An Update of Practical CT Adrenal Imaging: What Physicians Need to Know

Computed tomography (CT) is increasingly being utilized for patient care, with a subsequent increase in the detection of incidental adrenal masses. It is important for physicians to be familiar with the various current and investigational CT techniques used to image and characterize adrenal masses, including noncontrast CT, dual-energy CT, post-contrast imaging with percentage washout calculations, and investigational techniques including histogram, perfusion, and biphasic CT analyses. Once an incidental adrenal mass is detected, it is important to utilize current CT adrenal imaging techniques to characterize adrenal masses and differentiate the indolent adrenal masses that may be left alone from malignant and symptomatic masses that need timely medical or surgical management. Current CT imaging techniques can be utilized to differentiate benign adrenal masses from malignant counterparts. In this article, we describe the common CT features of benign adrenal masses, including hyperplasia, adenoma, pheochromocytoma, and myelolipoma. We also describe the common CT features of malignant adrenal masses, including metastases, and adrenal cortical carcinoma.