Adrenal Cancer

Preliminary Diagnosis: Adrenal Cancer

I. What imaging technique is first-line for this diagnosis?

CT abdomen with and without IV contrast (adrenal protocol CT)

II. Describe the advantages and disadvantages of this technique for diagnosis of adrenal cancer.

Advantages

• Combination of noncontrast, contrast-enhanced, and delayed images often gives the radiologist enough information to accurately diagnose adrenal lesions as benign or malignant.

Disadvantages

• Ionizing radiation exposure

• Administration of iodinated contrast material may cause further worsening of renal function (contrast nephropathy) in patients with existing renal disease. The contrast dose should be reduced or withheld in patients with renal dysfunction.

III. What are the contraindications for the first-line imaging technique?

• Patients with allergic reactions to intravenous contrast should be pretreated with steroids and antihistamines for a minimum of 13 hours before imaging.

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• CT is contraindicated in pregnant patients, especially within the first two trimesters.

IV. What alternative imaging techniques are available?

• MRI abdomen without contrast

• FDG-PET whole body

• May be seen incidentally on abdominal ultrasound or conventional angiogram; however, these modalities not recommended for workup.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of adrenal cancer.

MRI

Advantages

• Best test if CT is contraindicated

• Does not use ionizing radiation and may be performed safely on pregnent patients

• May be performed in cases where CT washout characteristics are not diagnostic of adrenal adenoma

Disadvantages

• More expensive

• Longer imaging time

• Requires greater patient cooperation, and may require sedation in pediatric patients

FDG-PET

Advantages

• Only perform if CT and MRI characteristics are not diagnostic of benign lesion, there is a history of primary malignancy, or there is no prior imaging to establish stability

• Able to evaluate the entire body for evidence of metastatic disease

Disadvantages

• Ionizing radiation exposure

• Reimbursement/insurance coverage issues. Often requires preapproval

VI. What are the contraindications for the alternative imaging techniques?

MRI

• Patients with non-MRI-approved metallic devices

PET

• PET should not be performed in pregnant patients.

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