DOI: 10.1148/rg.24si045514
Adrenal Masses: MR Imaging Features with Pathologic Correlation1
Khaled M. Elsayes, MD,
Govind Mukundan, MD,
Vamsidhar R. Narra, MD,
James S. Lewis, MD, Jr,
Ali Shirkhoda, MD,
Aamer Farooki, MD and
Jeffrey J. Brown, MD
1 From the Mallinckrodt Institute of Radiology (K.M.E., G.M., V.R.N., A.F., J.J.B.) and Department of Surgical Pathology (J.S.L.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; and the Department of Radiology, William Beaumont Hospital. Royal Oak, Mich (A.S.). Presented as an education exhibit at the 2003 RSNA scientific assembly. Received March 19, 2004; revision requested April 14 and received May 3; accepted May 19. All authors have no financial relationships to disclose. Address correspondence to K.M.E. (e-mail: elsayesk@mir.wustl.edu).
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Figure 1. Drawing depicts the gross anatomy of the left adrenal gland and its vascular supply. a = artery, l = left, v = vein.
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Figure 2. Photomicrograph (original magnification, x40; hematoxylin-eosin [H-E] stain) of a normal adrenal gland specimen shows an outer capsule (C) and the cortical layers: zona glomerulosa (G), fasciculata (F), and reticularis (R). The medulla (M) is present centrally.
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Figure 3. Coronal T1-weighted, three-dimensional, GRE MR image obtained with VIBE shows the normal inverted Y shape of the right adrenal gland (arrow).
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Figure 4a. (a, b) Axial in-phase (a) and out-of-phase (b) MR images show an adrenal adenoma (arrow), which exhibits the typical decrease in signal intensity on the out-of-phase image. (c) Photograph of the specimen shows a well-circumscribed bright yellow nodule, an appearance that is typical of adrenocortical adenoma.
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Figure 4b. (a, b) Axial in-phase (a) and out-of-phase (b) MR images show an adrenal adenoma (arrow), which exhibits the typical decrease in signal intensity on the out-of-phase image. (c) Photograph of the specimen shows a well-circumscribed bright yellow nodule, an appearance that is typical of adrenocortical adenoma.
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Figure 4c. (a, b) Axial in-phase (a) and out-of-phase (b) MR images show an adrenal adenoma (arrow), which exhibits the typical decrease in signal intensity on the out-of-phase image. (c) Photograph of the specimen shows a well-circumscribed bright yellow nodule, an appearance that is typical of adrenocortical adenoma.
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Figure 5. Axial T1-weighted out-of-phase MR image shows an adrenal adenoma (black arrow) with a focal area of high-signal-intensity hemorrhage (white arrow).
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Figure 6a. (a, b) Axial T1-weighted MR images obtained without fat suppression (a) and with fat suppression (b) show typical MR imaging features of right adrenal myelolipoma. The fatty component of the myelolipoma (arrow in a) shows a decrease in signal intensity on the fat-suppressed image. (c) Photomicrograph (original magnification, x100; H-E stain) shows the typical microscopic appearance of myelolipoma. There is fat and a maturing marrow element on the right side and an otherwise normal adrenal cortex on the left.
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Figure 6b. (a, b) Axial T1-weighted MR images obtained without fat suppression (a) and with fat suppression (b) show typical MR imaging features of right adrenal myelolipoma. The fatty component of the myelolipoma (arrow in a) shows a decrease in signal intensity on the fat-suppressed image. (c) Photomicrograph (original magnification, x100; H-E stain) shows the typical microscopic appearance of myelolipoma. There is fat and a maturing marrow element on the right side and an otherwise normal adrenal cortex on the left.
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Figure 6c. (a, b) Axial T1-weighted MR images obtained without fat suppression (a) and with fat suppression (b) show typical MR imaging features of right adrenal myelolipoma. The fatty component of the myelolipoma (arrow in a) shows a decrease in signal intensity on the fat-suppressed image. (c) Photomicrograph (original magnification, x100; H-E stain) shows the typical microscopic appearance of myelolipoma. There is fat and a maturing marrow element on the right side and an otherwise normal adrenal cortex on the left.
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Figure 7a. (a, b) Coronal T1-weighted in-phase (a) and T2-weighted half-Fourier RARE (b) MR images show an oval, well-circumscribed, right adrenal cyst (arrow in b) with a thin wall (arrowhead in b). The cyst has a typical appearance, showing low signal intensity at T1-weighted imaging and high signal intensity at T2-weighted imaging. (c) Photomicrograph (original magnification, x100; H-E stain) shows a cystic lesion with a simple cuboidal mesothelial lining.
