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Test Details
Test Code:NM0017
Test Name:Adrenal Imaging
Test Details & Preparation
The role of imaging in adrenal lesions is essentially to differentiate benign and malignant lesions, metastatic from non-metastatic lesions and provide definitive diagnosis wherever possible to obviate further invasive testing. Fortunately at present, with a wide array of imaging techniques at disposal, anatomic imaging can give the definitive diagnosis in most cases, thereby eliminating the need for further testing. Functional imaging however plays a greater role in imaging medullary tumours such as pheochromocytoma and occasionally in neuroblastoma.

Ultrasonography (USG) is a readily available technique for evaluation of abdominal pathologies. Though the visualization of retroperitoneal structures like adrenals is difficult on USG, it still has a role in incidentally detecting adrenal masses, in monitoring the changes during treatment of already established pathology and enables visualization of other abdominal organs at the same setting without any risk of radiation exposure and is cost effective. Ultrasonography shows adrenal glands quite accurately in infants and children as compared to adults where they may be obscured due to bowel gas and obesity. On Ultrasonography, if no mass is seen with or without visualization of normal adrenals, it is considered to be specific for the absence of malignancy.

Computed tomography (CT) is undoubtedly the mainstay of adrenal imaging. But with the widespread use of multi-detector CT, there has also been an increase in detection of incidental adrenal nodules. Normal adrenal glands are seen as inverted V- or Y-shaped structures lying anterosuperior to the kidneys in the retroperitoneum. The glands are readily identified owing to the presence of abundant retroperitoneal fat in most patients. The two limbs are thinner as compared to the apex where two limbs join. Mean thickness of gland is 5-6 mm with maximum width of 10 mm and approximate length is 2-4 cm in one section of CT. Paucity of retroperitoneal fat may render visualization of adrenals difficult due to overlap of surrounding structures.

Magnetic resonance imaging (MRI) has very specific indications in adrenal imaging. MRI does not offer additional spatial resolution and is chiefly used as an alternative to CT. Chemical shift imaging (CSI) is a non-contrast MRI technique that can be used for diagnosis of adenoma when CT is contraindicated or washout values are equivocal. It is based on the principle that fat has a lower precession resonant frequency than water in the presence of an externally applied magnetic field.

Positron emission tomography (PET) and PET-CT along with current high-resolution scanners can detect even minute lesions. Both qualitative and quantitative assessment can differentiate benign and malignant adrenal lesions with high sensitivity and specificity. PET can also help in response assessment in lymphomas and be used in disease staging by detecting total disease burden in both primary ACC, neuroblastomas and secondary metastases.
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