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Total lesion glycolysis as the best 18F-FDG PET/CT parameter in differentiating intermediatehigh risk adrenal incidentaloma

Kim, Yong-ila,b,d; Cheon, Gi Jeonga,b,c; Paeng, Jin Chula; Cho, Jeong Yeonc,e; Kang, Keon Wooka,b,c; Chung, June-Keya,b,c; Kim, Euishin Edmundd,f; Lee, Dong Sooa,d

Nuclear Medicine Communications: June 2014 - Volume 35 - Issue 6 - p 606–612
doi: 10.1097/MNM.0000000000000101
Original Articles

Objective: Characterization of intermediate–high risk adrenal incidentaloma (AI) is important because biopsy or surgery should be performed to confirm the malignancy. We investigated which parameters of 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) had an additive role in distinguishing malignancies in patients with incidental adrenal masses of intermediate–high risk.

Methods: From January 2008 to July 2013, 52 patients with a pathologically proven diagnosis of AI were retrospectively enrolled (age=56.4±12.7 years, M : F=34 : 18; benign : malignant=14 : 38). Volumetric parameters were size and volume according to combined CT, and metabolic parameters were peak standardized uptake value (SUVpeak), maximum SUV (SUVmax), mean SUV (SUVmean), and tumor-to-background ratio (SUVmax of adrenal mass/SUVmean of liver). Metabolovolumetric parameters of metabolic tumor volume and total lesion glycolysis (TLG, SUVmean×metabolic tumor volume) were also included and compared with the diagnostic value. In addition, the highest diagnostic parameters among volumetric and metabolic parameters were combined and compared in terms of diagnostic accuracy.

Results: Compared with benign adrenal adenoma, malignant lesions showed significantly higher values of all 18F-FDG PET/CT volumetric, metabolic, and metabolovolumetric parameters. Size showed the highest area under the curve (AUC) of 0.759 among the volumetric parameters, and SUVpeak showed the highest AUC of 0.853 among the metabolic parameters. Among all the PET/CT parameters, TLG showed the highest AUC of 0.900, with a sensitivity of 92.1% and specificity of 78.6% at a cutoff of 12.0. The combined value of size and SUVpeak showed lower diagnostic value than TLG.

Conclusion: We found that TLG showed the best result in distinguishing intermediate–high risk AI among PET/CT parameters. TLG can be a useful PET/CT parameter for differential diagnosis of AI.

aDepartment of Nuclear Medicine

bCancer Research Institute

cRadiological Science Research Institute, Seoul National University College of Medicine

dDepartment of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University

eDepartment of Radiology, Seoul National University Hospital, Seoul, Korea

fDepartment of Radiological Sciences, University of California, Irvine, California, USA

Correspondence to Gi Jeong Cheon, MD, Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongong-dong, Chongno-gu, Seoul 110-744, Korea Tel: +82 2 2072 3386; fax: +82 2 745 7690; e-mail:

Received February 6, 2014

Accepted February 9, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins