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Staging and Follow-up of Adrenal Cancer
Variant: 1
Adult. Known or suspected adrenocortical carcinoma. Initial staging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI abdomen and pelvis without and with IV contrast | Usually Appropriate | O |
| CT abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| FDG-PET/MRI skull base to mid-thigh | Usually Appropriate | ☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Appropriate | ☢☢☢☢ |
| Radiography chest | Usually Not Appropriate | ☢ |
| MRI abdomen and pelvis without IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without IV contrast | Usually Not Appropriate | ☢☢☢ |
| DOTATATE PET/CT skull base to mid-thigh | Usually Not Appropriate | ☢☢☢ |
| DOTATATE PET/MRI skull base to mid-thigh | Usually Not Appropriate | ☢☢☢ |
| MIBG scan whole body | Usually Not Appropriate | ☢☢☢ |
| MIBG scan whole body with SPECT or SPECT/CT area of interest | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 2
Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI abdomen and pelvis without and with IV contrast | Usually Appropriate | O |
| CT abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| FDG-PET/MRI skull base to mid-thigh | Usually Appropriate | ☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | Usually Appropriate | ☢☢☢☢ |
| CT chest without IV contrast | May Be Appropriate | ☢☢☢ |
| Radiography chest | Usually Not Appropriate | ☢ |
| MRI abdomen and pelvis without IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| DOTATATE PET/CT skull base to mid-thigh | Usually Not Appropriate | ☢☢☢ |
| DOTATATE PET/MRI skull base to mid-thigh | Usually Not Appropriate | ☢☢☢ |
| MIBG scan whole body | Usually Not Appropriate | ☢☢☢ |
| MIBG scan whole body with SPECT or SPECT/CT area of interest | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 3
Adult. Known or suspected pheochromocytoma. Initial staging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI abdomen and pelvis without and with IV contrast | Usually Appropriate | O |
| CT abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| DOTATATE PET/CT skull base to mid-thigh | Usually Appropriate | ☢☢☢ |
| DOTATATE PET/MRI skull base to mid-thigh | Usually Appropriate | ☢☢☢ |
| MIBG scan whole body with SPECT or SPECT/CT area of interest | Usually Appropriate | ☢☢☢ |
| FDG-PET/MRI skull base to mid-thigh | May Be Appropriate | ☢☢☢ |
| MIBG scan whole body | May Be Appropriate | ☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | May Be Appropriate | ☢☢☢☢ |
| Radiography chest | Usually Not Appropriate | ☢ |
| MRI abdomen and pelvis without IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Variant: 4
Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
| Procedure | Appropriateness Category | Relative Radiation Level |
| MRI abdomen and pelvis without and with IV contrast | Usually Appropriate | O |
| CT abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢ |
| CT chest with IV contrast | Usually Appropriate | ☢☢☢ |
| DOTATATE PET/CT skull base to mid-thigh | Usually Appropriate | ☢☢☢ |
| DOTATATE PET/MRI skull base to mid-thigh | Usually Appropriate | ☢☢☢ |
| FDG-PET/MRI skull base to mid-thigh | May Be Appropriate (Disagreement) | ☢☢☢ |
| MIBG scan whole body | May Be Appropriate | ☢☢☢ |
| MIBG scan whole body with SPECT or SPECT/CT area of interest | May Be Appropriate (Disagreement) | ☢☢☢ |
| FDG-PET/CT skull base to mid-thigh | May Be Appropriate | ☢☢☢☢ |
| Radiography chest | Usually Not Appropriate | ☢ |
| MRI abdomen and pelvis without IV contrast | Usually Not Appropriate | O |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Panel Members
Silvia D. Chang, MDa, Cassandra Jeavons, MDb, Gary A. Ulaner, MD, PhDc, Andrei S. Purysko, MDd, Melanie P. Caserta, MDe, Tara M. Catanzano, BCh, MBf, Alberto Diaz De Leon, MDg, Susie Q. Lew, MDh, Refky Nicola, DO, MSci, Nitya Raj, MDj, Tamer Refaat, MD, PhD, MSk, Benjamin T. Ristau, MD, MHAl, David Schultz, MDm, Carmen C. Solórzano, MDn, Venkateswar R. Surabhi, MDo, Myles T. Taffel, MDp, Gaurav Khatri, MDq
Summary of Literature Review
Introduction/Background
