Adrenal metastasis

Changed by Yaïr Glick, 20 Jun 2017

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Adrenal metastases are the most common malignant lesions involving the adrenal gland. Metastases are usually bilateral but may also be unilateral. When unilateralUnilateral involvement is thought to be more prevalent on the left side (ratio of 1.5:1).

Epidemiology

They are thought to be presentpresent at autopsy in up to 27% of patients with known malignant epithelial tumours at autopsy.

Pathology

Primary sites

Many primary tumours can potentially metastasise to the adrenal glands. Common primary tumours that metastasise to the adrenal glands include, commonly:

Other reported primary tumours include:

Radiographic features

CT

Adrenal metastases can have a variable CT appearances 4. Usually, demonstratesThey usually demonstrate less than 50% washout.

In patients with renal cell carcinoma and hepatocellular carcinoma who undergo dedicated adrenal CT imaging for known adrenal lesions, the percentage enhancement washout of adrenal metastases can be similar to that of lipid-poor adrenal adenomas. As hypervascular lesions, they commonly show vividintense enhancement on the portal venous phase, usually more than 120 HU, and thus can be easily identified. 

MRI

Exact signal characteristics can vary dependantdepending on the type of tumour. 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 less than 50% washout
  • if vividintense enhancement of more than 120 HU is identified in the portal venous phase, the washout should be ignored, and ana hypervascular lesion such as RCC and HCCrenal cell carcinoma or hepatocellular carcinoma metastasis should be considered
  • MRI: lack of no signal loss on out-of-phase images
  • -<p><strong>Adrenal metastases</strong> are the most common malignant lesions involving the adrenal gland. Metastases are usually bilateral but may also be unilateral. When unilateral involvement is thought to be more prevalent on the left side (ratio of 1.5:1).</p><h4>Epidemiology</h4><p>They are thought to be present in up to 27% of patients with known malignant epithelial tumours at autopsy.</p><h4>Pathology</h4><h5>Primary sites</h5><p>Many primary tumours can potentially metastasise to the adrenal glands. Common primary tumours that metastasise to the adrenal glands include:</p><ul>
  • +<p><strong>Adrenal metastases</strong> 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).</p><h4>Epidemiology</h4><p>They are present at autopsy in up to 27% of patients with known malignant epithelial tumours.</p><h4>Pathology</h4><h5>Primary sites</h5><p>Many primary tumours can potentially metastasise to the adrenal glands, commonly:</p><ul>
  • -</ul><h4>Radiographic features</h4><h5>CT</h5><p>Adrenal metastases can have a variable CT appearances <sup>4</sup>. Usually, demonstrates less than 50% washout.</p><p>In patients with renal cell carcinoma and hepatocellular carcinoma who undergo dedicated adrenal CT imaging for known adrenal lesions, the percentage enhancement washout of adrenal metastases can be similar to that of lipid-poor adrenal adenomas. As hypervascular lesions, they commonly show vivid enhancement on the portal venous phase, usually more than 120 HU, and thus can be easily identified. </p><h5>MRI</h5><p>Exact signal characteristics can vary dependant on the type of tumour. In general, commonly described signal characteristics include:</p><ul>
  • +</ul><h4>Radiographic features</h4><h5>CT</h5><p>Adrenal metastases can have a variable CT appearances <sup>4</sup>. They usually demonstrate less than 50% washout.</p><p>In patients with renal cell carcinoma and hepatocellular carcinoma 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. </p><h5>MRI</h5><p>Exact signal characteristics can vary depending on the type of tumour. In general, commonly described signal characteristics include:</p><ul>
  • -<li>if vivid enhancement of more than 120 HU is identified in the portal venous phase, the washout should be ignored, and an hypervascular lesion such as RCC and HCC metastasis should be considered </li>
  • -<li>MRI: lack of signal loss on out-of-phase images</li>
  • +<li>if intense enhancement of more than 120 HU is identified in the portal venous phase, washout should be ignored, and a hypervascular lesion such as renal cell carcinoma or hepatocellular carcinoma metastasis should be considered</li>
  • +<li>MRI: no signal loss on out-of-phase images</li>

Sections changed:

Systems changed:

  • Oncology
Images Changes:

Image 1 CT (C+ portal venous phase) ( create )

Image 4 CT (C+ portal venous phase) ( create )

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