Advances in Multimodal Imaging for Adrenal Gland Disorders: Integrating CT, MRI, and Nuclear Medicine

Overview

Journal Jpn J Radiol

Publisher Springer

Date 2025 Jan 10

PMID 39794659

Authors

Kota Yokoyama

Mitsuru Matsuki

Takanori Isozaki

Kimiteru Ito

Tomoki Imokawa

Akane Ozawa

Koichiro Kimura

Junichi Tsuchiya

Ukihide Tateishi

Affiliations

Soon will be listed here.

Abstract

Adrenal diseases pose significant diagnostic challenges due to the wide range of neoplastic and non-neoplastic pathologies. Radiologists have a crucial role in diagnosing and managing these conditions by, leveraging advanced imaging techniques. This review discusses the vital role of computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine in adrenal imaging, and focuses on morphological and functional evaluations. First, the anatomy and physiology of the adrenal glands are described, followed by a discussion on ectopic adrenocortical adenomas and how they develop. The concepts and imaging findings of congenital diseases, such as congenital adrenal hyperplasia (CAH), adrenal rest tumors, and adrenocortical nodular disease, considering recent updates to the WHO Classification of Tumours (5th ed.) terminology are highlighted. The diagnostic value of dynamic contrast-enhanced CT and chemical-shift MRI for identifying adrenocortical adenomas are emphasized, alongside the use of adrenocortical scintigraphy such as I-adosterol scintigraphy for diagnosing Cushing's disease, Cushing's syndrome (CS), subclinical CS, and ectopic adrenocorticotropic hormone-producing tumors. Systemic complications associated with CS, and the diagnosis and treatment of pheochromocytomas, paragangliomas (PPGLs), and neuroblastomas, will also be discussed focusing on I-metaiodobenzylguanidine (MIBG) imaging and I-MIBG therapy. Pitfalls in I-MIBG imaging and the increasing importance of diagnosing hereditary PPGLs due to increased genetic testing are also be discussed. Additionally, the broad differential diagnosis for adrenal masses-including malignancies like adrenal carcinoma, metastases, and malignant lymphoma, as well as benign conditions like myelolipoma and ganglioneuroma, and complications, such as adrenal hemorrhage, infarction, and infections-will be outlined. The goal of this review was to provide an overview of adrenal diseases that includes the most recent information for radiologists to stay updated on the latest imaging techniques and advancements that can ensure accurate diagnosis and effective management.

References

Nagayama Y, Inoue T, Kato Y, Tanoue S, Kidoh M, Oda S . Relative Enhancement Ratio of Portal Venous Phase to Unenhanced CT in the Diagnosis of Lipid-poor Adrenal Adenomas. Radiology. 2021; 301(2):360-368. DOI: 10.1148/radiol.2021210231. View

Korobkin M, Brodeur F, Francis I, Quint L, Dunnick N, Londy F . CT time-attenuation washout curves of adrenal adenomas and nonadenomas. AJR Am J Roentgenol. 1998; 170(3):747-52. DOI: 10.2214/ajr.170.3.9490968. View

Korobkin M, Giordano T, Brodeur F, Francis I, Siegelman E, Quint L . Adrenal adenomas: relationship between histologic lipid and CT and MR findings. Radiology. 1996; 200(3):743-7. DOI: 10.1148/radiology.200.3.8756925. View

Platzek I, Sieron D, Plodeck V, Borkowetz A, Laniado M, Hoffmann R . Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis. Eur Radiol. 2018; 29(2):806-817. DOI: 10.1007/s00330-018-5626-5. View

Timmers H, Taieb D, Pacak K . Current and future anatomical and functional imaging approaches to pheochromocytoma and paraganglioma. Horm Metab Res. 2012; 44(5):367-72. PMC: 4714588. DOI: 10.1055/s-0031-1299712. View

Bhatia K, Ismail M, Sahdev A, Rockall A, Hogarth K, Canizales A . 123I-metaiodobenzylguanidine (MIBG) scintigraphy for the detection of adrenal and extra-adrenal phaeochromocytomas: CT and MRI correlation. Clin Endocrinol (Oxf). 2008; 69(2):181-8. DOI: 10.1111/j.1365-2265.2008.03256.x. View

