CT of adrenal incidentalomas

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Author: Mikael Häggström [notes 1]

Axial slice of CT without contrast, showing an adenoma. It has low attenuation, and well-defined margins.

Evaluation

Measure:

  • Size
  • Attenuation
  • Heterogeneity[1]

Further workup

Adrenal masses discovered incidentally ("incidentalomas") have the following workup by Swedish national guidelines:[2]

Features Workup
Size < 1 cm No radiologic workup needed (but biochemical screening may be indicated if clinical suspicion of being hormonally active)
Size 1 to 4 cm Attenuation ≤10 HU (adenoma)
Attenuation >10 HU Without IV contrast CT after 6 months, then stop if size is unchanged
On contrast CT CT without contrast as either:
  • Within 1 month for attenuation value
  • After 6 months for size control

Report

  • Size
  • Attenuation. The attenuation value only needs to be reported as relative to the 10 HU threshold, such as "well below 10 HU" or "slightly below 10 HU".
  • Heterogeneity only if clearly present.[notes 2]
  • Optionally, a recommendation for further workup if applicable.

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
  2. Heterogeneity is a fairly specific but unacceptably non-sensitive finding of malignant tumors.
    - Tu, Wendy; Verma, Raman; Krishna, Satheesh; McInnes, Matthew D. F.; Flood, Trevor A.; Schieda, Nicola (2018). "Can Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT? ". American Journal of Roentgenology 211 (5): 1044–1050. doi:10.2214/AJR.17.19276. ISSN 0361-803X. 

References

  1. Tu, Wendy; Verma, Raman; Krishna, Satheesh; McInnes, Matthew D. F.; Flood, Trevor A.; Schieda, Nicola (2018). "Can Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT? ". American Journal of Roentgenology 211 (5): 1044–1050. doi:10.2214/AJR.17.19276. ISSN 0361-803X. 
  2. . Utredning av binjureincidentalom (Workup of adrenal incidentalomas). Swedish Society of Radiology.