Discussion of Procedures by Variant
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
A. CT Abdomen and Pelvis With IV Contrast
A. CT Abdomen and Pelvis With IV Contrast
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
B. CT Abdomen and Pelvis Without and With IV Contrast
B. CT Abdomen and Pelvis Without and With IV Contrast
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
C. CT Abdomen and Pelvis Without IV Contrast
C. CT Abdomen and Pelvis Without IV Contrast
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
D. CT Chest With IV Contrast
D. CT Chest With IV Contrast
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
E. CT Chest Without and With IV Contrast
E. CT Chest Without and With IV Contrast
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
F. CT Chest Without IV Contrast
F. CT Chest Without IV Contrast
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
G. DOTATATE PET/CT Skull Base to Mid-Thigh
G. DOTATATE PET/CT Skull Base to Mid-Thigh
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
H. DOTATATE PET/MRI Skull Base to Mid-Thigh
H. DOTATATE PET/MRI Skull Base to Mid-Thigh
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
I. FDG-PET/CT Skull Base to Mid-Thigh
I. FDG-PET/CT Skull Base to Mid-Thigh
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
J. FDG-PET/MRI Skull Base to Mid-Thigh
J. FDG-PET/MRI Skull Base to Mid-Thigh
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
K. MIBG Scan Whole Body
K. MIBG Scan Whole Body
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
L. MIBG Scan Whole Body With SPECT Or SPECT/CT Area Of Interest
L. MIBG Scan Whole Body With SPECT Or SPECT/CT Area Of Interest
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
M. MRI Abdomen and Pelvis Without and With IV Contrast
M. MRI Abdomen and Pelvis Without and With IV Contrast
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
N. MRI Abdomen and Pelvis Without IV Contrast
N. MRI Abdomen and Pelvis Without IV Contrast
Variant 1: Adult. Known or suspected adrenocortical carcinoma. Initial staging.
O. Radiography Chest
O. Radiography Chest
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
A. CT Abdomen and Pelvis With IV Contrast
A. CT Abdomen and Pelvis With IV Contrast
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
B. CT Abdomen and Pelvis Without and With IV Contrast
B. CT Abdomen and Pelvis Without and With IV Contrast
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
C. CT Abdomen and Pelvis Without IV Contrast
C. CT Abdomen and Pelvis Without IV Contrast
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
D. CT Chest With IV Contrast
D. CT Chest With IV Contrast
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
E. CT Chest Without and With IV Contrast
E. CT Chest Without and With IV Contrast
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
F. CT Chest Without IV Contrast
F. CT Chest Without IV Contrast
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
G. DOTATATE PET/CT Skull Base to Mid-Thigh
G. DOTATATE PET/CT Skull Base to Mid-Thigh
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
H. DOTATATE PET/MRI Skull Base to Mid-Thigh
H. DOTATATE PET/MRI Skull Base to Mid-Thigh
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
I. FDG-PET/CT Skull Base to Mid-Thigh
I. FDG-PET/CT Skull Base to Mid-Thigh
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
J. FDG-PET/MRI Skull Base to Mid-Thigh
J. FDG-PET/MRI Skull Base to Mid-Thigh
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
K. MIBG Scan Whole Body
K. MIBG Scan Whole Body
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
L. MIBG Scan Whole Body With SPECT Or SPECT/CT Area Of Interest
L. MIBG Scan Whole Body With SPECT Or SPECT/CT Area Of Interest
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
M. MRI Abdomen and Pelvis Without and With IV Contrast
M. MRI Abdomen and Pelvis Without and With IV Contrast
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
N. MRI Abdomen and Pelvis Without IV Contrast
N. MRI Abdomen and Pelvis Without IV Contrast
Variant 2: Adult. Known or suspected adrenocortical carcinoma. Restaging or surveillance.
