Adrenal masses: contemporary imaging characterization

Adrenal masses are among the most common incidentally discovered lesions on cross-sectional imaging with estimated incidence of approximately 5%. In addition, adrenal lesions can also be detected as part of an endocrinology workup with suspicion of a functional adrenal mass. Regardless of the source of detection, it is crucial to differentiate a benign from a malignant process and furthermore utilize characteristic imaging appearance of different adrenal masses to facilitate diagnosis and guide management. There are numerous imaging protocols and postprocessing methods for evaluation of adrenal masses with high sensitivity and specificity with small differences between institutions. Currently, the most widely used imaging modality for evaluation of adrenal mass is computed tomography without and with contrast washout assessment. In this article, we review diagnostic approaches to adrenal masses using computed tomography and magnetic resonance imaging techniques and present imaging strategies utilized at our institution. The advantages and challenges of these imaging modalities for evaluation of adrenal pathologies are discussed.