Weerakkody Y, Niknejad M, Knipe H, et al. Adrenal metastasis. Reference article, Radiopaedia.org (Accessed on 28 May 2023) https://doi.org/10.53347/rID-25045
Adrenal metastases are the most common malignant lesions involving the adrenal gland. Metastases are usually bilateral but may also be unilateral. Unilateral involvement is more prevalent on the left side (ratio of 1.5:1).
Adrenal metastases can have variable CT appearances 4. They usually demonstrate <50% washout.
In patients with RCC and HCC who undergo dedicated adrenal CT imaging for known adrenal lesions, the enhancement washout of adrenal metastases can be similar to that of lipid-poor adrenal adenomas. As hypervascular lesions, they commonly show intense enhancement on the portal venous phase, usually more than 120 HU, and thus can be easily identified.
MRI
Exact signal characteristics can vary depending on the type of tumor. In general, commonly described signal characteristics include:
T1: usually exhibit low signal intensity 2
T2: often show high signal intensity 2
T1 C+ (Gd): usually has progressive enhancement after administration of contrast material 2
An important diagnostic feature is the lack of signal loss on out-of-phase images (in contradistinction to that seen with adrenal adenoma).
Practical points
on CT, metastases usually demonstrate <50% washout
if intense enhancement of >120 HU is identified in the portal venous phase, washout should be ignored, and a hypervascular lesion such as RCC or HCC metastasis should be considered as a primary
2. Elsayes K, Mukundan G, Narra V et al. Adrenal Masses: MR Imaging Features with Pathologic Correlation. Radiographics. 2004;24 Suppl 1(suppl_1):S73-86. doi:10.1148/rg.24si045514 - Pubmed
3. Taniai N, Egami K, Wada M, Tajiri T, Onda M. Adrenal Metastasis from Hepatocellular Carcinoma (HCC): Report of 3 Cases. Hepatogastroenterology. 1999;46(28):2523-8. - Pubmed
4. Johnson P, Horton K, Fishman E. Adrenal Mass Imaging with Multidetector CT: Pathologic Conditions, Pearls, and Pitfalls. Radiographics. 2009;29(5):1333-51. doi:10.1148/rg.295095027 - Pubmed
5. Choi Y, Kim C, Park B, Kim B. Evaluation of Adrenal Metastases from Renal Cell Carcinoma and Hepatocellular Carcinoma: Use of Delayed Contrast-Enhanced CT. Radiology. 2013;266(2):514-20. doi:10.1148/radiol.12120110 - Pubmed
7. Zaidi S, Lakhani V, Fadare O, Khabele D. Adrenal Gland Metastasis is an Unusual Manifestation of Endometrial Cancer. Case Rep Surg. 2013;2013:428456. doi:10.1155/2013/428456 - Pubmed
8. Patlas M, O'Malley M, Chapman W. Adrenal Metastasis from Ovarian Carcinoma. AJR Am J Roentgenol. 2004;183(6):1711-2. doi:10.2214/ajr.183.6.01831711 - Pubmed
9. Zhou W, Modica I, Wenig B, Yi C. Solitary Adrenal Metastasis of Prostate Cancer Mimicking Primary Adrenocortical Carcinoma. Am J Clin Pathol. 2014;142(suppl_1):A258. doi:10.1093/ajcp/142.suppl1.258
10. Hasegawa K, Asakawa A, Kamiya A et al. [A Case of Gastric Cancer with Adrenal Metastasis That Responded to Chemotherapy]. Gan To Kagaku Ryoho. 2015;42(12):2078-80. - Pubmed
12. Hadlich E, Carbonari A, Assef M et al. Esophageal Adenocarcinoma Metastasis in the Left Adrenal Gland Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Aspiration. Endosc Ultrasound. 2017;6(2):142-4. doi:10.4103/2303-9027.204809 - Pubmed
13. Honda M, Suzuki K, Sugaya S et al. [Solitary Adrenal Metastasis of Bladder Carcinoma : A Case Report]. Hinyokika Kiyo. 2012;58(9):495-7. - Pubmed
14. Potepan P, Danesini G, Spagnoli I et al. Adrenal Gland Metastasis in Osteogenic Osteosarcoma. A Radiological Case Report. Tumori. 1992;78(6):417-20. - Pubmed
15. Koutkia P & Safer J. Adrenal Metastasis Secondary to Papillary Thyroid Carcinoma. Thyroid. 2001;11(11):1077-9. doi:10.1089/105072501753271798 - Pubmed
16. Zakaria B, Pierre-Etienne T, Véronique D, Vincent M, Walid M, Hervé B. A Case of Adrenal Metastasis in Seminoma. Case Rep Urol. 2013;2013:495743. doi:10.1155/2013/495743 - Pubmed
Unable to process the form. Check for errors and try again.