Adrenal magnetic resonance imaging in Addison's disease

Magnetic resonance imaging of the adrenal glands was performed in 9 patients with Addison's disease to evaluate the role of magnetic resonance (MR) in this entity. All patients had bilateral adrenal masses demonstrated by computed tomography (CT); etiologies included adrenal hemorrhage (2 patients), granulomatous disease (1 patient), adrenal lymphoma (3 patients), and adrenal metastases (3 patients). Spin-echo axial images were obtained at repetition times (TR) 0.5, 2.0 s and TE 28, 56 ms, using a Diasonics superconducting magnet operating at 0.35 T. In the patients with lymphoma, metastases, and granulomatous disease, the adrenal masses appeared hypointense or isointense with liver on the T1-weighted images (TR 0.5 s, TE 28 ms). In cases of adrenal hemorrhage, areas of hyperintensity were seen on TR 0.5, TE 56 ms sequences, due to shortening of T1 values. In both groups of patients the masses were hyperintense on T2 weighted sequences. Mean calculated T1 of the hemorrhagic glands was 449 ms, compared with a mean of 782 ms for metastases and lymphoma. While MR is not capable of distinguishing between acute inflammatory and metastatic diseases of the adrenal glands, it may be equally efficacious as CT in suggesting the diagnosis of adrenal hemorrhage in patients with Addison's disease.