Adrenal incidentalomas: imaging challenges\u2014role of MDCT scan versus MRI in evaluating adrenal incidentalomas

Monica Maher Amin Nawar,Sally Yehia Shokralla,Sameh Abdel Aziz Zaky Hanna,Shereen Sadik El-Sawy

doi:10.1186/s43055-021-00437-w

Monica Maher Amin Nawar, Sally Yehia Shokralla + Show 2 more

Open Access

https://doi.org/10.1186/s43055-021-00437-w

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Abstract

BackgroundThe term adrenal incidentaloma (AI), by definition, is an adrenal mass that is unexpectedly detected through an imaging procedure performed for reasons unrelated to adrenal dysfunction or suspected dysfunction. Despite their frequent appearance, the challenge remains in recognizing and treating the small percentage of AI that poses a significant risk, either because of their hormonal activity or because of their malignant histology. The aim of this study is to study the role of MRI, specifically chemical shift imaging (CSI), against various MDCT scans (non-enhanced, enhanced, and delayed) in the characterization of incidentally discovered adrenal masses to offer a way for the patients to avoid unnecessary time and money-wasting imaging modalities used to reach a diagnosis of their incidentally discovered adrenal lesions. We examined a total number of 20 patients with total of 22 adrenal lesions. The mean age was 51.1 ± 15.27.ResultsIn our study, we found that among CT parameters, APW and RPW showed the highest sensitivity and specificity for detection of lipid-rich adenomas. CSI has also proven to be the best MR technique. However, there is no statistically significant difference in the diagnostic capability of CSI versus the CT washout technique. Both modalities could be conducted, according to specific patient preferences and/or limitations, with comparable highly accurate outcomes.ConclusionThis study demonstrates that a similar diagnostic outcome is obtained from contrast-enhanced CT (CECT) and MRI with CSI of adrenal lesions.

Highlights

The term adrenal incidentaloma (AI), by definition, is an adrenal mass that is unexpectedly detected through an imaging procedure performed for reasons unrelated to adrenal dysfunction or suspected dysfunction
Youden index test was used to detect cut-off point, specificity, sensitivity, positive, and negative likelihood ratio. This cross-sectional study included a total of 20 patients with adrenal lesions
Benign adrenal lesions ranged in size from 1 to 10 cm with a mean of 3.05 while malignant lesions ranged from 2 to 6.5 with a mean of 4.64

Summary

Introduction

The term adrenal incidentaloma (AI), by definition, is an adrenal mass that is unexpectedly detected through an imaging procedure performed for reasons unrelated to adrenal dysfunction or suspected dysfunction. Despite their frequent appearance, the challenge remains in recognizing and treating the small percentage of AI that poses a significant risk, either because of their hormonal activity or because of their malignant histology. Adrenal masses discovered accidentally in the course of imaging for other abdominal conditions are known as adrenal incidentalomas (AIs). Those patients who are having these incidentalomas—by definition—have no history or symptoms of adrenal diseases prior to imaging procedures that lead to their discovery [1]. AIs are present in 4–5% 0f abdominal CT examinations [3]

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