Adrenal incidentalomas are found in approximately 5% of all CT examinations in the general population. In patients with a known malignancy, the likelihood of an adrenal nodule being malignant is approximately 25-36%. These imaging . 2. 3,4 The incidence increases to between 9% and 13% in patients imaged for a . Most imaging techniques were developed to differentiate adenoma from metastatases, with CT washout technique as the most sensitive and specific imaging technique. 1, 2 The adrenal gland is a relatively frequent site for metastatic disease but even in patients with a known carcinoma, only 26-36% of adrenal masses are metastatic. Blood and urine tests are as important as imaging tests in diagnosing adrenal cancer. Imaging now plays a critical role in the work-up and clinical management of adrenal disease. In patients with RCC and HCC who undergo dedicated adrenal CT imaging for known adrenal lesions, the enhancement washout of adrenal metastases can be similar to that of lipid-poor adrenal adenomas. Chemical shift imaging exploits the different proton resonance frequency rates in fat and water molecules to identify lipid-rich adenomas and is currently considered the most sensitive modality for distinguishing between benign and malignant adrenal masses, with a sensitivity of 79% to 100% and specificity of 82% to 100%. Most of these incidentalomas are benign non-functioning adenomas even in patients with a known malignancy. 2007; 7(1): . These tumors are usually detected incidentally on imaging done for unrelated reasons and only in some cases do patients present with symptoms and/or . Adrenal insufficiency is a bilateral process that cannot be diagnosed by imaging alone. Doctors might choose which tests to do based on the patient's symptoms. Because masses in the adrenal glands are one of the most commonly encountered incidentalomas, the American College of Radiology (ACR) has developed specific recommendations on how to manage incidentally discovered adrenal masses in the adult population. testicular cancer 16; Radiographic features CT. Adrenal metastases can have variable CT appearances 4. Background Guidelines recommending additional imaging for adrenal nodules lack relevant epidemiologic evidence. Adrenal adenomas are benign neoplasms of the adrenal cortex. Materials and Methods This retrospective study included 10 250 consecutive patients . It is used in many cancer patients (including lung, breast, kidney, colorectal cancer and melanoma) and provided information for diagnosis, surveillance, and . The prevalence of adrenal masses increases to 9-13% in patients with a known underlying malignancy. Diagnostic scores together with new immunohistological markers are the methods of choice to assess malignancy. Adrenal adenomas and carcinomas also occur in childhood; these tumours are indistinguishable on imaging but criteria for the diagnosis of adrenal carcinoma include size larger than 5 cm, a tendency to invade the inferior vena cava and to metastasise. The widespread use of imaging has led to increased detection of adrenal lesions and has underlined the importance of accurate adrenal lesion characterization [1, 2].Indeed, it is essential to characterize any adrenal lesion in patients with a known cancer because many tumors may metastasize to the adrenal glands [], and a metastasis might contraindicate a curative treatment of the patient and . However, if the patient has a known underlying extraadrenal malignancy, then the whole imaging algorithm changes because up to 50% of detected adrenal masses in these patients will be malignant and mostly metastatic . These two cases, one a functioning adenoma with small areas of hemorrhage and the other tuberculosis, emphasize that increased signal intensity in an adrenal mass on T2-weighted images is not always due to malignancy or a pheochromocytoma. The approach to the radiological and clinical evaluation of adrenal masses in the oncologic and non-oncologic patient is discussed. As a functional imaging modality, 18-FDG-PET/CT, which provides glucose metabolic information on malignant tumors, has shown great results for the detection of adrenal metastases. The detection of adrenal lesions has increased with the expanding use of cross-sectional imaging. An adrenal incidentaloma is defined as a mass > 1 cm that is detected on imaging exams not performed for suspected adrenal disease. Adrenal washout calculator (CT) Note: this calculator should be used primarily for adrenal washout protocol multi-phase CT examinations of lipid-poor adrenal lesions. The detection of incidental adrenal lesions has increased with the widespread use of cross-sectional imaging. Cancer Imaging. In addition, the value of unenhanced and enhanced CT densitometry with emphasis on the washout features to distinguish between lipid-rich and lipid-poor adenomas and malignant lesions is detailed. Approximately 3 to 4 . adrenal hemorrhage. Please also note that >4 cm lesions are concerning for malignancy regardless of their washout characteristics. In other words, unlike the