The incidental nonhyperfunctioning adrenal mass: an imaging algorithm for characterization

doi:10.1016/S0009-9260(98)80189-X

Clinical Radiology

Volume 53, Issue 11, November 1998, Pages 796-804

https://doi.org/10.1016/S0009-9260(98)80189-X Get rights and content

Nonhyperfunctioning adrenal lesions such as cysts, myelolipomas, adrenal haemorrhage, adenoma and metastases are described. Definitive imaging features that help characterize adrenal cysts, myelolipomas and adrenal haemorrhage are illustrated and the differentiation of benign from malignant adrenal lesions using an algorithmic approach based on lipid sensitive imaging is provided.

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Imaging of adrenal incidentaloma: Our experience
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Citation Excerpt :
Abdomen MDCT is the best choice, especially in relation to cost-effective; the dedicated examination protocol for the characterization of adrenal incidentaloma comprise a pre-contrast CT and two post-contrast scanning (after 35 s and 10 min) [22–25]; in the local practice the post-contrast phases could be performed at different times (90–120 s and 10–15 min) [5]. Homogeneous lesion with smooth margins and size less than 4 cm and density <10 HU without enhancement to contrast media, indicates benign lesions [26–28], with a specificity of 98–99% [29,30]; the presence of macroscopic fat, with a density of −10’ HU is characteristic of a myelolipoma; if the attenuation is of 0–15 HU without enhancement after contrast media administration, a simple cyst is suspected [5]. Adrenal lesions with the same attenuation values and an adenoma and/or a cyst appearance with a transverse diameter >4 cm, no further imaging is needed [30].
To investigate clinical, biochemical and radiological features in 35 patients with adrenal incidentaloma found on CT and/or MRI and to define the management of patients with adrenal masses.
From January 2011 and May 2013, 35 patients (19F, 16M) with an adrenal mass incidentally discovered on CT and/or MRI were enrolled in a retrospective study. Thirthy-two patients underwent MDCT and eight 1.5 MRI.
Patients consisted in 16 males and 19 females, aged between 25 and 89 yo. Adrenal lesions were most commonly found in the sixth decade; in relation to the side of the mass, 20 were found on left side, 15 on the right. Of all the mass analyzed, 3 were <1 cm diameter, 29 between 1 and 4 cm, 3 > 4 cm. The most common finding on CT was adenoma-like appearance (19 cases in relation to size, 14 in relation to attenuation values). Hormonal analysis showed 32 cases of nonfunctional masses and 3 cases of hormone activity. Adrenalectomy was performed in ten patients having adenoma (5 cases), malignant lesions (2 cases), pheocromocitoma, cyst and myelolipoma (1 case).
Diagnostic approach to adrenal incidentaloma is focused on the definition of malignancy and hormonal activity; the characterization is needs hormonal and radiological (CT and/or MRI) evaluation, even if a fine needle aspiration is needed in selected cases.
Benign and/or non-hypersecreting hormone lesion with <4 cm diameter could be sent to follow-up; active adrenal tumors or >4 cm diameter lesions with malignancy suspicious or growth during follow-up could be treated with surgical adrenalectomy.
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2005, Seminars in Ultrasound, CT and MRI
Differentiation of pathologic alterations of the adrenal glands is still a frequent and challenging problem of daily practice in radiology. Two main groups of patients have to be differentiated: those with clinical symptoms, mainly of endocrinopathies, and those in which a mass of the adrenal gland is detected incidentally. In the first group, magnetic resonance imaging (MRI) plays a minor role, although it allows to detect and often even differentiate the cause of the disease. In the second group, MRI has an excellent performance in differentiating between adenomas and non-adenomatous lesions of the adrenal glands.
Non-secreting adrenal tumours
2004, Annales d'Urologie
Le présent travail fait le point sur les tumeurs surrénaliennes non sécrétantes. Les auteurs établissent la stratégie diagnostique actuelle en mettant l’accent sur le rôle de l’imagerie. Le cas des incidentalomes est évoqué. Les principaux types histologiques de tumeurs non sécrétantes sont passés en revue ainsi que la stratégie thérapeutique.
This paper presents the clinical features, imaging methods and treatment of non-secreting adrenal tumours. Adrenal incidentalomas are especially discussed. The main histological types of adrenal non-secreting tumours are evoked. Therapeutic considerations are discussed.
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The incidental nonhyperfunctioning adrenal mass: an imaging algorithm for characterization

Seminars in Roentgenology

Clinical Radiology

Journal of Urology

Journal of Urology

Nonfunctioning adrenal masses: incidental discovery on computed tomography

American Journal of Roentgenology

Normal adrenal glands in small cell lung carcinoma: CT-guided biopsy

American Journal of Roentgenology

Isolated adrenal masses in nonsmall-cell bronchogenic carcinoma

Radiology

Fine needle aspiration cystology of the adrenal glands

Acta Cytologica

Metastases in carcinoma: analysis of 1000 autopsied cases

Cancer

CT-guided adrenal biopsy: accuracy, safety, and indications

American Journal of Roentgenology

Nonsmall cell lung carcinoma adrenal metastis: computed tomography and percutaneous needle biopsy in their diagnosis

Cancer

Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size and observer analysis

Radiology

Metastasis or adenoma? Computed tomographic evaluation of the adrenal mass

Cleveland Clinical Journal of Medicine

Differentiation of adrenal adenomas from nonadenomas using CT attenuation values

American Journal of Roentgenology

Magnetic resonance imaging of the adrenal gland

Critical Reviews in Diagnostic Imaging

Differentiation of adrenal masses with MR imaging: comparision of techniques

Radiology

CT and MR distinction of adenomas and non-adenomas of the adrenal gland

Journal of Computer Assisted Tomography

In vivo MR spectroscopic imaging of the adrenal glands: distincton between adenomas and carcinomas larger than 15mm based on lipid content

American Journal of Roentgenology

Benign adrenocortical masses: diagnosis with chemical shift MR imaging

Radiology

A step forward in the characterizations of adrenal cortical lesions (letter)

Radiology

Characterization of adrenal masses (<5 cm) by use of chemical shift MR imaging: observer performance versus quantitative measures

American Journal of Roentgenology

Adrenal masses: differentiation with chemical shift, fast low-angle shot MR imaging

Radiology

State-of-the-art MR imaging of the adrenal gland

Radiographics

MR imaging differentiation of adrenal masses: has the time finally come?

Radiology

Adrenal masses in oncologic patients: functional and morphologic evaluation

Radiology

Indeterminate adrenal mass in patients with cancer: evaluation at PET with 2-(F-18)-fluoro-2-deoxy-d-glucose

Radiology

Ectopic adrenocorticotropic hormone syndrome: localization studies in 28 patients

Radiology

Macronodular adrenal hyperplasia in Cushing disease

Radiology

Adrenal imaging: current status

American Journal of Roentgenology

Integrated imaging of adrenal disease

Radiology

Localisation of pheochromocytoma: MIGB, CT, and MRI correlation

Journal of Nuclear Medicine

MR imaging and MIBG scintigraphy of pheochromocytomas and extraadrenal functioning paragangliomas

Radiographics

Pheochromocytoma and paraganglioma: comparison of MR imaging with CT and 1–131 MIBG scintigraphy

Radiology