Adrenal imaging: what the clinician should be informed on?

Nowadays there is a “pandemic” of so-called adrenal incidentalomas. The frequency of detection of incidentalomas is around 4–6% in general population and 9–13% among the patients with diagnosed oncological diseases. It is obvious that it will be increasing because of the development of methods of visualization and improving of their availability. In most cases there is possiblle to establish exact diagnosis by means of using of modern devices of computed tomography (CT) and magnetic resonance imaging (MRI) with standardized study protocols for adrenal glands. Thus, radiologists play the key role in determining of the adrenal gland tumor nature and, consequently, further management of patients. However, in real clinical practice there is another situation. On the one hand, study protocols are often not followed and, as a consequence, the conclusions of radiologists are either primitive descriptive such as “formation of the right adrenal gland 3 cm”, or illiterate. On the other hand, even when the description is correct, in most cases the clinicians do not know which method of visualization should be chosen, the advantages over other methods and how to interpret the description and conclusion. Because of high prevalence of incidentalomas and current situation, it is necessary that physicians have basic knowledge of adrenal visualization and should be well versed in the capabilities of different visualization methods. The article provides, firstly, the review of modern data on opportunities of CT, MRI and PET in differential diagnostics of adrenal lesions, secondly, the description of evidence-based protocols for study adrenals, and, thirdly, critical review of techniques that shouldnat be used nowadays.