Adrenocortical carcinoma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2] Mohammed Abdelwahed M.D [3]

Overview

MRI scans are helpful in differentiating between adrenal adenoma, carcinoma, and metastatic lesions. Due to the multi-planar capability of MRI, direct invasion of adjacent organs may be better shown. Inferior vena cava invasion has been reported in 9% to 19% of cases at presentation.

Adrenocortical carcinomas are usually large and appear as heterogeneous masses on both T1- and T2-weighted images owing to the presence of internal hemorrhage and necrosis.^[1]
Adrenocortical carcinoma may contain foci of intra-cytoplasmic lipid, which results in a loss of signal intensity on out-of-phase images.^[2]
Large adrenal carcinomas tend to invade the adrenal vein and inferior vena cava.^[1]

On MRI, ACCs appear iso-intense to hypo-intense relative to liver parenchyma on T1-weighted images and hyper-intense relative to liver parenchyma on T2-weighted images.^[3]

On chemical-shift MRI, the presence of intracellular lipid can cause regions of signal loss on out-of-phase images relative to in-phase images.^[4]

Inferior vena cava invasion has been reported in 9% to 19% of cases at presentation.
Due to the multi-planar capability of MRI, direct invasion of adjacent organs may be better shown.

Source: Case courtesy of Radswiki, Radiopaedia.org, rID: 11176

↑ ^1.0 ^1.1 Bharwani N, Rockall AG, Sahdev A, Gueorguiev M, Drake W, Grossman AB; et al. (2011). "Adrenocortical carcinoma: the range of appearances on CT and MRI". AJR Am J Roentgenol. 196 (6): W706–14. doi:10.2214/AJR.10.5540. PMID 21606258.
↑ Ng L, Libertino JM (2003). "Adrenocortical carcinoma: diagnosis, evaluation and treatment". J Urol. 169 (1): 5–11. doi:10.1097/01.ju.0000030148.59051.35. PMID 12478091.
↑ Bharwani N, Rockall AG, Sahdev A, Gueorguiev M, Drake W, Grossman AB; et al. (2011). "Adrenocortical carcinoma: the range of appearances on CT and MRI". AJR Am J Roentgenol. 196 (6): W706–14. doi:10.2214/AJR.10.5540. PMID 21606258.
↑ Bharwani N, Rockall AG, Sahdev A, Gueorguiev M, Drake W, Grossman AB; et al. (2011). "Adrenocortical carcinoma: the range of appearances on CT and MRI". AJR Am J Roentgenol. 196 (6): W706–14. doi:10.2214/AJR.10.5540. PMID 21606258.