Adrenal mass imaging with multidetector Ct: Pathologic conditions, pearls, and pitfall

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Abstract

The adrenal gland is involved by a range of neoplasms, including primary and metastatic malignant tumors; however, the most common tumor detected is the incidental benign adenoma. Although computed tomographic (CT) findings will not always yield a definitive diagnosis, attention to these findings provides a road map to guide image interpretation. Adenomas typically demonstrate rapid washout, which is defined as an absolute percentage washout (APW) of more than 60% and a relative percentage washout (RPW) of more than 40% on delayed images. Adrenocortical carcinoma typically has an RPW of less than 40%; however, large size and heterogeneity are more reliable indicators of the diagnosis than are washout values. Washout characterissics of pheochromocytoma are variable; in conjunction with high levels of dynamic enhancement, pheochromocytomas may mimic adenoma (ie, APW > 60%, RPW > 40%). Myelolipomas appear as well-defined masses with variable quantities of fat and soft tissue. After contrast material administration, metastases usually demonstrate slower washout on delayed images (APW <60%, RPW <40%) than do adenomas, although hypervascular metastases may enhance similarly to pheochromocytoma. Finally, a number of nonadrenal pathologic conditions have been reported to mimic adrenal masses at CT.

Original languageEnglish (US)
Pages (from-to)1333-1351
Number of pages19
JournalRadiographics : a review publication of the Radiological Society of North America, Inc
Volume29
Issue number5
DOIs
StatePublished - Sep 2009

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Adenoma
Pheochromocytoma
Myelolipoma
Neoplasm Metastasis
Adrenocortical Carcinoma
Neoplasms
Adrenal Glands
Contrast Media
Fats

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

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title = "Adrenal mass imaging with multidetector Ct: Pathologic conditions, pearls, and pitfall",
abstract = "The adrenal gland is involved by a range of neoplasms, including primary and metastatic malignant tumors; however, the most common tumor detected is the incidental benign adenoma. Although computed tomographic (CT) findings will not always yield a definitive diagnosis, attention to these findings provides a road map to guide image interpretation. Adenomas typically demonstrate rapid washout, which is defined as an absolute percentage washout (APW) of more than 60{\%} and a relative percentage washout (RPW) of more than 40{\%} on delayed images. Adrenocortical carcinoma typically has an RPW of less than 40{\%}; however, large size and heterogeneity are more reliable indicators of the diagnosis than are washout values. Washout characterissics of pheochromocytoma are variable; in conjunction with high levels of dynamic enhancement, pheochromocytomas may mimic adenoma (ie, APW > 60{\%}, RPW > 40{\%}). Myelolipomas appear as well-defined masses with variable quantities of fat and soft tissue. After contrast material administration, metastases usually demonstrate slower washout on delayed images (APW <60{\%}, RPW <40{\%}) than do adenomas, although hypervascular metastases may enhance similarly to pheochromocytoma. Finally, a number of nonadrenal pathologic conditions have been reported to mimic adrenal masses at CT.",
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