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Chemical Shift MR Imaging of Hyperattenuating (>10 HU) Adrenal Masses: Does It Still Have a Role?¹

¹ From the Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9 (M.A.H., S.G., K.J.); and Department of Biostatistics, University Health Network and Princess Margaret Hospital, Toronto, Ontario, Canada (G.L.). Received April 28, 2003; revision requested July 9; final revision received September 23; accepted November 17. Address correspondence to M.A.H.

View larger version (15K): [in a new window]   Figure 1. Plot shows mean normalized percentage SI decrease for adenomas () and nonadenomas () with 99.9% CIs (error bars). Note that all metastases have an SI decrease less than 20% (dotted line).

View larger version (30K): [in a new window]   Figure 2. Plot of the corrected percentage SI decrease versus CT attenuation values of adrenal masses. Masses in the 10-30 HU range are left of the vertical dotted line. Note how none of the metastases exhibit more than 20% SI decrease, and only one of the adenomas with attenuation higher than 30 HU exhibits more than 20% SI decrease.

View larger version (191K): [in a new window]   Figure 3a. Example of a hyperattenuating adrenal adenoma with measurable SI decrease at MR imaging. (a) Unenhanced transverse CT scan shows an adrenal mass measuring 36 HU (arrowheads in a-c). A 22% SI decrease was seen between the (b) in-phase and (c) opposed-phase transverse MR images obtained by using a dual-echo two-dimensional spoiled gradient-echo pulse sequence in a single breath hold (150/4.6, 2.3; 5-mm section thickness; 256 x 192 matrix; 75° flip angle; 36-cm field of view). In this case, the SI decrease was not visually obvious throughout the adrenal mass, although the mass appeared homogeneous at CT.

View larger version (198K): [in a new window]   Figure 3b. Example of a hyperattenuating adrenal adenoma with measurable SI decrease at MR imaging. (a) Unenhanced transverse CT scan shows an adrenal mass measuring 36 HU (arrowheads in a-c). A 22% SI decrease was seen between the (b) in-phase and (c) opposed-phase transverse MR images obtained by using a dual-echo two-dimensional spoiled gradient-echo pulse sequence in a single breath hold (150/4.6, 2.3; 5-mm section thickness; 256 x 192 matrix; 75° flip angle; 36-cm field of view). In this case, the SI decrease was not visually obvious throughout the adrenal mass, although the mass appeared homogeneous at CT.

View larger version (207K): [in a new window]   Figure 3c. Example of a hyperattenuating adrenal adenoma with measurable SI decrease at MR imaging. (a) Unenhanced transverse CT scan shows an adrenal mass measuring 36 HU (arrowheads in a-c). A 22% SI decrease was seen between the (b) in-phase and (c) opposed-phase transverse MR images obtained by using a dual-echo two-dimensional spoiled gradient-echo pulse sequence in a single breath hold (150/4.6, 2.3; 5-mm section thickness; 256 x 192 matrix; 75° flip angle; 36-cm field of view). In this case, the SI decrease was not visually obvious throughout the adrenal mass, although the mass appeared homogeneous at CT.