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Open Access 11-01-2025 | Computed Tomography | Invited Review

Advances in multimodal imaging for adrenal gland disorders: integrating CT, MRI, and nuclear medicine

Authors: Kota Yokoyama, Mitsuru Matsuki, Takanori Isozaki, Kimiteru Ito, Tomoki Imokawa, Akane Ozawa, Koichiro Kimura, Junichi Tsuchiya, Ukihide Tateishi

Published in: Japanese Journal of Radiology

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Abstract

Adrenal diseases pose significant diagnostic challenges due to the wide range of neoplastic and non-neoplastic pathologies. Radiologists have a crucial role in diagnosing and managing these conditions by, leveraging advanced imaging techniques. This review discusses the vital role of computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine in adrenal imaging, and focuses on morphological and functional evaluations. First, the anatomy and physiology of the adrenal glands are described, followed by a discussion on ectopic adrenocortical adenomas and how they develop. The concepts and imaging findings of congenital diseases, such as congenital adrenal hyperplasia (CAH), adrenal rest tumors, and adrenocortical nodular disease, considering recent updates to the WHO Classification of Tumours (5th ed.) terminology are highlighted. The diagnostic value of dynamic contrast-enhanced CT and chemical-shift MRI for identifying adrenocortical adenomas are emphasized, alongside the use of adrenocortical scintigraphy such as 131I-adosterol scintigraphy for diagnosing Cushing’s disease, Cushing’s syndrome (CS), subclinical CS, and ectopic adrenocorticotropic hormone-producing tumors. Systemic complications associated with CS, and the diagnosis and treatment of pheochromocytomas, paragangliomas (PPGLs), and neuroblastomas, will also be discussed focusing on 123I-metaiodobenzylguanidine (MIBG) imaging and 131I-MIBG therapy. Pitfalls in 123I-MIBG imaging and the increasing importance of diagnosing hereditary PPGLs due to increased genetic testing are also be discussed. Additionally, the broad differential diagnosis for adrenal masses—including malignancies like adrenal carcinoma, metastases, and malignant lymphoma, as well as benign conditions like myelolipoma and ganglioneuroma, and complications, such as adrenal hemorrhage, infarction, and infections—will be outlined. The goal of this review was to provide an overview of adrenal diseases that includes the most recent information for radiologists to stay updated on the latest imaging techniques and advancements that can ensure accurate diagnosis and effective management.
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Metadata
Title
Advances in multimodal imaging for adrenal gland disorders: integrating CT, MRI, and nuclear medicine
Authors
Kota Yokoyama
Mitsuru Matsuki
Takanori Isozaki
Kimiteru Ito
Tomoki Imokawa
Akane Ozawa
Koichiro Kimura
Junichi Tsuchiya
Ukihide Tateishi
Publication date
11-01-2025