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Figure 7b. (a, b) Coronal T1-weighted in-phase (a) and T2-weighted half-Fourier RARE (b) MR images show an oval, well-circumscribed, right adrenal cyst (arrow in b) with a thin wall (arrowhead in b). The cyst has a typical appearance, showing low signal intensity at T1-weighted imaging and high signal intensity at T2-weighted imaging. (c) Photomicrograph (original magnification, x100; H-E stain) shows a cystic lesion with a simple cuboidal mesothelial lining.
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Figure 7c. (a, b) Coronal T1-weighted in-phase (a) and T2-weighted half-Fourier RARE (b) MR images show an oval, well-circumscribed, right adrenal cyst (arrow in b) with a thin wall (arrowhead in b). The cyst has a typical appearance, showing low signal intensity at T1-weighted imaging and high signal intensity at T2-weighted imaging. (c) Photomicrograph (original magnification, x100; H-E stain) shows a cystic lesion with a simple cuboidal mesothelial lining.
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Figure 8a. (a) Axial T2-weighted MR image obtained with inversion recovery shows a left adrenal pseudocyst. Note the soft-tissue component in the wall and the posteriorly located calcification (arrow). (b) Photograph of the specimen shows a well-circumscribed cystic mass with abundant gummous tan material compressing the nearby kidney (arrowhead) without infiltrating it or the surrounding soft tissue.
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Figure 8b. (a) Axial T2-weighted MR image obtained with inversion recovery shows a left adrenal pseudocyst. Note the soft-tissue component in the wall and the posteriorly located calcification (arrow). (b) Photograph of the specimen shows a well-circumscribed cystic mass with abundant gummous tan material compressing the nearby kidney (arrowhead) without infiltrating it or the surrounding soft tissue.
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Figure 9. (a, b) Coronal T2-weighted MR image obtained with half-Fourier RARE (a) and axial contrast-enhanced VIBE image (b) show a left adrenal mass with areas of signal intensity similar to that of blood. (c) Photograph of the specimen shows a hemorrhagic complicated adrenal cyst with hyalinized material.
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Figure 9b. (a, b) Coronal T2-weighted MR image obtained with half-Fourier RARE (a) and axial contrast-enhanced VIBE image (b) show a left adrenal mass with areas of signal intensity similar to that of blood. (c) Photograph of the specimen shows a hemorrhagic complicated adrenal cyst with hyalinized material.
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Figure 9. (a, b) Coronal T2-weighted MR image obtained with half-Fourier RARE (a) and axial contrast-enhanced VIBE image (b) show a left adrenal mass with areas of signal intensity similar to that of blood. (c) Photograph of the specimen shows a hemorrhagic complicated adrenal cyst with hyalinized material.
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Figure 10a. (a) Coronal T1-weighted, three-dimensional, GRE MR image obtained with VIBE shows a lymphangioma, which has the typical appearance of a well-circumscribed area of low signal intensity. (b) Photograph of the specimen shows the thin-walled lymphangioma.
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Figure 10b. (a) Coronal T1-weighted, three-dimensional, GRE MR image obtained with VIBE shows a lymphangioma, which has the typical appearance of a well-circumscribed area of low signal intensity. (b) Photograph of the specimen shows the thin-walled lymphangioma.
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Figure 11a. (a-c) Axial T1-weighted in-phase MR image (a), out-of-phase MR image (b), and three-dimensional GRE contrast-enhanced MR image with VIBE (c) show a pheochromocytoma (arrow). The pheochromocytoma shows the typical features of no loss of signal intensity on the out-of-phase image and intense enhancement on the contrast-enhanced image. (d) Photograph of sections of the resected specimen shows a typical, homogeneous, well-circumscribed, tan-pink lesion, an appearance typical of pheochromocytoma.
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Figure 11b. (a-c) Axial T1-weighted in-phase MR image (a), out-of-phase MR image (b), and three-dimensional GRE contrast-enhanced MR image with VIBE (c) show a pheochromocytoma (arrow). The pheochromocytoma shows the typical features of no loss of signal intensity on the out-of-phase image and intense enhancement on the contrast-enhanced image. (d) Photograph of sections of the resected specimen shows a typical, homogeneous, well-circumscribed, tan-pink lesion, an appearance typical of pheochromocytoma.
