European Radiology

, Volume 18, Issue 12, pp 2885–2892

Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function

  • Audrey E. T. Jacques
  • Anju Sahdev
  • Madrika Sandrasagara
  • Rick Goldstein
  • Daniel Berney
  • Andrea G. Rockall
  • Shern Chew
  • Rodney H. Reznek
Magnetic Resonance

Abstract

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.

Keywords

Magnetic resonance imaging Adrenal gland Phaeochromocytoma 

References

  1. 1.
    Minno AM, Bennett WA, Kvale WF (1955) Pheochromocytoma — study of 15 cases diagnosed at autopsy. Proc Staff Meet. Mayo Clinic 30:394–396Google Scholar
  2. 2.
    Baguet J-P, Hammer L, Longo Mazzuco T et al (2004) Circumstances of discovery of phaeochromocytoma: a retrospective study of 41 consecutive patients. E J Endocrinol 150:681–686CrossRefGoogle Scholar
  3. 3.
    Lucon AM, Pereira MAA, Mendonca BB, Halpern A, Wajchenbeg BL, Sami A (1997) Pheochromocytoma: study of 50 cases. J Urol 157:1208–1212PubMedCrossRefGoogle Scholar
  4. 4.
    Francis IR, Korobkin M (1996) Pheochromocytoma. Radiol Clin North Am 34:1101–1112PubMedGoogle Scholar
  5. 5.
    Neumann HPH, Bausch B, McWhinney SR et al (2002) Germ-line mutations in nonsyndromic phaeochromocytoma. N Engl J Med 346:1459–1466PubMedCrossRefGoogle Scholar
  6. 6.
    Heinz-Peer G, Hönigschnabl S, Schneider B, Niederle B, Kaserer K, Lechner G (1999) Characterization of adrenal masses using MR imaging with histopathologic correlation. AJR Am J Roentgenol 173:15–22PubMedGoogle Scholar
  7. 7.
    Hussain HK, Korobkin M (2004) MR Imaging of the adrenal glands. Magn Reson Imaging Clin N Am 12:515–544PubMedCrossRefGoogle Scholar
  8. 8.
    Fink IJ, Reinig JW, Dwyer AJ, Doppman JL, Linehan WM, Keiser HR (1985) MR imaging of pheochromocytomas. J Comput Assist Tomogr 9:454–458PubMedCrossRefGoogle Scholar
  9. 9.
    Reinig JW, Doppman JL, Dwyer AJ, Johnson AR, Knop RH (1986) Adrenal masses differentiated by MR. Radiology 158:81–84PubMedGoogle Scholar
  10. 10.
    Reinig JW, Doppman JL, Dwyer AJ, Frank J (1986) MRI of indeterminate adrenal masses. AJR Am J Roentgenol 147:493–496PubMedGoogle Scholar
  11. 11.
    Glazer GM, Woolsey EJ, Borrello J et al (1986) Adrenal tissue characterization using MR imaging. Radiology 158:73–79PubMedGoogle Scholar
  12. 12.
    Quint LE, Glazer GM, Francis IR, Shapiro B, Chenevert TL (1987) Pheochromocytoma and paragangliomas: comparison of MR imaging with CT and I-131 MIBG scintigraphy. Radiology 165:89–93PubMedGoogle Scholar
  13. 13.
    Varghese JC, Hahn PF, Papanicolaou N, Mayo-Smith WW, Gaa JA, Lee MJ (1997) MR differentiation of phaeochromocytoma from other adrenal lesions based on qualitative analysis of T2 relaxation times. Clin Radiol 52:603–606PubMedCrossRefGoogle Scholar
  14. 14.
    Blake MA, Krishnamoorthy SK, Boland GW, Sweeney AT (2003) Low-density pheochromocytoma on CT: a mimicker of adrenal adenoma. AJR Am J Roentgenol 181:1663–1668PubMedGoogle Scholar
  15. 15.
    Blake MA, Kalra MK, Maher MM et al (2004) Pheochromocytoma: an imaging chameleon. Radiographics Suppl 1:S87–S99CrossRefGoogle Scholar
  16. 16.
    Korobkin M, Brodeur FJ, Yutzy GG et al (1996) Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. AJR Am J Roentgenol 166:531–536PubMedGoogle Scholar
  17. 17.
    Korobkin M, Brodeur FJ, Francis IR, Quint LE, Dunnick NR, Londy F (1998) CT time-attenuation washout curves of adrenal adenomas and nonadenomas. AJR Am J Roentgenol 170:747–752PubMedGoogle Scholar
  18. 18.
    Pena CS, Boland GWL, Hahn PF, Lee MJ, Mueller PR (2000) Characterization of indeterminate (lipid poor) adrenal masses: use of washout characteristics at contrast-enhanced CT. Radiology 217:798–802PubMedGoogle Scholar
  19. 19.
