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

Pediatric Lesions: Neuroblastoma, Ganglioneuroma, Ganglioneuroblastoma


Neuroblastomas comprise the third-most common malignant tumors in children, but are rare in the adult population.[33] It usually demonstrates heterogeneous low signal on T1-weighted images, high signal on T2-weighted images and enhancement following administration of intravenous contrast (Figure 8).[42] Calcification is present in 80–90% of the lesions, but may be difficult to discern on MR images.

Figure 8.

Right neuroblastoma. Axial T1 in-phase image (A) demonstrates areas of hyperintensity compatible with intralesional hemorrhage. Foci of T2 hyperintensity (B) consistent with cystic elements within.


These are benign neoplasms composed of Schwann cells and ganglion cells that arise from the sympathetic ganglia; 20–30% arise in the adrenal medulla.[33] These lesions do not secrete hormones and are usually incidental findings. They demonstrate soft tissue attenuation, variable size and homogenous or mildy heterogeneous enhancement.[51] They are typically low on T1-weighted imaging and can have heterogeneous hyperintense T2 signal (Figure 9).[52]

Figure 9.

Right ganglioneuroma. Axial pre- (A) and postcontrast (B), T1-weighted images. The lesion is heterogeneous on the precontrast T1, with patchy mild enhancement on the postcontrast sequence.


Gangioneuroblastomas arise from the neural crest. They tend to be smaller and more well defined than neuroblastoma at diagnosis.[53] They typically demonstrate intermediate signal intensity on T1-weighted images and heterogeneously high signal on T2-weighted images, with heterogeneous, moderate enhancement following administration of contrast material.[42]