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Figure 11c. (a-c) Axial T1-weighted in-phase MR image (a), out-of-phase MR image (b), and three-dimensional GRE contrast-enhanced MR image with VIBE (c) show a pheochromocytoma (arrow). The pheochromocytoma shows the typical features of no loss of signal intensity on the out-of-phase image and intense enhancement on the contrast-enhanced image. (d) Photograph of sections of the resected specimen shows a typical, homogeneous, well-circumscribed, tan-pink lesion, an appearance typical of pheochromocytoma.
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Figure 11d. (a-c) Axial T1-weighted in-phase MR image (a), out-of-phase MR image (b), and three-dimensional GRE contrast-enhanced MR image with VIBE (c) show a pheochromocytoma (arrow). The pheochromocytoma shows the typical features of no loss of signal intensity on the out-of-phase image and intense enhancement on the contrast-enhanced image. (d) Photograph of sections of the resected specimen shows a typical, homogeneous, well-circumscribed, tan-pink lesion, an appearance typical of pheochromocytoma.
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Figure 12a. (a, b) Coronal in-phase (a) and out-of-phase (b) MR images show bilateral large, adreniform masses (arrows), which represent adrenal cortical hyperplasia. (c) Photomicrograph (H-E stain) shows that the adrenal cortex has extensive nodules of clear cells (arrows), a finding typical of adrenal cortical hyperplasia.
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Figure 12b. (a, b) Coronal in-phase (a) and out-of-phase (b) MR images show bilateral large, adreniform masses (arrows), which represent adrenal cortical hyperplasia. (c) Photomicrograph (H-E stain) shows that the adrenal cortex has extensive nodules of clear cells (arrows), a finding typical of adrenal cortical hyperplasia.
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Figure 12c. (a, b) Coronal in-phase (a) and out-of-phase (b) MR images show bilateral large, adreniform masses (arrows), which represent adrenal cortical hyperplasia. (c) Photomicrograph (H-E stain) shows that the adrenal cortex has extensive nodules of clear cells (arrows), a finding typical of adrenal cortical hyperplasia.
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Figure 13. Axial unenhanced T1-weighted three-dimensional GRE MR image obtained with VIBE demonstrates a right adrenal gland with a high-signal-intensity rim (arrows), a finding that is consistent with subacute hematoma.
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Figure 14a. (a, b) Sagittal T1-weighted three-dimensional contrast-enhanced GRE MR image obtained with VIBE (a) and coronal T2-weighted MR image obtained with half-Fourier RARE (b) show a large mass involving the right adrenal gland. The mass exhibits heterogeneous low signal intensity on the T1-weighted image and high signal intensity with a heterogeneous pattern of contrast enhancement and areas of necrosis (arrow in b) on the T2-weighted image. (c) Photograph of the specimen shows a yellow and red tumor with large areas of necrosis, findings typical of adrenocortical carcinoma.
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Figure 14b. (a, b) Sagittal T1-weighted three-dimensional contrast-enhanced GRE MR image obtained with VIBE (a) and coronal T2-weighted MR image obtained with half-Fourier RARE (b) show a large mass involving the right adrenal gland. The mass exhibits heterogeneous low signal intensity on the T1-weighted image and high signal intensity with a heterogeneous pattern of contrast enhancement and areas of necrosis (arrow in b) on the T2-weighted image. (c) Photograph of the specimen shows a yellow and red tumor with large areas of necrosis, findings typical of adrenocortical carcinoma.
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Figure 14c. (a, b) Sagittal T1-weighted three-dimensional contrast-enhanced GRE MR image obtained with VIBE (a) and coronal T2-weighted MR image obtained with half-Fourier RARE (b) show a large mass involving the right adrenal gland. The mass exhibits heterogeneous low signal intensity on the T1-weighted image and high signal intensity with a heterogeneous pattern of contrast enhancement and areas of necrosis (arrow in b) on the T2-weighted image. (c) Photograph of the specimen shows a yellow and red tumor with large areas of necrosis, findings typical of adrenocortical carcinoma.
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Figure 15a. (a, b) Axial T1-weighted in-phase (a) and out-of-phase (b) MR images show bilateral lymphomatous deposits. The deposits have low signal intensity, and the signal intensity does not decrease on the out-of-phase compared with the in-phase image. (c) Photomicrograph (H-E stain) shows moderately pleomorphic large tumor cells in sheets, with abundant apoptosis and mitotic activity. These findings helped characterize this diffuse large cell lymphoma that manifested as an adrenal mass.
