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DOI:10.2214/AJR.06.0506
AJR 2006; 187:W550-W551
© American Roentgen Ray Society

Intracellular Lipid Within Metastatic Hepatocellular Carcinoma of the Adrenal Gland: A Potential Diagnostic Pitfall of Chemical Shift Imaging of the Adrenal Gland

Brian D. Sydow, Mark A. Rosen and Evan S. Siegelman

Department of Radiology Hospital of the University of Pennsylvania Philadelphia, PA 19104



 
WEB—This is a Web exclusive article.

Keywords: adrenal gland • chemical shift MRI • hepatocellular carcinoma


Introduction
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 Introduction
Discussion
 References
 
A 48-year-old man with a history of hepatitis C, hepatic cirrhosis, and hepatocellular carcinoma was being treated with chemotherapy. A baseline MRI examination (Fig. 1A) revealed a 2.5-cm hepatocellular carcinoma of the right lobe and normal adrenal glands. An adrenal mass was discovered during an MR examination performed 3 months later (Figs. 1B, 1C, and 1D). The adrenal mass was isointense to the spleen on both in-phase gradient-echo T1- and T2-weighted fast spin-echo images but lost signal relative to spleen on opposed-phase imaging (Fig. 1D).


Figure 1
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  		Fig. 1A —48-year-old man with hepatocellular carcinoma. This opposed-phase gradient-echo T1-weighted image obtained during original baseline study shows normal adrenal glands (arrow).

 

Figure 2
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  		Fig. 1B —48-year-old man with hepatocellular carcinoma. On follow-up study performed 3 months after A, in-phase (B) and opposed-phase (C) gradient-echo T1-weighted and subtraction (D) MR images show new right adrenal lesion (arrow) that exhibits loss of signal intensity on opposed-phase image, indicating presence of intracellular lipid.

 

Figure 3
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  		Fig. 1C —48-year-old man with hepatocellular carcinoma. On follow-up study performed 3 months after A, in-phase (B) and opposed-phase (C) gradient-echo T1-weighted and subtraction (D) MR images show new right adrenal lesion (arrow) that exhibits loss of signal intensity on opposed-phase image, indicating presence of intracellular lipid.

 

Figure 4
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  		Fig. 1D —48-year-old man with hepatocellular carcinoma. On follow-up study performed 3 months after A, in-phase (B) and opposed-phase (C) gradient-echo T1-weighted and subtraction (D) MR images show new right adrenal lesion (arrow) that exhibits loss of signal intensity on opposed-phase image, indicating presence of intracellular lipid.

 

Discussion
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 Introduction
 Discussion
References
 
Detection of intracellular lipid in masses of the adrenal glands on chemical shift MRI has been used to characterize an adrenal adenoma and exclude metastasis [1]. Both clear cell renal cell carcinoma and hepatocellular carcinoma have been shown to have intracellular lipid [2, 3]. Metastatic clear cell renal cell carcinoma of the adrenal gland with loss of signal intensity on chemical shift imaging has been reported [4]. To our knowledge, the MR characterization of intracellular lipid within metastatic hepatocellular carcinoma has not been described. The interval development of the right adrenal mass in 3 months helped to confirm the diagnosis of metastatic disease.

Chemical shift imaging remains an accurate technique for distinguishing between adenomas and metastatic disease of the adrenal glands. However, false-positive findings of benignancy can occur in cases of metastatic disease, related to clear cell renal cell carcinoma and hepatocellular carcinoma. Radiologists should be aware of this possibility when performing MRI to characterize adrenal lesions, especially as in this case where the adrenal lesion was the only evidence of extrahepatic metastasis.


References
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 Introduction
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 References
 

  1. Outwater EK, Siegelman ES, Radecki PD, et al. Distinction between benign and malignant adrenal masses: value of T1-weighted chemical-shift MR imaging. AJR 1995;165 : 579-583[Abstract/Free Full Text]
  2. Outwater EK, Bhatia M, Siegelman ES, et al. Lipid in renal clear cell carcinoma: detection on opposed-phase gradient-echo MR images. Radiology 1997;205 : 103-107[Abstract/Free Full Text]
  3. Martin J, Sentis M, Zidan A, et al. Fatty metamorphosis of hepatocellular carcinoma: detection with chemical shift gradient-echo MR imaging. Radiology 1995;195 : 125-130[Abstract/Free Full Text]
  4. Shinozaki K, Yoshimitsu K, Honda H, et al. Metastatic adrenal tumor from clear-cell renal cell carcinoma: a pitfall of chemical shift MR imaging. Abdom Imaging 2001;26 : 439-442[CrossRef][Medline]

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