Transcript Document

ADRENAL MASSES: MR IMAGING
FEATURES WITH PATHOLOGIC
CORRELATION
By :
Nour Eldin Mohammed
Ref: Khaled M. Elsayes, et al , 2004, Radiographics
Normal Anatomy
 The adrenal glands are two
small, yellowish bodies located
in the perirenal space,
immediately anterosuperior to
the upper pole of the kidneys.
 They are very vascular and
receive blood supply from the
superior, middle, and inferior
suprarenal arteries
 The adrenal gland is
composed of an outer
cortex and thinner inner
medulla.
 The cortex is further
subdivided into three
zones: outer zona
glomerulosa, middle zona
fasciculata, and inner zona
reticularis
Normal MRI Appearance
 The right adrenal gland is
located posterior to the inferior
vena cava and superior to the
upper pole of the right kidney.
 The left adrenal gland is
anteromedial to the upper pole
of the kidney and posterior to
the pancreas
 Normal adrenal glands range
from 2 to 6 mm in thickness
and from 2 to 4 cm in length
Fat-containing Adrenal
Masses

Fat-containing adrenal masses can be classified
into two main types:
those that contain intracellular fat (eg,
adenoma)
2. and those with macroscopic fat (eg,
myelolipoma).
1.
Adrenal Adenoma
 The most common adrenal lesions.
 Characterised by the presence of intracellular lipid.
 Chemical shift imaging is the most reliable technique for
diagnosing adrenal adenoma with loss of signal intensity
on out-of-phase images.
 Uniform enhancement with contrast enhanced images is
typical of adenomas.
 Cystic changes, hemorrhage, or variation in vascularity
lead to small, rounded foci of altered signal intensity.
Axial in Phase MRI
Axial out of phase MRI
Myelolipoma
 The myelolipoma is an uncommon benign tumor
composed of mature adipose tissue and hematopoietic
tissue.
 Mostly discovered accidentally.
 The fatty component of this tumor is hyperintense on T1weighted images.
 With loss of signal intensity of the fatty component on
Fat-Suppressed Technique.
Axial T1 MRI
Axial T1 with Fat
Suppressed Technique
Cystic Masses

These include :
1. Simple Cysts
2. Pseudocysts
3. Lymphangioma
Simple Cysts
T1 Coronal MRI
T2 Coronal MRI
Pseudocysts
 Pseudocysts typically arise after an episode of adrenal
hemorrhage and do not have an epithelial lining.
 Have a complicated appearance on MR images,
manifesting with septations, blood products, or a softtissue component secondary to hemorrhage or
hyalinized thrombus.
 Peripheral curvilinear calcification may be present.
Axial T1 with Contrast
Coronal T2 MRI
Lymphangioma
Low signal intensity at T1-weighted imaging and high
signal intensity at T2-weighted
Hypervascular Lesions
(Pheochromocytoma)


It arises from the adrenal medulla.
10% of pheochromocytomas are bilateral,10% are
extraadrenal,10% occur in children, and 10% are
malignant

Pheochromocytomas do not contain a substantial
amount of cytoplasmic lipid, So they maintain their
signal intensity on out-of-phase GRE chemical shift
images.

Most pheochromocytomas demonstrate high signal
intensity on T2-weighted images (light bulb sign).
Axial T1 in Phase MRI
Contrast-enhanced Image
Axial T1 out of Phase MRI
Malignant Neoplasms
 Adrenocortical Carcinoma
 Adrenal Lymphoma
 Metastases
Adrenocortical Carcinoma
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a rare tumor.
Age : 30 - 70
Large size
Can manifest as a hyperfunctioning mass
causing Cushing syndrome or Conn
syndrome.
 Other manifestations include an
abdominal mass and abdominal pain.
Sagittal 3D contrastenhanced MRI
Coronal T2-weighted MRI
Adrenal Lymphoma
 More with non-Hodgkin lymphoma
 Bilateral involvement occurs in 50% of
patients .
 Characterized by low signal intensity on T1 WI
and heterogeneous high signal intensity on
T2 WI , with minimal progressive
enhancement after administration of
contrast material.
Axial T1-weighted MRI
Axial T2-weighted MRI
Metastases
 The most common malignant lesions involving
the adrenal gland.
 Found in up to 27% of patients with Carcinomas
at autopsy.
 Common primary sites of tumors that
metastasize to the adrenal glands include the
lung, bowel, breast, and pancreas.
 Usually bilateral but may also be unilateral.
Contrast Enhanced T1 Image Of Metastatic
Deposit From Renal Cell Carcinoma
Pediatric Neoplasms
 Neuroblastoma
 Ganglioneuroblastoma
Neuroblastoma
 The 2nd most common pediatric abdominal
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mass (after Wilms tumor).
Representing 5%–15% of all malignant tumors in
children .
Arises from the neural crest in the adrenal
medulla or along the sympathetic chain.
Usually demonstrates heterogeneous low signal
intensity on T1-weighted images, high signal
intensity on T2-weighted images , and
enhancement after administration of contrast
material.
Calcification is present in 80%–90% of the
lesions
Coronal unenhanced T1 MRI
Axial T2 MRI
Ganglioneuroblastoma
 Intermediate in malignancy between that of
neuroblastoma and ganglioneuroma
 arise from the neural crest.
 Ganglioneuroblastoma are smaller and more
well defined than neuroblastoma
 Demonstrates Intermediate signal intensity on
T1 WI and heterogeneously high signal intensity
on T2 WI, with heterogeneous enhancement
after administration of contrast material.
T1-WI shows a heterogeneous mass with
intermediate signal intensity
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