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World J Radiol. Mar 28, 2013; 5(3): 88-97
Published online Mar 28, 2013. doi: 10.4329/wjr.v5.i3.88
Cross-sectional imaging work-up of adrenal masses
Brinda Rao Korivi, Khaled M Elsayes
Brinda Rao Korivi, Khaled M Elsayes, Department of Radiology, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: Korivi BR and Elsayes KM designed the manuscript; Korivi BR wrote the paper; Elsayes KM edited the paper.
Correspondence to: Brinda Rao Korivi, MD, MPH, Department of Radiology, University of Texas, MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, United States. brrao@mdanderson.org
Telephone: +1-713-7922720 Fax: +1-713-7944379
Received: June 4, 2012
Revised: August 12, 2012
Accepted: January 31, 2013
Published online: March 28, 2013
Abstract

Advances in medical imaging with current cross-section modalities enable non-invasive characterization of adrenal lesions. Computed tomography (CT) provides characterization with its non-contrast and wash-out features. Magnetic resonance imaging (MRI) is helpful in further characterization using chemical shift imaging (CSI) and MR spectroscopy. For differentiating between benign and malignant masses, positron emission tomography (PET) imaging is useful with its qualitative analysis, as well as its ability to detect the presence of extra-adrenal metastases in cancer patients. The work-up for an indeterminate adrenal mass includes evaluation with a non-contrast CT. If a lesion is less than 10 Hounsfield Units on a non-contrast CT, it is a benign lipid-rich adenoma and no further work-up is required. For the indeterminate adrenal masses, a lipid-poor adenoma can be differentiated from a metastasis utilizing CT wash-out features. Also, MRI is beneficial with CSI and MR spectroscopy. If a mass remains indeterminate, PET imaging may be of use, in which benign lesions demonstrate low or no fluorodeoxyglucose activity. In the few cases in which adrenal lesions remain indeterminate, surgical sampling such as percutaneous biopsy can be performed.

Keywords: Cross-sectional imaging; Adrenal; Masses