Adrenal incidentaloma. Part 2. Modern concepts of computed tomography semiotics of adrenal gland incidentalomas: algorithm of differential diagnosis

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Abstract

While accidentally detecting an adrenal gland lesion (incidentaloma) during a routine computed tomography (CT) scan, the radiologist should correctly interpret revealed changes. The most common lesion is adenoma with high lipid content, but a lipid poor adenoma, pheochromocytoma, adrenocortical cancer, metastasis and other less common adrenal diseases are also worth of attention and require detailed knowledge of their CT semiotics. The article presents criteria of differential diagnosis of the adrenal incidentalomas on the basis of which an algorithm of differential diagnosis was proposed for the most common adrenal lesions.

About the authors

Svetlana A. Buryakina

Endocrinology Research Centre

Author for correspondence.
Email: sburyakina@yandex.ru
ORCID iD: 0000-0001-9065-7791

канд. мед. наук, врач-рентгенолог консультативно-диагностического отд-ния ФГБУ «НМИЦ эндокринологии»

Russian Federation, Moscow

Natalia V. Tarbaeva

Endocrinology Research Centre

Email: sburyakina@yandex.ru
ORCID iD: 0000-0001-7965-9454

канд. мед. наук, врач-рентгенолог, зав. отд-нием компьютерной и магнитно-резонансной томографии ФГБУ «НМИЦ эндокринологии

Russian Federation, Moscow

Natalia N. Volevodz

Endocrinology Research Centre

Email: sburyakina@yandex.ru
ORCID iD: 0000-0001-6470-6318

д-р мед. наук, проф., зам. дир. по научной и консультативно-диагностической работе ФГБУ «НМИЦ эндокринологии»

Russian Federation, Moscow

Grigorii G. Karmazanovsky

Vishnevsky National Medical Research Center of Surgery

Email: sburyakina@yandex.ru
ORCID iD: 0000-0002-9357-0998

чл.-кор. РАН, д-р мед. наук, проф., зав. отд-нием рентгенологии и магнитно-резонансных исследований ФГБУ «НМИЦ хирургии им. А.В. Вишневского»

Russian Federation, Moscow

Liliia D. Kovalevich

Endocrinology Research Centre

Email: sburyakina@yandex.ru
ORCID iD: 0000-0001-8958-8223

врач-рентгенолог лечебно-реабилитационного отд. ФГБУ «НМИЦ эндокринологии»

Russian Federation, Moscow

Marina V. Shestakova

Endocrinology Research Centre

Email: sburyakina@yandex.ru
ORCID iD: 0000-0002-5057-127X

акад. РАН, д-р мед. наук, проф., зав. каф. диабетологии и диетологии, зам. дир. – дир. Института диабета ФГБУ «НМИЦ эндокринологии»

Russian Federation, Moscow

Ivan I. Dedov

Endocrinology Research Centre

Email: sburyakina@yandex.ru
ORCID iD: 0000-0002-8175-7886

акад. РАН, д-р мед наук, проф., президент ФГБУ «НМИЦ эндокринологии»

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Lipid-poor adrenal adenoma (arrow). MSCT, axial projection: a – native phase; b – arterial phase; c – venous phase; d – delayed phase.

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3. Fig. 2. Right adrenal myelolipoma surrounded by a thin pseudocapsule (arrow). MSCT, axial projection, native phase.

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4. Fig. 3. Pheochromocytoma in the right adrenal gland (arrow). MSCT, axial projection: a – native phase; b – arterial phase; c – venous phase; d – delayed phase.

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5. Fig. 4. Right adrenal cancer. MSCT, axial projection: a – native phase; b – arterial phase; c – venous phase; d – delayed phase. In the right adrenal gland, an inhomogeneous rounded mass (arrow) with smooth and well-delineated margins and uneven accumulation of contrast, is identified.

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6. Fig. 5. Left adrenal collision tumor (cancer in the structure of adenoma). MSCT, axial projection: a – native phase; b – arterial phase; c – venous phase; d – delayed phase. In the left adrenal gland, a low-density rounded mass (arrow) with smooth and well-delineated margins and an inhomogeneous appearance due to the presence of soft tissue inclusions that intensively accumulate contrast with a slow washout of contrast in the venous and delayed phases is identified.

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7. Fig. 6. Right adrenal simple cyst (arrow). MSCT, axial projection, native phase.

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8. Fig. 7. Algorithm for CT assessment of adrenal tumors (incidentalomas).

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