Non-small cell lung carcinoma: Usefulness of unenhanced helical CT of the adrenal glands in an unmonitored environment

PURPOSE: To evaluate routine non-contrast material-enhanced helical computed tomography (CT) of the adrenal glands in patients with non-small cell lung carcinoma to facilitate characterization of adrenal masses detected in an unmonitored environment (ie, the radiologist on duty did not look at the acquired images before the patient left the scanner). MATERIALS AND METHODS: One hundred consecutive patients with non-small cell lung carcinoma were referred for CT evaluation of the chest; chest and abdomen; or chest, abdomen, and brain. All underwent unenhanced CT of the adrenal glands before the requested CT examination. The morphologic features, size, and attenuation values of the adrenal masses were calculated. Attenuation values of adrenal masses from prior imaging, if available, were compared with those at follow- up imaging to classify these masses. Variable unit cost increase in obtaining these additional images was estimated. RESULTS: Fifteen adrenal masses were identified in 13 patients. In one patient, bilateral ill-defined adrenal masses were present. In 12 patients, 13 masses were sharply circumscribed: Seven were less than 10 HU and six were 20 HU or greater at unenhanced CT. Nine of these 12 patients received iodinated contrast material. Without the unenhanced CT, 10 adrenal masses in these nine patients would have been indeterminate for malignancy. In six of these nine patients, the adrenal mass was the only potential site of metastatic disease. The unenhanced CT data helped classify three of these masses as benign - 10 HU or less - and three as indeterminate - greater than 10 HU. CONCLUSION: Unenhanced CT of the adrenal glands can prospectively characterize adrenal masses and obviate further examination in patients with lung carcinoma.