Guidelines For the incidental Adrenal mass under 5 cm.

Can be considered benign if any of the following:

1. 10 HU or less

2. 50% washout at 15 min.

3. Drop out on out-of-phase imaging.

W/U for incidental adrenal nodule under 5 cm that does not fit the above criteria:

W/u of choice is a CT Adrenal mass protocol which will be a without, 70 sec and 15min images through adrenal glands

If there is some reason that CT cannot or should not be performed, an MRI is suggested. MR is considered as sensitive, but because of cost, it is second in workup order. If the patient is young, consideration should be given to radiation dose and MR may be better suited. Also, no contrast is needed for MR of adrenal nodules.

If Pheo is a consideration, consultation with nuclear medicine is suggested

***The above criteria derived from the literature and local standards of care. No criteria or modality is 100% accurate

CT and MRI of Adrenal Masses: Westphalen and Joe; Appl Radiol 2006;35(8): 10-26

Incidentally Discovered Adrenal Masses Kloos et al.; Endocrine Reviews Vol 16 No 4 1995

An Imaging Algorithm for the Differential Diagnosis of Adrenal Adenomas and Metastases

McNicholas et al; AJR 1995; 165:1453-1459

Adrenal masses: Capabilities of MRI for Simple Characterization Applied Radiology July

1997 21-24

CT Time-Attenuation Washout Curves of Adrenal Adenomas and Nonadenomas; Korobkin

et al.; AJR 170 March 1998