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Imaging of Adrenal Incidentalomas: Current Status

¹ Both authors: Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0030.

View larger version (164K): [in a new window]   Fig. 1. —Myelolipoma in 69-year-old man. Large, fatty right adrenal mass can be seen on this contrast-enhanced CT scan.

View larger version (165K): [in a new window]   Fig. 2. —Adrenal pseudocyst in 35-year-old woman. CT scan shows homogeneous left adrenal mass that measured near-water density (8 H). Wall of mass is thickened but smooth and measures less than 3 mm.

View larger version (114K): [in a new window]   Fig. 3. —Adrenal hematoma in 75-year-old woman. Bilateral adrenal masses can be seen on this unenhanced CT scan. High density of masses suggests hematoma.

View larger version (133K): [in a new window]   Fig. 4. —Histoplasmosis in 68-year-old man. CT scan shows that both adrenal glands are enlarged but maintain adreniform configuration.

View larger version (162K): [in a new window]   Fig. 5. —Lipid-rich adenoma in 74-year-old woman. Unenhanced CT scan shows 3-cm right adrenal mass. Attenuation value of -4 H allows confident diagnosis of benign lesion, either cyst or lipid-rich adenoma.

View larger version (146K): [in a new window]   Fig. 6. —Adenoma in 74-year-old man. Contrast-enhanced CT scan reveals 4-cm mass in right adrenal gland. Attenuation value on enhanced scans is not sufficiently characteristic to distinguish benign from malignant causes.

View larger version (144K): [in a new window]   Fig. 7A. —Adenoma in 69-year-old woman. Left adrenal mass can be seen on this in-phase MR image.

View larger version (146K): [in a new window]   Fig. 7B. —Adenoma in 69-year-old woman. Decrease in signal on this out-of-phase MR image compared with A indicates the presence of lipid.

View larger version (168K): [in a new window]   Fig. 8A. —Carcinoma in 59-year-old man. Contrast-enhanced CT scan shows 9-cm right adrenal mass. Irregular wall and low-density center indicate necrosis.

View larger version (154K): [in a new window]   Fig. 8B. —Carcinoma in 59-year-old man. CT scan obtained during same examination but more cephalad than A reveals tumor extension into inferior vena cava.

View larger version (151K): [in a new window]   Fig. 9. —Metastasis from renal carcinoma in 31-year-old woman. Small, homogeneous left adrenal mass can be seen on this contrast-enhanced CT scan.

View larger version (140K): [in a new window]   Fig. 10. —Metastases from adenocarcinoma of lung in 34-year-old woman. Bilateral adrenal masses with areas of central necrosis can be seen on this contrast-enhanced CT scan.

View larger version (136K): [in a new window]   Fig. 11A. —Lipid-poor adenoma in 15-year-old girl. Left adrenal mass measured 40 H on this unenhanced CT scan.

View larger version (146K): [in a new window]   Fig. 11B. —Lipid-poor adenoma in 15-year-old girl. Tumor enhanced to 114 H on CT scan obtained immediately after contrast administration.

View larger version (143K): [in a new window]   Fig. 11C. —Lipid-poor adenoma in 15-year-old girl. Delayed CT image shows mass has attenuation value of 65 H. Thus, adenoma could be diagnosed on basis of washout of contrast material but not on basis of unenhanced attenuation value.

View larger version (172K): [in a new window]   Fig. 8C. —Carcinoma in 59-year-old man. Gadolinium-enhanced T1-weighted MR image shows large right adrenal mass with intracaval extension.

View larger version (171K): [in a new window]   Fig. 12A. —Adrenal metastasis from adenocarcinoma of lung in 69-year-old man. Left adrenal mass (outlined by cursor, 1) measured 32 H on this unenhanced CT scan.

View larger version (190K): [in a new window]   Fig. 12B. —Adrenal metastasis from adenocarcinoma of lung in 69-year-old man. Tumor (outlined by cursor, 1) enhanced to 83 H on CT scan obtained immediately after contrast administration.

View larger version (159K): [in a new window]   Fig. 12C. —Adrenal metastasis from adenocarcinoma of lung in 69-year-old man. Delayed image shows washout (outlined by cursor, 1) of contrast material to only 57 H.

View larger version (147K): [in a new window]   Fig. 13. —Adenoma in 39-year-old woman. Right adrenal mass takes up radionuclide in this radioiodocholesterol scan using NP-59 (iodomethylnorcholesterol). Concordance of mass and radionuclide indicates adenoma.

View larger version (144K): [in a new window]   Fig. 14A. —Adrenal metastasis in 46-year-old man with small cell carcinoma of lung. Contrast-enhanced CT scan reveals small, homogeneous left adrenal mass.

View larger version (121K): [in a new window]   Fig. 14B. —Adrenal metastasis in 46-year-old man with small cell carcinoma of lung. FDG positron emission tomography image shows radionuclide uptake, which indicates mass is metastatic tumor. (Courtesy of Bin C and Shreve P, Ann Arbor, MI)

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