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MRI of the Adrenal Glands

Basics: What is an MRI of the Adrenal glands?

MRI of the Adrenal Glands is a MRI of the abdomen with and without contrast, with attention to the adrenal glands, which are usually in the upper abdomen, just above the kidneys. Special MRI sequences, called “In phase, and Out of Phase” are obtained to help delineate benign from malignant pathology.

Additional:
James B. Schnitker, MD; David W. Light, MD MRI of the adrenal glands is performed primarily to distinguish an adrenal adenoma from a metastatic lesion. Adrenal adenomas are often incidentally noted on CT scans, and characteristics may be equivocal or the patient may have no known primary neoplasm. These masses typically are unilateral and less than 3 cm in diameter. Because adrenal adenomas contain intracellular lipids, opposed-phase or chemical-shift MRI scanning is used to distinguish these lesions from non-lipid-containing metastatic lesions. A lesion signal that decreases on the opposed-phase image is characteristic of an adenoma. Other benign fat-containing lesions of the adrenal system, such as myelolipoma or lipoma, also may lose signal on the opposed-phase image; however, these lesions usually have focal collections of fat that are readily visible on CT and do not present the same diagnostic challenge. Metastatic lesions maintain a similar appearance on the in-phase and opposed-phase images, a characteristic that distinguishes them from adenomas.

Pheochromocytomas and other paragangliomas classically have a "light bulb" (very intense) appearance on T2-weighted images. Pheochromocytoma has been listed as one of the contraindications for administration of iodinated contrast material, but the abdomen can be scanned with MRI for evidence of adrenal masses or typical locations for paragangliomas, such as the organ of Zuckerkandl and the sympathetic chain. Imaging with indium In 111 and pentetreotide (OctreoScan) or iobenguane sulfate I 131 typically is used if the patient is hypertensive and has biochemical evidence of pheochromocytoma but the MRI shows no evidence of adrenal or other abdominal masses.

Discussion of images above:

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