PET/CT Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy.
Q J Nucl Med Mol Imaging. 2022 Jun;66(2):104-115. doi: 10.23736/S1824-4785.22.03449-5. Epub 2022 Mar 28.
Adrenal masses are a frequent finding in clinical practice. Many of them are incidentally discovered with a prevalence of 4% in patients undergoing abdominal anatomic imaging and require a differential diagnosis. Biochemical tests, evaluating hormonal production of both adrenal cortex and medulla (in particular, mineralocorticoids, glucocorticoids and catecholamines), have a primary importance in distinguishing functional or non-functional lesions. Conventional imaging techniques, in particular computerized tomography (CT) and magnetic resonance imaging (MRI), are required to differentiate between benign and malignant lesions according to their appearance (size stability, contrast enhanced CT and/or chemical shift on MRI). In selected patients, functional imaging is a non-invasive tool able to explore the metabolic pathways involved thus providing additional diagnostic information. Several single photon emission tomography (SPET) and positron emission tomography (PET) radiopharmaceuticals have been developed and are available, each of them suitable for studying specific pathological conditions. In functional masses causing hypersecreting diseases (mainly adrenal hypercortisolism, primary hyperaldosteronism and pheochromocytoma), functional imaging can lateralize the involvement and guide the therapeutic strategy in both unilateral and bilateral lesions. In non-functioning adrenal masses with inconclusive imaging findings at CT/MR, [F]-FDG evaluation of tumor metabolism can be helpful to characterize them by distinguishing between benign nodules and primary malignant adrenal disease (mainly adrenocortical carcinoma), thus modulating the surgical approach. In oncologic patients, [F]-FDG uptake can differentiate between benign nodule and adrenal metastasis from extra-adrenal primary malignancies.
肾上腺肿块在临床实践中很常见。其中许多是在对进行腹部解剖成像的患者进行常规检查时偶然发现的，需要进行鉴别诊断。生化检测评估肾上腺皮质和髓质的激素产生（特别是盐皮质激素、糖皮质激素和儿茶酚胺）对于区分功能性或非功能性病变具有重要意义。传统的成像技术，特别是计算机断层扫描（CT）和磁共振成像（MRI），根据病变的外观（大小稳定性、CT 增强扫描和/或 MRI 化学位移）来区分良性和恶性病变。在选择的患者中，功能成像是非侵入性工具，能够探索涉及的代谢途径，从而提供额外的诊断信息。已经开发并可获得几种单光子发射断层扫描（SPET）和正电子发射断层扫描（PET）放射性药物，每种药物都适用于研究特定的病理状况。在引起激素分泌过多疾病的功能性肿块中（主要是肾上腺皮质醇增多症、原发性醛固酮增多症和嗜铬细胞瘤），功能成像可以对单侧和双侧病变进行定位，并指导治疗策略。在 CT/MR 成像无明确结果的无功能性肾上腺肿块中，[F]-FDG 评估肿瘤代谢有助于通过区分良性结节和原发性恶性肾上腺疾病（主要是肾上腺皮质癌）来对其进行特征描述，从而调整手术方法。在肿瘤患者中，[F]-FDG 摄取可以区分良性结节和来自肾上腺外原发性恶性肿瘤的肾上腺转移。
