The right adrenal gland is located posterior to the inferior vena cava (IVC) at the level where the IVC enters the liver. The adrenal glands lie within the perirenal space surrounded by fat. MDCT remains the imaging modality of choice, whereas MR, PET, PET-CT, US, scintigraphy, adrenal vein sampling, and image-guided adrenal biopsy all have significant roles ( 5). In patient with adrenal endocrine syndromes diagnosed clinically, imaging is used to find and characterize the causative lesion. The adrenal glands are routinely imaged in patients with known malignancy, especially lung cancer, in order to detect metastatic disease. Additional considerations include myelolipoma, adrenal carcinoma, hemorrhage, cyst, neuroblastoma, and ganglioneuroma. Within the differential diagnosis are subclinical pheochromocytomas, or functioning cortical adenomas, causing unrecognized hyperaldosteronism or Cushing syndrome. Up to 5% of patients who undergo MDCT of the abdomen will have an incidental adrenal lesion, an “incidentaloma.” The predominant consideration is to determine if the lesion is a benign nonfunctioning adrenal adenoma or is it a metastasis. The current major challenge of adrenal imaging is to provide noninvasive characterization of the many adrenal nodules found incidentally on CT or MR performed for other purposes ( 1, 2, 3, 4).
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