- Solid Adrenal Mass
- Typically benign (<10 HU)
- Lipid-rich adenoma
CT: Typically small (< 2 cm), circumscribed and low density (< 10 HU).
MR: Signal loss on OOP
- Myelolipoma
CT: Low density (-30 to -90 HU). May have benign Ca++
MR: High T1, signal loss on FS. Large lesions may spontaenously haemorrhage.
- Indeterminate (≥10 HU)
- 1 – 4 cm
Recommend MRI
- Washout or OOP signal loss
- Lipid-poor adenoma
(DDx: hypervascular adrenal met., pheochromocytoma, adrenocortical carcinoma)
CT: >60% absolute/>40% relative washout. Mild enhancement.
MR: OOP signal loss (T1FS not helpful)
- No washout or no OOP signal loss
- Pheochromocytoma
CT: >10HU on NCCT may suggest haemorrhage. Hypodensity may represent cysts or necrosis. Strong heterogenous enhancement. Delayed washout. Ca++ uncommon.
MR: Lightbulb bright T2, vivid enhancement
MIBG/Octeroscan: Increased activity
- Adrenal cortical carcinoma
CT: Heterogenous enhancement. Dystrophic Ca++ may be seen.
- Lipid-poor adenoma
- Adrenal Leiomyoma
CT: Heterogenous enhancement
- ≥ 4 cm
- Cancer hx
- Metastasis
Recommend PET/biopsy
- Primary RCC (clear cell)
MR: T2 bright, OOP signal loss, vividly enhances (matching cortex on corticomedullary phase)
- Primary HCC
MR: OOP signal loss
- Primary Liposarcoma
MR: OOP signal loss
- No cancer hx
- Adrenocortical carcinoma
CT: Bulky, irregular, unilateral. Heterogenous and capsular enhancement. Central necrosis, haemorrhage, suspicious Ca++ . Macroscopic fat very rare. Washout very uncommon. Adjc. invasion, nodal and distal mets. common.
- Calcified Adrenal Mass
- Benign
Coarse, rounded, peripheral or septal
- Adenoma
- Myelolipoma
- Trauma
- Granulomatous infection
- Suspicious
Punctate, dystrophic or irregular
- Adrenocortical cancer
- Adrenal metastases
Updated on 23 August 2024
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