Imaging Pearls ❯ Adrenal ❯ Metastases
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- Adrenal Metastases: Sites of Origin
• Lung
• Gastric or esophageal cancer
• Hepatic-biliary or pancreatic cancer
• Colon cancer
• Renal cancer
• Breast cancer
• Melanoma
• Sarcoma
• Hematopoietic tumors - “In patients with RCC and HCC who undergo dedicated adrenal CT imaging for known adrenal lesions, the percentage enhancement washout of adrenal metastases is similar to that of lipid-poor adrenal adenomas. Careful imaging follow-up or pathologic tissue confirmation is needed."
Evaluation of adrenal metastases from renal cell carcinoma and hepatocellular carcinoma: Use of Delayed Contrast-enhanced CT Choi YA et al. Radiology 2013; 266:514–520 - “For the workup of adrenal masses in patients with extraadrenal primary RCC or HCC, a careful serial imaging follow-up or tissue con rmation at biopsy or surgery is recommended to exclude the possibility of metastasis."
Evaluation of adrenal metastases from renal cell carcinoma and hepatocellular carcinoma: Use of Delayed Contrast-enhanced CT Choi YA et al. Radiology 2013; 266:514–520 - Adrenal Metastases: CT Findings
• Variable size but often size greater than 4-6 cm
• interval change in size
• irregular shape and necrosis
• invasion of adjacent structures
• Vascularity variable but may be hypervascular - Adrenal Metastases: CT Findings
• Adrenal metastases are commonly bilateral
• Large bilateral metastases are often seen with melanoma
• "collision tumors", in which malignancy occurs in or adjacent to a known pre-existing benign adrenal lesion, such as metastatic disease arising within an adrenal adenoma can occur - “Malignant melanoma is an extremely aggressive form of cancer. Adrenal metastases are found in 50% of cases of malignant melanoma, and are most often clinically and biochemically silent. Clinical presentation varies, and the diagnosis of adrenal metastases is often made incidentally, and frequently years after treatment of the primary lesion. An adrenal mass lesion seen on a CT scan, greater than 5 cm in diameter, with central or irregular areas of necrosis/haemorrhage (and no lipomatous component) is characteristic of a metastasis from malignant melanoma, in the setting of normal gland function. If these features are bilateral, they are pathognomonic. Oval, low-attenuation (on CT) adrenal masses less than 3 cm in diameter should not be considered benign in a patient with any prior history of melanoma.”
Adrenal metastases of malignant melanoma: characteristic computed tomography appearances. Rajaratnam A1, Waugh J. Australas Radiol. 2005 Aug;49(4):325-9.
- “ In patients with RCC and HCC who undergo dedicated adrenal CT imaging for known adrenal lesions, the percentage enhancement washout of adrenal metastases is similar to that of lipid-poor adrenal adenomas. Careful imaging follow-up or pathologic tissue confirmation is needed.”
Evaluation of Adrenal Metastases from Renal Cell Carcinoma and hepatocellular Carcinoma: Use of Delayed Contrast Enhanced CT
Choi YA et al
Radiology 2013; 266:514-520 - The key is the attenuation differences of the venous phase images