Adrenal imaging

The differentiation of adrenal nodules is wide and varies from primary benign neoplasia, through hormone secreting lesions, to primary and secondary malignant masses. With the rapid development of cross-sectional imaging, incidental detection of adrenal nodules has become an everyday practice, leaving clinicians with the necessity of further investigation. In this article, we present the current possibilities of adrenal gland imaging and we propose a diagnostic schema for differential diagnosis of incidentaloma. Non-contrast enhanced computer tomography (CT) is a modality of choice used for the differential diagnosis of adrenal lesions. It allows the detection of 95% of adrenal masses, and the characterisation of most of them. Magnetic resonance imaging (MRI) is a good modality for cases in which CT examination cannot determine the character of an adrenal tumour. Nuclear medicine study with the use of Iodine-131 meta iodobenzylguanidine(MIBG) is helpful in the diagnosis of pheochromocytoma. Positron Emission Tomography-Computed Tomography (PET-CT) is considered a useful method in patients with a known malignancy history. Ultrasound has a low sensitivity for the detection of small lesions and is not capable of reliable characterisation of visualised masses. However, this technique plays an important role in the follow-up of non-hypersecreting adrenal lesions.