Extrahepatic metastases of hepatocellular carcinoma. Radiology. 2000; 216(3):698-703. DOI: 10.1148/radiology.216.3.r00se24698. View

Uchino K, Tateishi R, Shiina S, Kanda M, Masuzaki R, Kondo Y . Hepatocellular carcinoma with extrahepatic metastasis: clinical features and prognostic factors. Cancer. 2011; 117(19):4475-83. DOI: 10.1002/cncr.25960. View

Mayo-Smith W, Song J, Boland G, Francis I, Israel G, Mazzaglia P . Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2017; 14(8):1038-1044. DOI: 10.1016/j.jacr.2017.05.001. View

Caoili E, Korobkin M, Francis I, Cohan R, Platt J, Reed Dunnick N . Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology. 2002; 222(3):629-33. DOI: 10.1148/radiol.2223010766. View

Choi Y, Kim C, Park B, Kim B . Evaluation of adrenal metastases from renal cell carcinoma and hepatocellular carcinoma: use of delayed contrast-enhanced CT. Radiology. 2012; 266(2):514-20. DOI: 10.1148/radiol.12120110. View

10.

Haider M, Ghai S, Jhaveri K, Lockwood G . Chemical shift MR imaging of hyperattenuating (>10 HU) adrenal masses: does it still have a role?. Radiology. 2004; 231(3):711-6. DOI: 10.1148/radiol.2313030676. View

11.

Taffel M, Petrocelli R, Rigau D, Schieda N, Al-Rasheed S, Carney B . Prevalence of Malignancy in Adrenal Nodules With Heterogeneous Microscopic Fat on Chemical-Shift MRI: A Multiinstitutional Study. AJR Am J Roentgenol. 2022; 220(1):86-94. DOI: 10.2214/AJR.22.27976. View

12.

Sydow B, Rosen M, Siegelman E . Intracellular lipid within metastatic hepatocellular carcinoma of the adrenal gland: a potential diagnostic pitfall of chemical shift imaging of the adrenal gland. AJR Am J Roentgenol. 2006; 187(5):W550-1. DOI: 10.2214/AJR.06.0506. View

13.

Tariq U, Poder L, Carlson D, Courtier J, Joe B, Coakley F . Multimodality imaging of fat-containing adrenal metastasis from hepatocellular carcinoma. Clin Nucl Med. 2012; 37(6):e157-9. DOI: 10.1097/RLU.0b013e31824439ab. View

14.

Adam S, Nikolaidis P, Horowitz J, Gabriel H, Hammond N, Patel T . Chemical Shift MR Imaging of the Adrenal Gland: Principles, Pitfalls, and Applications. Radiographics. 2016; 36(2):414-32. DOI: 10.1148/rg.2016150139. View

15.

Schieda N, Siegelman E . Update on CT and MRI of Adrenal Nodules. AJR Am J Roentgenol. 2017; 208(6):1206-1217. DOI: 10.2214/AJR.16.17758. View

16.

Elsayes K, Elmohr M, Javadi S, Menias C, Remer E, Morani A . Mimics, pitfalls, and misdiagnoses of adrenal masses on CT and MRI. Abdom Radiol (NY). 2019; 45(4):982-1000. DOI: 10.1007/s00261-019-02082-4. View

17.

Nagayama Y, Inoue T, Kato Y, Tanoue S, Kidoh M, Oda S . Relative Enhancement Ratio of Portal Venous Phase to Unenhanced CT in the Diagnosis of Lipid-poor Adrenal Adenomas. Radiology. 2021; 301(2):360-368. DOI: 10.1148/radiol.2021210231. View

18.

Lee H, Oh Y, Park S . Hyperattenuating adrenal lesions in lung cancer: biphasic CT with unenhanced and 1-min enhanced images reliably predicts benign lesions. Eur Radiol. 2021; 31(8):5948-5958. DOI: 10.1007/s00330-020-07648-1. View

19.

Jin S, Zhang H, Pan W, Yang J, Zhang B, Dong X . Diagnostic value of the relative enhancement ratio of the portal venous phase to unenhanced CT in the identification of lipid-poor adrenal tumors. Abdom Radiol (NY). 2022; 47(9):3308-3317. DOI: 10.1007/s00261-022-03593-3. View

20.

Kim M, Kang K, Kim C, Park S . Inter-method agreement between wash-in and wash-out computed tomography for characterizing hyperattenuating adrenal lesions as adenomas or non-adenomas. Eur Radiol. 2022; 33(3):2218-2226. DOI: 10.1007/s00330-022-09144-0. View