Diagnostic accuracy of contrast-enhanced CT in diagnosis of adrenal adenoma taking histopathology as gold standard.

Abstract

Objective: To determine the diagnostic accuracy of contrast-enhanced CT in diagnosis of adrenal adenoma taking histopathology as gold standard. Study Design: Cross-Sectional Validation Study. Setting: Department of Radiology, Allied Hospital, Faisalabad. Period: July 2025 to December 2025. Methods: A total of 130 patients aged 50–80 years suspected of adrenal carcinoma were enrolled through consecutive sampling. All underwent contrast-enhanced CT (CECT), interpreted by a blinded consultant radiologist. Adenomas were defined as lesions with unenhanced attenuation ≤10 HU and absolute percentage washout >60%. Histopathology after surgical excision or biopsy served as the gold standard. Diagnostic accuracy parameters including sensitivity, specificity, PPV, NPV, and overall accuracy were calculated using a 2×2 table. Data were analyzed with SPSS 25, with stratification for demographic and clinical factors. Results: Among 130 patients, CT detected adenoma in 40.8% while histopathology confirmed 75.4%. CT showed high specificity and PPV (93.8% and 96.2%) but low sensitivity and NPV (52.0% and 39.0%), reflecting substantial false-negative rates. Conclusion: Although contrast-enhanced CT remains a valuable first-line modality with strong specificity and confirmatory accuracy, its low sensitivity requires cautious interpretation when classic washout features are absent. Emerging quantitative radiomics and functional imaging techniques may enhance diagnostic confidence and support more precise patient management.