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Figure 15b. (a, b) Axial T1-weighted in-phase (a) and out-of-phase (b) MR images show bilateral lymphomatous deposits. The deposits have low signal intensity, and the signal intensity does not decrease on the out-of-phase compared with the in-phase image. (c) Photomicrograph (H-E stain) shows moderately pleomorphic large tumor cells in sheets, with abundant apoptosis and mitotic activity. These findings helped characterize this diffuse large cell lymphoma that manifested as an adrenal mass.
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Figure 15c. (a, b) Axial T1-weighted in-phase (a) and out-of-phase (b) MR images show bilateral lymphomatous deposits. The deposits have low signal intensity, and the signal intensity does not decrease on the out-of-phase compared with the in-phase image. (c) Photomicrograph (H-E stain) shows moderately pleomorphic large tumor cells in sheets, with abundant apoptosis and mitotic activity. These findings helped characterize this diffuse large cell lymphoma that manifested as an adrenal mass.
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Figure 16a. (a, b) Axial T2-weighted MR image obtained with inversion recovery (a) and contrast-enhanced T1-weighted MR image obtained with VIBE (b) show metastasis from renal cell carcinoma, which has a central area of necrosis. (c) Photograph of the specimen shows tan to yellow nodules of focally hemorrhagic tumor (left side, arrow) within an otherwise normal yellow and brown adrenal cortex and medulla (right side).
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Figure 16b. (a, b) Axial T2-weighted MR image obtained with inversion recovery (a) and contrast-enhanced T1-weighted MR image obtained with VIBE (b) show metastasis from renal cell carcinoma, which has a central area of necrosis. (c) Photograph of the specimen shows tan to yellow nodules of focally hemorrhagic tumor (left side, arrow) within an otherwise normal yellow and brown adrenal cortex and medulla (right side).
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Figure 16c. (a, b) Axial T2-weighted MR image obtained with inversion recovery (a) and contrast-enhanced T1-weighted MR image obtained with VIBE (b) show metastasis from renal cell carcinoma, which has a central area of necrosis. (c) Photograph of the specimen shows tan to yellow nodules of focally hemorrhagic tumor (left side, arrow) within an otherwise normal yellow and brown adrenal cortex and medulla (right side).
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Figure 17a. (a, b) Coronal unenhanced T1-weighted MR image (a) and axial T2-weighted MR image obtained with inversion recovery (b) show a right adrenal tumor. The tumor is predominantly hypointense on the T1-weighted image and has areas of high-signal-intensity hemorrhage (arrow in a). The tumor is hyperintense on the T2-weighted image. (c) Photograph of the specimen shows a lobulated and hemorrhagic-appearing neuroblastoma originating in the adrenal gland. (Case courtesy of Marilyn Siegel, MD, Mallinckrodt Institute of Radiology, Washington University, St Louis, Mo.)
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Figure 17b. (a, b) Coronal unenhanced T1-weighted MR image (a) and axial T2-weighted MR image obtained with inversion recovery (b) show a right adrenal tumor. The tumor is predominantly hypointense on the T1-weighted image and has areas of high-signal-intensity hemorrhage (arrow in a). The tumor is hyperintense on the T2-weighted image. (c) Photograph of the specimen shows a lobulated and hemorrhagic-appearing neuroblastoma originating in the adrenal gland. (Case courtesy of Marilyn Siegel, MD, Mallinckrodt Institute of Radiology, Washington University, St Louis, Mo.)
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Figure 17c. (a, b) Coronal unenhanced T1-weighted MR image (a) and axial T2-weighted MR image obtained with inversion recovery (b) show a right adrenal tumor. The tumor is predominantly hypointense on the T1-weighted image and has areas of high-signal-intensity hemorrhage (arrow in a). The tumor is hyperintense on the T2-weighted image. (c) Photograph of the specimen shows a lobulated and hemorrhagic-appearing neuroblastoma originating in the adrenal gland. (Case courtesy of Marilyn Siegel, MD, Mallinckrodt Institute of Radiology, Washington University, St Louis, Mo.)
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Figure 18a. (a) Axial in-phase T1-weighted MR image shows a heterogeneous mass with intermediate signal intensity involving the right adrenal gland. (b) Photograph of the specimen shows a dark brown to tan lobulated ganglioneuroblastoma with areas of necrosis and compression of the adjacent kidney. There is a rim of residual yellow cortex.
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Figure 18b. (a) Axial in-phase T1-weighted MR image shows a heterogeneous mass with intermediate signal intensity involving the right adrenal gland. (b) Photograph of the specimen shows a dark brown to tan lobulated ganglioneuroblastoma with areas of necrosis and compression of the adjacent kidney. There is a rim of residual yellow cortex.
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Copyright © 2004 by the Radiological Society of North America.
