Genitourinary Radiology > Adrenal Glands > Metastases


Metastases


The adrenal gland is a common location for metastatic spread: as many as 10-30% of non-small cell lung cancers and 30% of breast cancers have adrenal metastases. Melanoma metastases are also common and are notable for their propensity to hemorrhage. When adrenal masses are found during a metastatic survey, effort must be taken to differentiate between a metastatic lesion and a benign adenoma, which are found in 1% of all abdominal CT scans and 3-9% of autopsy studies. Once adenoma is excluded, effort to further characterize the adrenal mass usually includes adrenal biopsy.

Metastatic lesions are variable in size, increase in size with time, and do not display rapid contrast washout on delayed CT images.

MRI gradient echo T1 weighted images.  Opposed phase (left) and in phase (right) show no drop in signal on opposed phase images when compared with in phase and therefore, this adrenal lesion (arrow) cannot be diagnosed as a benign adrenal adenoma.  Biopsy would be required for further evaluation in a patient with a malignancy.

Same patient as above.  T2 weighted image (left) and post gadolinium T1 weighted image (right) show a high signal mass on T2WI and heterogeneous enhancement following gadolinium administration.  These findings are not specific for metastases.  A pheochromocytoma, for example, would image similarly.  Biopsy would still be required for definitive diagnosis.



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