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By : Nour Eldin Mohammed Ref: Khaled M. Elsayes, et al, 2004, Radiographics.

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Presentation on theme: "By : Nour Eldin Mohammed Ref: Khaled M. Elsayes, et al, 2004, Radiographics."— Presentation transcript:

1 By : Nour Eldin Mohammed Ref: Khaled M. Elsayes, et al, 2004, Radiographics

2 Normal Anatomy  The adrenal glands are two small, yellowish bodies located in the perirenal space, immediately anterosuperior to the upper pole of the kidneys.  They are very vascular and receive blood supply from the superior, middle, and inferior suprarenal arteries


4  The adrenal gland is composed of an outer cortex and thinner inner medulla.  The cortex is further subdivided into three zones: outer zona glomerulosa, middle zona fasciculata, and inner zona reticularis

5 Normal MRI Appearance  The right adrenal gland is located posterior to the inferior vena cava and superior to the upper pole of the right kidney.  The left adrenal gland is anteromedial to the upper pole of the kidney and posterior to the pancreas  Normal adrenal glands range from 2 to 6 mm in thickness and from 2 to 4 cm in length

6 Fat-containing Adrenal Masses  Fat-containing adrenal masses can be classified into two main types: 1. those that contain intracellular fat (eg, adenoma) 2. and those with macroscopic fat (eg, myelolipoma).

7 Adrenal Adenoma  The most common adrenal lesions.  Characterised by the presence of intracellular lipid.  Chemical shift imaging is the most reliable technique for diagnosing adrenal adenoma with loss of signal intensity on out-of-phase images.  Uniform enhancement with contrast enhanced images is typical of adenomas.  Cystic changes, hemorrhage, or variation in vascularity lead to small, rounded foci of altered signal intensity.

8 Axial in Phase MRI Axial out of phase MRI

9 Myelolipoma  The myelolipoma is an uncommon benign tumor composed of mature adipose tissue and hematopoietic tissue.  Mostly discovered accidentally.  The fatty component of this tumor is hyperintense on T1- weighted images.  With loss of signal intensity of the fatty component on Fat-Suppressed Technique.

10 Axial T1 MRI Axial T1 with Fat Suppressed Technique

11 Cystic Masses  These include : 1. Simple Cysts 2. Pseudocysts 3. Lymphangioma

12 Simple Cysts T1 Coronal MRIT2 Coronal MRI

13 Pseudocysts  Pseudocysts typically arise after an episode of adrenal hemorrhage and do not have an epithelial lining.  Have a complicated appearance on MR images, manifesting with septations, blood products, or a soft- tissue component secondary to hemorrhage or hyalinized thrombus.  Peripheral curvilinear calcification may be present.

14 Coronal T2 MRI Axial T1 with Contrast

15 Lymphangioma Low signal intensity at T1-weighted imaging and high signal intensity at T2-weighted

16 Hypervascular Lesions (Pheochromocytoma)  It arises from the adrenal medulla.  10% of pheochromocytomas are bilateral,10% are extraadrenal,10% occur in children, and 10% are malignant  Pheochromocytomas do not contain a substantial amount of cytoplasmic lipid, So they maintain their signal intensity on out-of-phase GRE chemical shift images.  Most pheochromocytomas demonstrate high signal intensity on T2-weighted images (light bulb sign).

17 Axial T1 in Phase MRIAxial T1 out of Phase MRI Contrast-enhanced Image

18 Malignant Neoplasms  Adrenocortical Carcinoma  Adrenal Lymphoma  Metastases

19 Adrenocortical Carcinoma  a rare tumor.  Age :  Large size  Can manifest as a hyperfunctioning mass causing Cushing syndrome or Conn syndrome.  Other manifestations include an abdominal mass and abdominal pain.

20 Sagittal 3D contrast- enhanced MRI Coronal T2-weighted MRI

21 Adrenal Lymphoma  More with non-Hodgkin lymphoma  Bilateral involvement occurs in 50% of patients.  Characterized by low signal intensity on T1 WI and heterogeneous high signal intensity on T2 WI, with minimal progressive enhancement after administration of contrast material.

22 Axial T1-weighted MRIAxial T2-weighted MRI

23 Metastases  The most common malignant lesions involving the adrenal gland.  Found in up to 27% of patients with Carcinomas at autopsy.  Common primary sites of tumors that metastasize to the adrenal glands include the lung, bowel, breast, and pancreas.  Usually bilateral but may also be unilateral.

24 Contrast Enhanced T1 Image Of Metastatic Deposit From Renal Cell Carcinoma

25 Pediatric Neoplasms  Neuroblastoma  Ganglioneuroblastoma

26 Neuroblastoma  The 2nd most common pediatric abdominal mass (after Wilms tumor).  Representing 5%–15% of all malignant tumors in children.  Arises from the neural crest in the adrenal medulla or along the sympathetic chain.  Usually demonstrates heterogeneous low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and enhancement after administration of contrast material.  Calcification is present in 80%–90% of the lesions

27 Coronal unenhanced T1 MRIAxial T2 MRI

28 Ganglioneuroblastoma  Intermediate in malignancy between that of neuroblastoma and ganglioneuroma  arise from the neural crest.  Ganglioneuroblastoma are smaller and more well defined than neuroblastoma  Demonstrates Intermediate signal intensity on T1 WI and heterogeneously high signal intensity on T2 WI, with heterogeneous enhancement after administration of contrast material.

29 T1-WI shows a heterogeneous mass with intermediate signal intensity

30 Thank you

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