O. Radiography Chest
O. Radiography Chest
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
A. CT Abdomen and Pelvis With IV Contrast
A. CT Abdomen and Pelvis With IV Contrast
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
B. CT Abdomen and Pelvis Without and With IV Contrast
B. CT Abdomen and Pelvis Without and With IV Contrast
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
C. CT Abdomen and Pelvis Without IV Contrast
C. CT Abdomen and Pelvis Without IV Contrast
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
D. CT Chest With IV Contrast
D. CT Chest With IV Contrast
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
E. CT Chest Without and With IV Contrast
E. CT Chest Without and With IV Contrast
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
F. CT Chest Without IV Contrast
F. CT Chest Without IV Contrast
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
G. DOTATATE PET/CT Skull Base to Mid-Thigh
G. DOTATATE PET/CT Skull Base to Mid-Thigh
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
H. DOTATATE PET/MRI Skull Base to Mid-Thigh
H. DOTATATE PET/MRI Skull Base to Mid-Thigh
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
I. FDG-PET/CT Skull Base to Mid-Thigh
I. FDG-PET/CT Skull Base to Mid-Thigh
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
J. FDG-PET/MRI Skull Base to Mid-Thigh
J. FDG-PET/MRI Skull Base to Mid-Thigh
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
K. MIBG Scan Whole Body
K. MIBG Scan Whole Body
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
L. MIBG Scan Whole Body with SPECT Or SPECT/CT Area Of Interest
L. MIBG Scan Whole Body with SPECT Or SPECT/CT Area Of Interest
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
M. MRI Abdomen and Pelvis Without and With IV Contrast
M. MRI Abdomen and Pelvis Without and With IV Contrast
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
N. MRI Abdomen and Pelvis Without IV Contrast
N. MRI Abdomen and Pelvis Without IV Contrast
Variant 3: Adult. Known or suspected pheochromocytoma. Initial staging.
O. Radiography Chest
O. Radiography Chest
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
A. CT Abdomen and Pelvis With IV Contrast
A. CT Abdomen and Pelvis With IV Contrast
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
B. CT Abdomen and Pelvis Without and With IV Contrast
B. CT Abdomen and Pelvis Without and With IV Contrast
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
C. CT Abdomen and Pelvis Without IV Contrast
C. CT Abdomen and Pelvis Without IV Contrast
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
D. CT Chest With IV Contrast
D. CT Chest With IV Contrast
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
E. CT Chest Without and With IV Contrast
E. CT Chest Without and With IV Contrast
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
F. CT Chest Without IV Contrast
F. CT Chest Without IV Contrast
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
G. DOTATATE PET/CT Skull Base to Mid-Thigh
G. DOTATATE PET/CT Skull Base to Mid-Thigh
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
H. DOTATATE PET/MRI Skull Base to Mid-Thigh
H. DOTATATE PET/MRI Skull Base to Mid-Thigh
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
I. FDG-PET/CT Skull Base to Mid-Thigh
I. FDG-PET/CT Skull Base to Mid-Thigh
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
J. FDG-PET/MRI Skull Base to Mid-Thigh
J. FDG-PET/MRI Skull Base to Mid-Thigh
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
K. MIBG Scan Whole Body
K. MIBG Scan Whole Body
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
L. MIBG Scan Whole Body With SPECT Or SPECT/CT Area Of Interest
L. MIBG Scan Whole Body With SPECT Or SPECT/CT Area Of Interest
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
M. MRI Abdomen and Pelvis Without and With IV Contrast
M. MRI Abdomen and Pelvis Without and With IV Contrast
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
N. MRI Abdomen and Pelvis Without IV Contrast
N. MRI Abdomen and Pelvis Without IV Contrast
Variant 4: Adult. Known or suspected pheochromocytoma. Restaging or surveillance.
O. Radiography Chest
O. Radiography Chest
Summary of Highlights
Supporting Documents
The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.
For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.
