Authors (including presenting author) :
Shen CHP(1), Chan YHH(1), Leung HSH(1), Chan CMJ(2), Ozaki R(2) , Hung HYE(1), Wong KTJ(1)
Affiliation :
(1)Department of Imaging and Interventional Radiology, Prince of Wales Hospital (2)Department of Medicine and Therapeutics, Prince of Wales Hospital
Keyword 1: :
Adrenal incidentaloma
Keyword 2: :
Imaging follow up
Keyword 3: :
Imaging follow up
Keyword 4: :
Interdisciplinary
Keyword 5: :
Prevention of unnecessary investigations
Keyword 6: :
Streamlined management
Introduction :
As the use of medical imaging becomes increasingly common, so too does the detection of widely prevalent incidental findings such as adrenal incidentalomas. These lesions have a low propensity of malignancy in otherwise asymptomatic patients without known cancer but would result in significant burden for imaging workload.
Objectives :
To evaluate the effectiveness of a local consensus protocol based on International guidelines (“Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee), on imaging follow-up of adrenal incidentalomas.
Methodology :
Retrospective review of CT requests and reports for any adrenal lesions within our department (during the periods of 1/12/2023 to 31/1/2024 and 1/12/2024 to 31/1/2025; reviewing a total of 124 CT requests). The indication for follow-up imaging, whether the appropriate investigation (contrast versus non-contrast) was suggested and / or requested was assessed and compared against the local consensus from multidisciplinary cooperation based on international guidelines, where imaging is not indicated for non-functioning lesions with any of the following criteria: (1) ≤1cm in diameter, (2) homogeneous lesion with HU ≤10HU on non-contrast CT, (3) previous CT with imaging features consistent with adenoma or myelolipoma. Furthermore, a plain CT should be considered for follow-up in size of nodules where indicated.
Result & Outcome :
Following the initial review, discussion and reassessment, the number of scan requests for adrenal lesions fell by 45%. The proportion of requests for lesions that did not meet the criteria for follow-up fell significantly from 78% to 27%. Inappropriate requests in terms of selection of contrast vs. non-contrast CT were also reduced from 70% to 33% for lesions requiring size monitoring. High compliance of 100% was maintained for contrast CT requests indicated for further characterization of the adrenal incidentaloma. Overall, this practice has shown to enhance compliance with international practices, reducing unnecessary follow-up and allow better utilization of imaging resources.
