Should we be using a cut off of 20 rather than the traditional 10 Hounsfield units to distinguish between benign and malignant adrenocortical tumors on imaging?
What HFU cut off do you use to distinguish between benign and malignant adrenocortical tumors on CT imaging?
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A higher CT density cut-off of 20 (even 30 in most cases) may be used to rule out ACC. However, some metastatic lesions can have a non-contrast CT density between 10 and 20 HU.
A combination of a tumor size <4 cm and CT density <20 HU is pretty good in excluding almost all malignant lesions.
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In at least one high-risk population, a HU cutoff of less than 10 has been shown to have a sensitivity of 100% for excluding malignancy and Pheo. Over 10, I do not feel comfortable excluding it based on one imaging study alone, and would be more likely to order imaging followup (or other, more aggressive measures when clinically appropriate).
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