Adrenal Imaging: Why, When, What, and How? Part 1. Why and When to Image?

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Lesion Detection and Characterization When should imagers move from simple lesion detection to definitive lesion characterization? Unfortunately, most incidentally detected adrenal lesions, whether benign or malignant, functioning or nonfunctioning, appear similar when detected (Fig. 1). Fortunately, however, most will prove to be benign [2]. This fact becomes even more definitive when the patient has no history of malignancy. Song et al. [2] showed that not a single lesion in 1,049 lesions in patients without any history of malignancy turned out to be malignant [2]. Given that the a priori chance of an adrenal mass in this subgroup being malignant is almost nil, it could be argued that no further tests are needed. Although reassuring to imagers, most referring physicians are uncomfortable with no further follow-up, particularly because a minority of lesions, despite still being benign, may represent hyperfunctioning adenomas (Fig. 2) or pheochromocytomas (Fig. 3). Other benign adrenal neoplasms include myelolipoma (Fig. 4) and very rarely other lesions such as cysts (Fig. 5) and ganglioneuroma (Fig. 6). Other nonneoplastic lesions include hematomas and infectious masses [1] (Table 1). Given the chance that a small minority of incidentally detected adrenal lesions are hyperfunctioning, there is currently significant debate between imagers and endocrinologists Adrenal Imaging: Why, When, What, and How? Part 1. Why and When to Image?