Yokoyama Kota, Matsuki Mitsuru, Isozaki Takanori, Ito Kimiteru, Imokawa Tomoki, Ozawa Akane, Kimura Koichiro, Tsuchiya Junichi, Tateishi Ukihide
Department of Diagnostic Radiology, Institute of Science Tokyo, Bunkyo-ku, Tokyo, Japan.
Department of Pediatric Medical Imaging, Jichi Children's Medical Center Tochigi, Jichi Medical University, Shimotsuke, Tochigi, Japan.
Jpn J Radiol. 2025 Jan 11. doi: 10.1007/s11604-025-01732-6.
Adrenal diseases pose significant diagnostic challenges due to the wide range of neoplastic and non-neoplastic pathologies. Radiologists have a crucial role in diagnosing and managing these conditions by, leveraging advanced imaging techniques. This review discusses the vital role of computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine in adrenal imaging, and focuses on morphological and functional evaluations. First, the anatomy and physiology of the adrenal glands are described, followed by a discussion on ectopic adrenocortical adenomas and how they develop. The concepts and imaging findings of congenital diseases, such as congenital adrenal hyperplasia (CAH), adrenal rest tumors, and adrenocortical nodular disease, considering recent updates to the WHO Classification of Tumours (5th ed.) terminology are highlighted. The diagnostic value of dynamic contrast-enhanced CT and chemical-shift MRI for identifying adrenocortical adenomas are emphasized, alongside the use of adrenocortical scintigraphy such as I-adosterol scintigraphy for diagnosing Cushing's disease, Cushing's syndrome (CS), subclinical CS, and ectopic adrenocorticotropic hormone-producing tumors. Systemic complications associated with CS, and the diagnosis and treatment of pheochromocytomas, paragangliomas (PPGLs), and neuroblastomas, will also be discussed focusing on I-metaiodobenzylguanidine (MIBG) imaging and I-MIBG therapy. Pitfalls in I-MIBG imaging and the increasing importance of diagnosing hereditary PPGLs due to increased genetic testing are also be discussed. Additionally, the broad differential diagnosis for adrenal masses-including malignancies like adrenal carcinoma, metastases, and malignant lymphoma, as well as benign conditions like myelolipoma and ganglioneuroma, and complications, such as adrenal hemorrhage, infarction, and infections-will be outlined. The goal of this review was to provide an overview of adrenal diseases that includes the most recent information for radiologists to stay updated on the latest imaging techniques and advancements that can ensure accurate diagnosis and effective management.
由于肿瘤性和非肿瘤性病变范围广泛，肾上腺疾病在诊断上面临重大挑战。放射科医生通过利用先进的成像技术，在这些疾病的诊断和管理中发挥着关键作用。本综述讨论了计算机断层扫描（CT）、磁共振成像（MRI）和核医学在肾上腺成像中的重要作用，并重点关注形态学和功能评估。首先描述肾上腺的解剖和生理，接着讨论异位肾上腺皮质腺瘤及其发展方式。考虑到世界卫生组织《肿瘤分类》（第5版）术语的最新更新，突出了先天性肾上腺增生（CAH）、肾上腺残余肿瘤和肾上腺皮质结节性疾病等先天性疾病的概念和影像学表现。强调了动态对比增强CT和化学位移MRI对识别肾上腺皮质腺瘤的诊断价值，以及使用肾上腺皮质闪烁显像，如碘-胆固醇闪烁显像诊断库欣病、库欣综合征（CS）、亚临床CS和异位促肾上腺皮质激素分泌肿瘤。还将讨论与CS相关的全身并发症，以及嗜铬细胞瘤、副神经节瘤（PPGLs）和神经母细胞瘤的诊断和治疗，重点是碘-间位碘苄胍（MIBG）成像和碘- MIBG治疗。还将讨论MIBG成像中的陷阱以及由于基因检测增加而导致诊断遗传性PPGLs的重要性日益增加。此外，将概述肾上腺肿块的广泛鉴别诊断，包括肾上腺癌、转移瘤和恶性淋巴瘤等恶性肿瘤，以及髓脂肪瘤和神经节瘤等良性疾病，以及肾上腺出血、梗死和感染等并发症。本综述的目的是提供肾上腺疾病的概述，包括最新信息，以便放射科医生了解最新的成像技术和进展，确保准确诊断和有效管理。
