Diagnostic value of pre-operative imaging for pheochromocytoma
Keywords:
Pheochromocytoma, pre-operative imaging, adrenalectomyAbstract
Objective: This study aims to investigate the predictive value of preoperative imaging findings for pathological outcomes by comparing preoperative imaging findings with pathological results.
Material and Method: From 2006-2018, 58 adrenal PCC patients underwent adrenalectomy at King Chulalongkorn Memorial Hospital (KCMH). Patients were divided into PCC and non-PCC groups by pathological results. Preoperative imaging (CT and/or MRI) was retrospectively reviewed by a uro-radiologist who classified patients into imaging suggested PPC (group 1) and imaging non-suggested PCC
(group 2). Imaging criteria for suggested PCC in this study were defined as 1. hypervascularity on CECT scan: detected focus of high attenuation more than 140 HU on portovenous phase; 2. high SI on T2W as compared to adjacent renal cortex SI and 3. hypervascularity mass with uptake MIBG scan. Diagnostic value of preoperative imaging for PCC diagnosis was reported in sensitivity, specificity, PPV, NPV, and ROC area.
Result: Forty-six patients (79%) were PCC and 12 patients (21%) were non-PCC. According to imaging findings, 38 patients (66%) were group 1 and 20 patients (34%) were group 2. In group 2, 8 patients were PCC and 12 patients were non-PCC. Sensitivity of preoperative imaging to the diagnosis of PCC was 82.6% (95% CI, 0.68-0.92), specificity was 100% (95% CI, 0.73-1.0), PPV was 100% (95% CI, 0.9-1.0), NPV was 60% (95% CI, 0.36-0.8) and ROC area was 0.91% (95% CI, 0.86-0.9).
Conclusion: Preoperative imaging with a new threshold of HU offers excellent specificity and PPV to detect PCC.
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