This work is licensed under a Table 3.
Test performance according to clinical pathway. Studies focusing on truly incidentally discovered adrenal masses (incidentaloma pathway) vs studies on adrenal masses discovered during follow-up monitoring for extra-adrenal malignancy (follow-up from previous malignancy pathway).
| ≥ 50%* | ≥90%** | |||||
|---|---|---|---|---|---|---|
| Studies (n/N) | Sensitivity (95% CI) | Specificity (95% CI) | Studies (n/N) | Sensitivity (95% CI) | Specificity (95% CI) | |
| Incidentaloma pathway | ||||||
| CT non–contrast tumor density (>10HU) | 2 (41/102) | 100% (91–100%) | 72% (60–82%) | 1 (13/52) | 100% (75–100%) | 72% (55–85%) |
| CT contrast enhanced washout (combination at 10min) | 1 (14/25) | 93% (68–100%) | 100% (69–100%) | 0 | – | – |
| CT contrast enhanced washout (combination at 15min) | 1 (13/25) | 100% (75–100%) | 92% (62–100%) | 0 | – | |
| MRI adrenal-liver ratio (1.5Tesla only) | 1 (8/26) | 100% (63–100%) | 44% (22–69%) | 0 | – | – |
| MRI adrenal-spleen ratio (1.5Tesla only) | 1 (12/49) | 58% (28–85%) | 86% (71–95%) | 0 | – | – |
| MRI loss of signal intensity (1.5Tesla only) | 2 (20/75) | 86% (31–99%) | 85% (73–93%) | 0 | – | – |
| PET ALR SUVmax | 2 (15/64) | 100% (78–100%) | 96% (57–100%) | 1 (12/41) | 100% (74–100%) | 100% (88–100%) |
| PET SUVmax | 2 (15/64) | 93% (65–99%) | 73% (59–84%) | 1 (12/41) | 92% (62–100%) | 72% (53–87%) |
| Follow-up from previous malignancy pathway | ||||||
| CT non–contrast tumor density (>10HU) | 5 (93/168) | 93% (79–98%) | 71% (38–91%) | 5 (93/168) | 93% (79–98%) | 71% (38–91%) |
| CT contrast enhanced washout (absolute at 15min) | 1 (19/40) | 16% (3–40%) | 86% (64–97%) | 1 (19/40) | 16% (3–40%) | 86% (64–97%) |
| CT contrast enhanced washout (relative at 15min) | 1 (19/40) | 16% (3–40%) | 95% (76–100%) | 1 (19/40) | 16% (3–40%) | 95% (76–100%) |
| MRI adrenal-liver ratio (1.5Tesla only) | 3 (37/129) | 89% (74–96%) | 60% (21–89%) | 2 (27/93) | 92% (55–99%) | 39% (21–60%) |
| MRI adrenal-spleen ratio (1.5Tesla only) | 3 (52/142) | 99% (69–100%) | 84% (72–91%) | 2 (42/105) | 100% (92–100%) | 79% (68–88%) |
| MRI adrenal-muscle ratio (1.5Tesla only) | 1 (10/37) | 90% (55–100%) | 93% (76–99%) | 0 | – | – |
| MRI loss of signal intensity (1.5Tesla only) | 1 (10/37) | 90% (55–100%) | 85% (66–96%) | 0 | – | – |
| PET ALR SUVmax | 2 (45/117) | 82% (41–97%) | 96% (76–99%) | 1 (34/102) | 94% (80–99%) | 94% (86–98%) |
| PET SUVmax | 3 (72/156) | 84% (62–94%) | 90% (71–97%) | 2 (61/141) | 90% (80–96%) | 87% (78–93%) |
ALR SUVmax, ratio of SUVmax in the adrenal gland compared with the liver; HU, Hounsfield units; n, number of cases; N, total population; PET, positron emission tomography; SUVmax, maximum standardized uptake value.
refers to ≥50% with incidentaloma in studies in the incidentaloma pathway and ≥50% with current or prior non-adrenal malignancy in the follow-up from previous malignancy pathway; **refers to ≥90% with incidentaloma in studies in the incidentaloma pathway and ≥90% with current or prior non-adrenal malignancy in the follow-up from previous malignancy pathway.