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Adrenal mass imaging with multidetector CT: pathologic conditions, pearls, and pitfalls Johnson PT; Horton KM; Fishman EKRadiographics 2009[Sep]; 29 (5): 1333-51The 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 characteristics 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.|Adrenal Gland Neoplasms/*diagnostic imaging[MESH]|Adrenal Glands/*diagnostic imaging[MESH]|Adult[MESH]|Aged[MESH]|Diagnostic Errors/*prevention & control[MESH]|Female[MESH]|Humans[MESH]|Image Enhancement/*methods[MESH]|Male[MESH]|Middle Aged[MESH]|Tomography, X-Ray Computed/*methods[MESH]|United States[MESH] |
