COMPARISON OF 2 ALGORITHMS AND THEIR ASSOCIATED CHARGES WHEN EVALUATING ADRENAL MASSES IN PATIENTS WITH MALIGNANCIES

OBJECTIVE. This study was performed to compare two proposed algorithms used when evaluating an adrenal mass discovered during staging evalua tion of a patient with a known malignancy, Such evaluation was meant t o lead to determination of the relative charges associated with each a lgorithm. SUBJECTS AND METHODS. Fifty-four patients with known maligna ncies who required evaluation of an adrenal mass underwent both chemic al shift imaging (CSI) and CT-guided percutaneous biopsy of those mass es, Adrenal-to-spleen signal intensity ratios were calculated for CSI, The hospital charges incurred for each procedure and any associated c omplications were normalized using national relative-value scale charg es and conversion factors, A decision analysis was performed to compar e the relative charges that would have been incurred if adrenal MR ima ging had been performed in all patients, followed by CT-guided biopsy only in those patients with MR findings not diagnostic of adrenocortic al adenoma, and the relative charges incurred if only CT-guided adrena l biopsy had been performed in every patient, RESULTS. Twenty-three (4 3%) of 54 adrenal masses were shown to be metastases by CT-guided biop sy, The sensitivity and specificity of CSI for the diagnosis of adreno cortical adenoma were 94% and 100%, respectively, The charges incurred by performing MR imaging as the initial examination with subsequent C T-guided biopsy only in those patients with CSI findings not diagnosti c of adenoma would have been similar to those incurred by first perfor ming CT-guided adrenal biopsy in every patient, CONCLUSION. CSI is an accurate, noninvasive technique for evaluating adrenal masses in patie nts with cancer. If CT-guided biopsy is used only when CSI is not diag nostic of adrenocortical adenoma, the associated charges would be virt ually the same as when CT-guided biopsy is performed as the first test in every patient, Moreover, biopsies could have been avoided in 54% o f these patients.