patient with no known primary lesion, the a priori chance that an incidentally detected adrenal . Therefore a strategy for characterizing these . Although these abnormalities may not represent potential malignancy, identification is important nonetheless. In general, males have a poorer prognosis, largely because they are less likely to have functioning tumors, and thus present later, with more advanced disease 5. Adrenal tumors classified as benign undergo follow-up imaging to assess tumor growth. For further information please read the detailed notes below the . In addition to neoplastic disease, a range of disorders can alter the size or morphology of the adrenal gland. In addition, the value of unenhanced and enhanced CT densitometry with emphasis on the washout features to distinguish between lipid-rich and lipid-poor adenomas and malignant lesions is detailed. Magnetic resonance (MR) imaging is often useful for characterizing adrenal masses. Purpose To measure the prevalence of adrenal nodules detected at staging CT in patients with potentially resectable gastric cancer and the proportion of patients with malignant nodules among them. The increasing use of computed tomography (CT) and magnetic resonance imaging (MRI) has led to a rise in the incidental discovery of adrenal masses (adrenal incidentalomas). . CT. The most topical dilemmas in the radiological assessment of . Adrenal lesions are very common. Adrenal adenoma is the most common adrenal mass, and metastases is the most common malignant adrenal mass. known primary neoplasm adrenal adenoma. These include hyperplasia, hemorrhage, infection, and cystic lesions. 1,2 Incidental adrenal nodules are present in approximately 5% of all abdominal CT examinations in patients with no known malignancy or endocrine abnormality. Radiology plays a significant role in differentiation. pheochromocytoma Differential diagnosis. For an adrenal mass consider other adrenal lesions 2: adrenal metastases. Cross-sectional imaging is the mainstay of imaging for identifying and assessing adrenal lesions, for which an algorithm to aid characterization is helpful 5. Is the "Incidentaloma" an Adrenocortical Carcinoma or Metastatic Disease? While the signal . CT would be the best imaging modality for adrenal assessment but is not necessary for diagnosis. For urine tests, you may be asked to collect all of your urine for 24 hours. Radiographic features. PCCs follow the 10% rule: 10% of cases are bilateral, 10% occur in children, 10% are non-secreting, 10% are bilateral, 10% are malignant, 10% are asymptomatic, and 10% arise outside of the adrenal gland from the sympathetic chain (paraganglioma). With respect to adrenal imaging, the key role of CT . Many of these lesions are incidentally discovered and called incidentalomas. 5 This incidence of metastatic adrenal lesions increases to 71% if the . Pheochromocytoma (PCC) is a tumor arising from the adrenal medulla. Adrenal masses can be classified into various groups on the basis of the presence of intracellular lipid, macroscopic fat, hemorrhage, and cystic changes and the vascularity and shape of the tumor. Imaging features depend on the cause and the course of the disease either acute, subacute, or chronic: acute: bilateral adrenal hematomas. 35 - 40 Sensitivity . Two cases of nonmalignant adrenal masses with prolonged T2 relaxation time and increased adrenal/liver signal ratios are reported. Adrenal adenomas are the most common cause of incidentally found adrenal tumors known as "adrenal incidentalomas." Adrenal adenomas can be either hormonally active or inactive. If an increase in diameter of >1 cm is seen, surgical removal is recommended. Adrenal enlargement is also - rarely - called adrenomegaly, which can be unilateral or bilateral. The roles of magnetic resonance imaging and positron emission tomography in distinguishing benign from malignant adrenal masses will also be discussed. The roles of magnetic resonance imaging and positron emission . Using CT, <10 HU on noncontrast series indicates a lipid-rich adenoma, and . But often doctors will check hormone levels even when symptoms of high hormone levels are not present. In healthy individuals, 80% of incidentally found adrenal masses are benign nonfunctioning adenomas [].Even in those with a known primary malignancy, approximately 40-57% of adrenal incidentalomas are benign [].Accurate characterization of adrenal nodules is critical for appropriate staging . Adrenal adenomas (alternative plural: adenomata) are the most common adrenal lesion and are often found incidentally during abdominal imaging for other reasons. Even after tumor removal the diagnosis of dignity may remain difficult. They usually demonstrate <50% washout. In all cases, but especially in the setting of known current or previous malignancy, adrenal adenomas need to be distinguished from adrenal metastases or other adrenal malignancies. However, in the population without a known malignancy, the prevalence is less than 0.5% [9-12].
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