Characterization of adrenal masses using MR imaging with histopathologic correlation

OBJECTIVE, The purpose of this study was to evaluate the sensitivity, specificity, and accuracy of MR imaging in the characterization of adrenal masses by correlating imaging findings with histopathologic results. In addition, adrenal tumors that were of an indeterminate nature on MR imaging were analyzed. SUBJECTS AND METHODS. For 114 patients with 134 adrenal masses, MR findings were compared with histologic results. In all patients, MR imaging was performed using T2-weighted fast spin-echo imaging and unenhanced and gadolinium-enhanced T1-weighted spin-echo imaging. Chemical-shift imaging was performed in 92 patients and dynamic gadolinium-enhanced studies in 108 patients. Chemical-shift images were analyzed quantitatively and qualitatively, and dynamic gadolinium-enhanced studies were qualitatively assessed. RESULTS. The sensitivity of MR imaging in differentiating between benign and malignant adrenal masses was 91%, the specificity was 94%, and the accuracy was 93%. The diagnosis at MR imaging differed from that at histology in 12 (9%) of 134 patients. Results of quantitative analyses of chemical-shift imaging techniques showed significant differences between adenomas and nonadenomas (-36.0% versus -3.7%; p < .001). Qualitative analysis provided a similar diagnostic confidence compared with quantitative analysis. Both chemical-shift and dynamic gadolinium-enhanced studies proved to be unreliable in characterizing borderline tumors (epithelial tumors with high malignant potential). Moreover, such imaging failed to allow correct diagnosis of adenomas in two patients. CONCLUSION. The characterization of an adrenal mass can be made with high sensitivity and specificity using MR imaging. The increased reliance on MR imaging seems to be based mainly on findings from chemical-shift and dynamic gadolinium-enhanced studies. The need to perform histologic sampling of incidentally discovered adrenal masses may be reduced to some problematic lesions, which will remain during the era of MR imaging.