Adrenal tumour imaging: clinical, molecular, and radiomics perspectives

Adrenal tumours have become a common incidental finding in the radiological evaluation of patients. Estimates suggest that 1-10% of the general population currently harbours an adrenal tumour, peaking in prevalence in the seventh and eighth decades of life. Advances in CT and MR have contributed to improved characterisation of adrenal masses, and novel radiopharmaceuticals are being developed for molecular characterisation and disease subtyping. As a result, the imaging and management of adrenal tumours have been important subjects of many guidelines and consensus statements. New radiomics approaches, together with machine learning, are now being introduced and are quickly shaping the way that imaging data are analysed and interpreted. Furthermore, the development of theranostics links the molecular biology of functioning tumours to targeted treatment options. In this Review, we summarise up-to-date imaging and follow-up approaches for adrenal tumours to provide patients with the most accurate diagnosis, thereby avoiding unnecessary additional tests or surgery.