Adrenal Metastasis: Diagnostic Strategies and Key Considerations

Adrenal lesions are common findings on imaging studies, with the vast majority being benign, even in patients with a known malignancy. However, distinguishing benign lesions from adrenal metastases is critical for patient management. This review outlines imaging strategies, including with computed tomography (CT), MR imaging, and FDG PET/CT, to evaluate malignancy risk. A structured, risk-based approach is provided to guide clinical decisions and optimize diagnostic accuracy. The diagnostic evaluation should integrate lesion size, growth rate, fat content, and ancillary imaging features to stratify the likelihood of malignancy. Key challenges include fat-containing metastases, limitations of washout CT, and atypical adenomas.