An adrenal mass discovered incidentally during imaging for unrelated clinical reasons is termed an “adrenal incidentaloma” (AI). AIs can be categorized as primary or metastatic, functioning or non-functioning, and benign or malignant. The primary goal of radiological evaluation is to exclude malignancy by differentiating between benign and malignant lesions. Most AIs are benign, with adenomas and macronodular bilateral adrenal hyperplasia being the most common types. Less common benign lesions include myelolipomas, pheochromocytomas, cysts, and hematomas. Malignant adrenal masses account for less than 10% of cases and often include metastases from other cancers or primary adrenal diseases, such as adrenocortical carcinoma and pheochromocytoma. Computed Tomography (CT) remains the gold standard for diagnosing adrenal incidentalomas, while Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) are utilized for indeterminate cases. Additionally, innovative imaging techniques such as texture analysis are gaining importance, as they can assess quantitative parameters that are not visible to the human eye. This review aims to provide an updated overview of malignant adrenal lesions on CT and MRI, emphasizing key imaging features suspicious for malignancy to aid in distinguishing between benign and malignant lesions. Furthermore, it highlights the growing role of radiomics as a supportive tool for radiologists.
在因其他临床原因进行影像学检查时偶然发现的肾上腺肿块被称为“肾上腺偶发瘤”。肾上腺偶发瘤可分为原发性或转移性、功能性或非功能性、良性或恶性。影像学评估的主要目标是通过区分良恶性病变来排除恶性肿瘤。大多数肾上腺偶发瘤为良性，其中腺瘤和大结节性双侧肾上腺增生是最常见的类型。较少见的良性病变包括髓样脂肪瘤、嗜铬细胞瘤、囊肿和血肿。恶性肾上腺肿块占病例比例不足10%，通常包括其他癌症的转移灶或原发性肾上腺疾病，如肾上腺皮质癌和嗜铬细胞瘤。计算机断层扫描（CT）仍是诊断肾上腺偶发瘤的金标准，而磁共振成像（MRI）和正电子发射断层扫描（PET）则用于不确定病例的评估。此外，纹理分析等创新影像技术正日益受到重视，它们能够评估人眼无法观察到的定量参数。本综述旨在提供关于CT和MRI上恶性肾上腺病变的最新概述，重点介绍提示恶性的关键影像学特征，以帮助区分良恶性病变。同时，本文还强调了放射组学作为放射科医师辅助工具的日益重要的作用。
Adrenal Mass Evaluation: Suspicious Radiological Signs of Malignancy
肿瘤(癌症)患者之家