Three-dimensional image guidance for diagnosis and treatment of adrenal disease: a systematic review

Adrenal abnormalities are common imaging findings requiring comprehensive workup. Invasive diagnostic and therapeutic procedures, including adrenal surgery, demand expertise to mitigate risks of severe complications. Recent applications of 3D image analyses range from enhanced diagnosis to therapeutic guidance with anatomical visualisation. This study assesses the efficacy and clinical utility of 3D image analyses in managing adrenal disease. This systematic review, registered with PROSPERO (CRD42024500783), adheres to PRISMA guidelines. Searches of PubMed, Google Scholar and ClinicalTrials.gov up to August 2024 identified eligible studies. Extracted data included imaging modalities, 3D applications for diagnosis or treatment, volumetric segmentation techniques, and differentiation between pathologic and normal adrenal glands. Technological maturity was assessed with the IDEAL framework. Of 1813 studies screened, 30 met inclusion criteria, encompassing 5304 imaging exams (2060F/2106M, and 10 studies with 1115 cases), predominantly CT (27 CT, 90%; 2 MRI, 6.7%; 1 CT/MRI 3.3%). Volumetric reconstructions employed manual, semiautomatic and automatic methods for digital visualisation, and subsequent 3D printing. 3D analyses of normal vs. neoplastic adrenal tissue supported diagnosis in 18 studies (60%), and treatment in 12 (40%), improving understanding of respective anatomical features and planning for operative and interventional procedures. These applications represented early IDEAL stages of surgical innovation (0-preclinical, 1-idea and 2-development/exploration). 3D image analyses show promise in optimising adrenal disease management by aiding adrenal lesion characterisation and treatment optimisation through pre- and intraprocedural guidance. Further clinical assessment and long-term studies are warranted to establish the broader clinical impact.