Gender Equality and Inclusivity Clause
The ACR acknowledges the limitations in applying inclusive language when citing research studies that predates the use of the current understanding of language inclusive of diversity in sex, intersex, gender, and gender-diverse people. The data variables regarding sex and gender used in the cited literature will not be changed. However, this guideline will use the terminology and definitions as proposed by the National Institutes of Health.
Appropriateness Category Names and Definitions
|
Appropriateness Category Name |
Appropriateness Rating |
Appropriateness Category Definition |
|
Usually Appropriate |
7, 8, or 9 |
The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients. |
|
May Be Appropriate |
4, 5, or 6 |
The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal. |
|
May Be Appropriate (Disagreement) |
5 |
The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned. |
|
Usually Not Appropriate |
1, 2, or 3 |
The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable. |
Relative Radiation Level Information
Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria® Radiation Dose Assessment Introduction document.
|
Relative Radiation Level Designations |
||
|
Relative Radiation Level* |
Adult Effective Dose Estimate Range |
Pediatric Effective Dose Estimate Range |
|
O |
0 mSv |
0 mSv |
|
☢ |
<0.1 mSv |
<0.03 mSv |
|
☢☢ |
0.1-1 mSv |
0.03-0.3 mSv |
|
☢☢☢ |
1-10 mSv |
0.3-3 mSv |
|
☢☢☢☢ |
10-30 mSv |
3-10 mSv |
|
☢☢☢☢☢ |
30-100 mSv |
10-30 mSv |
|
*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.” |
||
References
| 1. | Kebebew E, Reiff E, Duh QY, Clark OH, McMillan A. Extent of disease at presentation and outcome for adrenocortical carcinoma: have we made progress? World J Surg 2006;30:872-8. | |
| 2. | Kerkhofs TM, Verhoeven RH, Van der Zwan JM, et al. Adrenocortical carcinoma: a population-based study on incidence and survival in the Netherlands since 1993. Eur J Cancer 2013;49:2579-86. | |
| 3. | Wolf KI, Rose-Krasnor L, Alband S, Lenders JWM, Fishbein L. Patient-reported burden associated with pheochromocytoma/paraganglioma diagnosis. Endocr Relat Cancer 2024;31. | |
| 4. | Ayala-Ramirez M, Jasim S, Feng L, et al. Adrenocortical carcinoma: clinical outcomes and prognosis of 330 patients at a tertiary care center. Eur J Endocrinol 2013;169:891-99. | |
| 5. | Tella SH, Kommalapati A, Yaturu S, Kebebew E. Predictors of Survival in Adrenocortical Carcinoma: An Analysis From the National Cancer Database. Journal of Clinical Endocrinology & Metabolism. 103(9):3566-3573, 2018 09 01. | |
| 6. | Ichijo T, Ueshiba H, Nawata H, Yanase T. A nationwide survey of adrenal incidentalomas in Japan: the first report of clinical and epidemiological features. Endocr J. 67(2):141-152, 2020 Feb 28. | |
| 7. | Aggarwal S, Prete A, Chortis V, et al. Pheochromocytomas Most Commonly Present As Adrenal Incidentalomas: A Large Tertiary Center Experience. J Clin Endocrinol Metab 2023;109:e389-e96. | |
| 8. | Jimenez C, Ma J, Roman Gonzalez A, et al. TNM Staging and Overall Survival in Patients With Pheochromocytoma and Sympathetic Paraganglioma. Journal of Clinical Endocrinology & Metabolism. 108(5):1132-1142, 2023 04 13. | |
| 9. | Taïeb D, Hicks RJ, Hindié E, et al. European Association of Nuclear Medicine Practice Guideline/Society of Nuclear Medicine and Molecular Imaging Procedure Standard 2019 for radionuclide imaging of phaeochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging. 2019 Sep;46(10):2112-2137. | |