Timmers H, Chen C, Carrasquillo J, Whatley M, Ling A, Havekes B . Comparison of 18F-fluoro-L-DOPA, 18F-fluoro-deoxyglucose, and 18F-fluorodopamine PET and 123I-MIBG scintigraphy in the localization of pheochromocytoma and paraganglioma. J Clin Endocrinol Metab. 2009; 94(12):4757-67. PMC: 2795662. DOI: 10.1210/jc.2009-1248. View

Janssen I, Chen C, Millo C, Ling A, Taieb D, Lin F . PET/CT comparing (68)Ga-DOTATATE and other radiopharmaceuticals and in comparison with CT/MRI for the localization of sporadic metastatic pheochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging. 2016; 43(10):1784-91. PMC: 8194362. DOI: 10.1007/s00259-016-3357-x. View

Kroiss A . Current status of functional imaging in neuroblastoma, pheochromocytoma, and paraganglioma disease. Wien Med Wochenschr. 2018; 169(1-2):25-32. DOI: 10.1007/s10354-018-0658-7. View

10.

Nolting S, Ullrich M, Pietzsch J, Ziegler C, Eisenhofer G, Grossman A . Current Management of Pheochromocytoma/Paraganglioma: A Guide for the Practicing Clinician in the Era of Precision Medicine. Cancers (Basel). 2019; 11(10). PMC: 6827093. DOI: 10.3390/cancers11101505. View

11.

Nockel P, El Lakis M, Gaitanidis A, Yang L, Merkel R, Patel D . Preoperative genetic testing in pheochromocytomas and paragangliomas influences the surgical approach and the extent of adrenal surgery. Surgery. 2017; 163(1):191-196. PMC: 5736453. DOI: 10.1016/j.surg.2017.05.025. View

12.

Bausch B, Wellner U, Bausch D, Schiavi F, Barontini M, Sanso G . Long-term prognosis of patients with pediatric pheochromocytoma. Endocr Relat Cancer. 2013; 21(1):17-25. DOI: 10.1530/ERC-13-0415. View

13.

Shroff G, Strange C, Ahuja J, Altan M, Sheshadri A, Unlu E . Imaging of Immune Checkpoint Inhibitor Immunotherapy for Non-Small Cell Lung Cancer. Radiographics. 2022; 42(7):1956-1974. DOI: 10.1148/rg.220108. View

14.

Lam K, Chan A, Lo C . Morphological analysis of adrenal glands: a prospective analysis. Endocr Pathol. 2001; 12(1):33-8. DOI: 10.1385/ep:12:1:33. View

15.

Gurun E, Kaya M, Gurun K . Evaluation of Normal Adrenal Gland Volume and Morphometry and Relationship with Waist Circumference in an Adult Population Using Multidetector Computed Tomography. Sisli Etfal Hastan Tıp Bul. 2021; 55(3):333-338. PMC: 8526233. DOI: 10.14744/SEMB.2021.96462. View

16.

Vincent J, Morrison I, Armstrong P, Reznek R . The size of normal adrenal glands on computed tomography. Clin Radiol. 1994; 49(7):453-5. DOI: 10.1016/s0009-9260(05)81739-8. View

17.

Kangarloo H, Diament M, Gold R, Barrett C, Lippe B, Geffner M . Sonography of adrenal glands in neonates and children: changes in appearance with age. J Clin Ultrasound. 1986; 14(1):43-7. DOI: 10.1002/jcu.1870140109. View

18.

van Vuuren S, Damen-Elias H, Stigter R, van der Doef R, Goldschmeding R, de Jong T . Size and volume charts of fetal kidney, renal pelvis and adrenal gland. Ultrasound Obstet Gynecol. 2012; 40(6):659-64. DOI: 10.1002/uog.11169. View

19.

Karsli T, Strickland D, Livingston J, Wu Q, Mhanna M, Shekhawat P . Assessment of neonatal adrenal size using high resolution 2D ultrasound and its correlation with birth demographics and clinical outcomes. J Matern Fetal Neonatal Med. 2017; 32(3):377-383. DOI: 10.1080/14767058.2017.1378340. View

20.

Planz V, Dyer R . The "pancake" adrenal. Abdom Imaging. 2014; 40(6):2041-3. DOI: 10.1007/s00261-014-0287-6. View