title: Chemical shift MR imaging of hyperattenuating (>10 HU) adrenal masses: does it still have a role?
abstract: OBJECTIVE
  To evaluate chemical shift magnetic resonance (MR) imaging for the characterization of hyperattenuating adrenal masses.
  
  
  METHODS
  Adrenal MR images obtained from January 1998 to February 2003 were reviewed. Patients were excluded if they did not undergo unenhanced computed tomography or did not have an adrenal mass with attenuation higher than 10 HU, adequate follow-up, or pathologic diagnosis for use as a reference standard. A diagnosis of adenoma required at least 24 weeks of stability on images. Thirty-eight masses in 36 patients were identified (27 adenomas, nine metastases, one adrenocortical oncocytoma, and one pheochromocytoma). Signal intensity (SI) decrease between in-phase and opposed-phase MR images was measured for the entire mass and normalized to the renal parenchymal SI. In 21 of 36 (58%) patients, dual-echo single-breath-hold MR imaging was used to eliminate misregistration.
  
  
  RESULTS
  The attenuation of 61% (23 of 38) of all masses and 70% (19 of 27) of adenomas was 10-30 HU. With a threshold of 20% SI decrease, the sensitivity of chemical shift MR imaging for hyperattenuating adenoma was 67% (18 of 27 masses). When considering masses with attenuation of 10-30 HU, the sensitivity for adenoma was 89% (17 of 19 masses) and remained reasonable at 75% (six of eight masses) for adenomas with attenuation of 20-30 HU. Only one adenoma with attenuation higher than 30 HU had SI decrease of more than 20%. Specificity for diagnosis of adenoma was 100% (11 of 11).
  
  
  CONCLUSIONS
  In certain circumstances, chemical shift MR imaging is a reasonable second imaging test for further characterization of a hyperattenuating adrenal mass.
authors.affiliation: Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9.
authors.forename: Masoom A
authors.initials: MA
authors.lastname: Haider
authors.forename: Sangeet
authors.initials: S
authors.lastname: Ghai
authors.forename: Kartik
authors.initials: K
authors.lastname: Jhaveri
authors.forename: Gina
authors.initials: G
authors.lastname: Lockwood
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000000981:diagnostic imaging; D018249:Adenoma, Oxyphilic / Q000175:diagnosis / Q000000981:diagnostic imaging; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed