Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function

• Published in: European radiology Vol. 18; no. 12; pp. 2885 - 2892
• Main Authors: Jacques, Audrey E. T., Sahdev, Anju, Sandrasagara, Madrika, Goldstein, Rick, Berney, Daniel, Rockall, Andrea G., Chew, Shern, Reznek, Rodney H.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.12.2008; Springer Nature B.V
• Subjects: Adolescent; Adrenal Gland Neoplasms - diagnosis; Adrenal glands; Adrenal Glands - pathology; Adult; Aged; Catecholamines; Diagnostic Radiology; Female; Histopathology; Humans; Imaging; Internal Medicine; Interventional Radiology; Magnetic Resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Metabolites; Middle Aged; Neuroradiology; Patients; Pheochromocytoma - diagnosis; Radiology; Statistics as Topic; Tumors; Ultrasound; Young Adult; United Kingdom > UK; Magnetic resonance imaging; Phaeochromocytoma; Adrenal gland
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-008-1073-z

The purpose of this study was to describe the range of appearances of adrenal phaeochromocytomas on T2-weighted MRI, correlate appearances with histopathology, and quantify the incidence of the previously described hyperintense appearance. The appearance and MR characteristics of 44 phaeochromocytomas were reviewed retrospectively. T2-weighted appearances were grouped: (1) ‘classical’, homogeneous, high signal intensity, isointense to CSF; (2) homogeneous, isointense or minimally hyperintense to spleen, hypointense to CSF; (3) heterogeneous, marbled appearance; (4) heterogeneous, multiple high signal intensity pockets. All 44 adrenal phaeochromocytomas were well circumscribed, 1.2–15 cm in maximum diameter, with no visual or quantitative signal loss on chemical shift imaging. On T2-weighted MRI 5/44 (11%) had group 1 appearance; 15/44 (34%) group 2, 7/44 (16%) group 3; and 17/44 (39%) group 4. Homogeneous group 1 and 2 lesions were smaller (mean 4.5 cm) than heterogeneous group 3 and 4 lesions (mean 6.3 cm). Increasing MRI heterogeneity correlated pathologically with increasing amounts of haemorrhage, necrosis and fibrosis. No MRI features were predictive of malignancy. Non-functioning phaeochromocytomas were larger than functioning lesions. No size difference was seen between syndrome and sporadic lesions. In this large series we report a wide range of appearances of adrenal phaeochromocytomas on T2-weighted MRI. The previously described classical hyperintense phaeochromocytoma is relatively uncommon.