| 10. | Fassnacht M, Dekkers OM, Else T, et al. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. European Journal of Endocrinology. 179(4):G1-G46, 2018 10 01. | |
| 11. | NCCN Clinical Practice Guidelines in Oncology. Neuroendocrine and Adrenal Tumors. Version 1.2025. Available at: https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf. | |
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| 13. | Mody RN, Remer EM, Nikolaidis P, et al. ACR Appropriateness Criteria R Adrenal Mass Evaluation: 2021 Update. [Review]. J. Am. Coll. Radiol.. 18(11S):S251-S267, 2021 11. | |
| 14. | Angeli A, Osella G, Ali A, Terzolo M. Adrenal incidentaloma: an overview of clinical and epidemiological data from the National Italian Study Group. Horm Res. 1997; 47(4-6):279-283. | |
| 15. | Kedra A, Dohan A, Gaujoux S, et al. Preoperative Detection of Liver Involvement by Right-Sided Adrenocortical Carcinoma Using CT and MRI. Cancers. 13(7): 1603 2021 Mar 31. | |
| 16. | Ranathunga DS, Cherpak LA, Schieda N, Flood TA, McInnes MDF. Macroscopic Fat in Adrenocortical Carcinoma: A Systematic Review. AJR Am J Roentgenol. 214(2):390-394, 2020 02. | |
| 17. | Libe R, Haissaguerre M, Renaudin K, et al. [Guidelines of the French National ENDOCAN-COMETE, Association of Endocrine Surgery, Society of Urology for the management of adrenocortical carcinoma]. [French]. Bulletin du Cancer. 110(6):707-730, 2023 Jun. | |
| 18. | Krishnaraju VS, Kumar R, Subramanian K, et al. Fluoro-2-Deoxyglucose-Positron Emission Tomography/Computed Tomography in the Diagnosis and Management of Adrenocortical Carcinoma: A 10-Year Experience from a Tertiary Care Institute. Indian Journal of Nuclear Medicine. 37(3):227-235, 2022 Jul-Sep. | |
| 19. | Takeuchi S, Balachandran A, Habra MA, et al. Impact of (1)(8)F-FDG PET/CT on the management of adrenocortical carcinoma: analysis of 106 patients. Eur J Nucl Med Mol Imaging 2014;41:2066-73. | |
| 20. | Leboulleux S, Dromain C, Bonniaud G, et al. Diagnostic and prognostic value of 18-fluorodeoxyglucose positron emission tomography in adrenocortical carcinoma: a prospective comparison with computed tomography. J Clin Endocrinol Metab 2006;91:920-5. | |
| 21. | Jha A, Patel M, Carrasquillo JA, et al. Sporadic Primary Pheochromocytoma: A Prospective Intraindividual Comparison of Six Imaging Tests (CT, MRI, and PET/CT Using 68Ga-DOTATATE, FDG, 18F-FDOPA, and 18F-FDA). AJR. American Journal of Roentgenology. 218(2):342-350, 2022 02. | |
| 22. | van Berkel A, Pacak K, Lenders JW. Should every patient diagnosed with a phaeochromocytoma have a (1)(2)(3) I-MIBG scintigraphy? Clin Endocrinol (Oxf) 2014;81:329-33. | |
| 23. | Archier A, Varoquaux A, Garrigue P, et al. Prospective comparison of (68)Ga-DOTATATE and (18)F-FDOPA PET/CT in patients with various pheochromocytomas and paragangliomas with emphasis on sporadic cases. Eur J Nucl Med Mol Imaging. 43(7):1248-57, 2016 Jul. | |
| 24. | Xu S, Pan Y, Zhou J, Ju H, Zhang Y. Integrated PET/MRI With 68Ga-DOTATATE and 18F-FDG in Pheochromocytomas and Paragangliomas: An Initial Study. Clin Nucl Med. 47(4):299-304, 2022 Apr 01. | |
| 25. | Cantalamessa A, Caobelli F, Paghera B, Caobelli A, Vavassori F. Role of (18)F-FDG PET/CT, (123)I-MIBG SPECT, and CT in Restaging Patients Affected by Malignant Pheochromocytoma. Nucl Med Mol Imaging 2011;45:125-31. | |
| 26. | Measuring Sex, Gender Identity, and Sexual Orientation. | |
| 27. | American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. |
Disclaimer
| The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination. |