MR Imaging of Adrenal Lesions

Aoife Kilcoyne, MB BCh BAO, FFR, RCSI; Shaunagh McDermott, MB BCh BAO, FFR, RCSI; Michael A. Blake, MB BCh BAO, MRCPI, FRCR, FFR, RCSI


Appl Radiol. 2017;46(4) 

In This Article

Abstract and Introduction


The role of MRI in the evaluation of adrenal lesions has evolved tremendously over the last twenty years. This is due primarily to the modality's inherent tissue characterizing ability, but also to a variety of accelerated pulse sequences which confer some advantages over other imaging modalities used for adrenal imaging. MRI's absence of ionizing radiation is additionally beneficial, particularly in young patients or in those undergoing repeated imaging.

The detection of incidental adrenal lesions has increased with the widespread use of cross-sectional imaging.[1,2] Incidental adrenal nodules are present in approximately 5% of all abdominal CT examinations in patients with no known malignancy or endocrine abnormality.[3,4] The incidence increases to between 9% and 13% in patients imaged for a known malignancy.[3] Up to 27% of oncology patients will have microscopic adrenal metastases and approximately 50% of imaging-detected adrenal lesions in cancer patients will represent metastatic disease.[5–8]

Accurate characterization of adrenal lesions in patients with a known primary malignancy is extremely relevant in clinical practice.[9] For example, an isolated ipsilateral adrenal metastasis in a patient with resectable, primary, non-small cell lung carcinoma is treated as localized disease. In such a patient, resection of an isolated adrenal metastasis has been demonstrated to extend disease-free survival.[10]