    Kudva YC, Young WF, Thompson GB (1999) Adrenal incidentaloma: an important component of the clinical presentation spectrum of benign sporadic adrenal phaeochromocytoma. Endocrinologist 9:77–84CrossRefGoogle Scholar
  20. 20.
    Noshiro T, Shimizu K, Watanabe T et al (2000) Changes in clinical features and long-term prognosis in patients with pheochromocytoma. Am J Hyperten 13:35–43CrossRefGoogle Scholar
  21. 21.
    Sahdev A, Sohaib A, Monson JP, Chew SL, Reznek RH (2005) CT and MRI imaging of unusual locations of extra-adrenal paragangliomas (pheochromocytomas). Eur Radiol 15:85–92PubMedCrossRefGoogle Scholar
  22. 22.
    Melicow MM (1977) One hundred cases of pheochromocytoma (107 tumors) at the Columbia-Presbyterian Medical Center, 1926–1976. Cancer 40:1987–2004PubMedCrossRefGoogle Scholar
  23. 23.
    Baker ME, Blinder R, Spritzer C, Leight GS, Herfkens RJ, Dunnick NR (1989) MR evaluation of adrenal masses at 1.5 T. AJR Am J Roentgenol 153:307–312PubMedGoogle Scholar
  24. 24.
    Kier R, McCarthy S (1989) MR characterization of adrenal masses: field strength and pulse sequence considerations. Radiology 171:671–674PubMedGoogle Scholar
  25. 25.
    Bilbey JH, McLoughlin, Kurkjian PS et al (1995) MR imaging of adrenal masses: value of chemical-shift imaging for distinguishing adenomas from other tumors. AJR Am J Roentgenol 164:637–642PubMedGoogle Scholar
  26. 26.
    Mitchell DG, Crovello BS, Matteucci T, Petersen RO, Miettinen MM (1992) Benign adrenocortical masses: diagnosis with chemical shift MR imaging. Radiology 185:345–351PubMedGoogle Scholar
  27. 27.
    Tsushima Y, Ishizaka H, Matsumoto M (1993) Adrenal masses: differentiation with chemical shift, fast low-angle shot MR imaging. Radiology 186:705–709PubMedGoogle Scholar
  28. 28.
    Korobkin M, Lombardi TJ, Aisen AM et al (1995) Characterization of adrenal masses with chemical shift and gadolinium-enhanced MR imaging. Radiology 197:411–418PubMedGoogle Scholar
  29. 29.
    Mayo-Smith WW, Lee MJ, McNicholas MMJ, Hahn PF, Boland GW, Saini S (1995) Characterization of adrenal masses (<5 cm) by use of chemical shift MR imaging: observer performance versus quantitative measures. AJR Am J Roentgenol 165:91–95PubMedGoogle Scholar
  30. 30.
    Fujiyoshi F, Nakajo M, Fukukura Y, Tsuchimochi S (2003) Characterisation of adrenal tumours by chemical shift fast low-angle shot MR imaging: comparison of four methods of quantitative evaluation. AJR Am J Roentgenol 180:1649–1657PubMedGoogle Scholar
  31. 31.
    Outwater EK, Siegelman ES, Radecki PD, Piccoli CW, Mitchell DG (1995) Distinction between benign and malignant adrenal masses: value of T1-weighted chemical -shift MR imaging. AJR Am J Roentgenol 165:579–583PubMedGoogle Scholar
  32. 32.
    Slapa RZ, Jakubowski W, Januszewicz A, Kasperlik-Zaluska AA, Dabrowska E, Fijuth J et al (2000) Discriminatory power of MRI for differentiation of adrenal non-adenomas vs adenomas evaluated by means of ROC analysis: can biopsy be obviated? Eur Radiol 10:95–104PubMedCrossRefGoogle Scholar
  33. 33.
    Thompson LDR (2002) Pheochromocytoma of the adrenal gland scaled score (PASS) to separate benign from malignant neoplasms. A clinicopathologic and immunophenotypic study of 100 cases. Am J Surg Pathol 26:551–566PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2008

Authors and Affiliations

  • Audrey E. T. Jacques
    • 1
    • 4
  • Anju Sahdev
    • 1
  • Madrika Sandrasagara
    • 1
  • Rick Goldstein
    • 2
  • Daniel Berney
    • 3
  • Andrea G. Rockall
    • 1
  • Shern Chew
    • 2
  • Rodney H. Reznek
    • 1
  1. 1.Cancer ImagingSt Bartholomew’s HospitalLondonUK
  2. 2.Department of EndocrinologySt Bartholomew’s HospitalLondonUK
  3. 3.Department of HistopathologySt Bartholomew’s HospitalLondonUK
  4. 4.Cancer ImagingLondonUK

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