Positron Emission Tomography

Whole body positron emission tomography (PET) with 18-F-fluorodeoxyglucose (18-FDG) allows malignant adrenal lesions to be recognized. The contribution of 18-FDG PET has been well evaluated in large studies in relation to lung cancer, and is highly accurate in differentiating benign non-inflammatory lesions from malignant disease. Using 18-FDG PET, these studies have shown a 100% sensitivity and specificity for the diagnosis of malignant adrenal mass when CT or MRI identify enlarged adrenal glands or a focal mass. Recent studies have reported false positive results as a result of 18-FDG uptake by pheochromocytomas and benign adenomas. For the diagnosis of a malignant adrenal tumour, the positive predictive value of 18-FDG PET was 100% and the negative predictive value (NPV) to rule out malignancy was also 100%. Within these study populations, 18-FDG PET also has the ability to detect metastatic lesions in non-enlarged adrenal glands, but its accuracy in this situation has not been fully evaluated. In addition, 18-FDG PET has the advantage of simultaneously detecting metastases at other sites. However, in some countries, PET is not readily available. Nevertheless, it is a useful tool for evaluating masses that are indeterminate by both CT and MRI. PET can substitute for percutaneous biopsy and has the advantage of being non-invasive and therefore a safer investigation for the patient [25].

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