Summary

There has been a large amount of recent research discussing the evolving role of radiology in both detecting and characterizing abnormalities of the adrenal gland. 

The role of CT has continued to expand in both detection and characterization of an adrenal mass. 

For a suspected hyperfunctioning adrenal neoplasm, CT should be performed after the appropriate biochemical screening examinations have been performed.

To differentiate a benign adenoma from a metastasis in the oncology patient, nonenhanced CT should be performed and attenuation of the mass quantified. 

If the attenuation of the adrenal mass is 10 HU or less, the mass is an adenoma and the work-up can stop.

If the attenuation is over 10 HU, contrast-enhanced CT should be performed and washout calculated.

A washout of over 50% implies an adenoma.

If the mass remains indeterminate, MR imaging or adrenal biopsy should be performed. 

Finally, certain features can be used by the radiologist to establish a definitive diagnosis for an adrenal mass based on imaging findings alone.