Skip to main content

Advertisement

SpringerLink
Log in

Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Minno AM, Bennett WA, Kvale WF (1955) Pheochromocytoma — study of 15 cases diagnosed at autopsy. Proc Staff Meet. Mayo Clinic 30:394–396

    Google Scholar 

  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 150:681–686

    Article  CAS  Google Scholar 

  3. Lucon AM, Pereira MAA, Mendonca BB, Halpern A, Wajchenbeg BL, Sami A (1997) Pheochromocytoma: study of 50 cases. J Urol 157:1208–1212

    Article  PubMed  CAS  Google Scholar 

  4. Francis IR, Korobkin M (1996) Pheochromocytoma. Radiol Clin North Am 34:1101–1112

    PubMed  CAS  Google Scholar 

  5. Neumann HPH, Bausch B, McWhinney SR et al (2002) Germ-line mutations in nonsyndromic phaeochromocytoma. N Engl J Med 346:1459–1466

    Article  PubMed  CAS  Google Scholar 

  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 173:15–22

    PubMed  CAS  Google Scholar 

  7. Hussain HK, Korobkin M (2004) MR Imaging of the adrenal glands. Magn Reson Imaging Clin N Am 12:515–544

    Article  PubMed  Google Scholar 

  8. Fink IJ, Reinig JW, Dwyer AJ, Doppman JL, Linehan WM, Keiser HR (1985) MR imaging of pheochromocytomas. J Comput Assist Tomogr 9:454–458

    Article  PubMed  CAS  Google Scholar 

  9. Reinig JW, Doppman JL, Dwyer AJ, Johnson AR, Knop RH (1986) Adrenal masses differentiated by MR. Radiology 158:81–84

    PubMed  CAS  Google Scholar 

  10. Reinig JW, Doppman JL, Dwyer AJ, Frank J (1986) MRI of indeterminate adrenal masses. AJR Am J Roentgenol 147:493–496

    PubMed  CAS  Google Scholar 

  11. Glazer GM, Woolsey EJ, Borrello J et al (1986) Adrenal tissue characterization using MR imaging. Radiology 158:73–79

    PubMed  CAS  Google Scholar 

  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 165:89–93

    PubMed  CAS  Google Scholar 

  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 52:603–606

    Article  PubMed  CAS  Google Scholar 

  14. Blake MA, Krishnamoorthy SK, Boland GW, Sweeney AT (2003) Low-density pheochromocytoma on CT: a mimicker of adrenal adenoma. AJR Am J Roentgenol 181:1663–1668

    PubMed  Google Scholar 

  15. Blake MA, Kalra MK, Maher MM et al (2004) Pheochromocytoma: an imaging chameleon. Radiographics Suppl 1:S87–S99

    Article  Google Scholar 

  16. Korobkin M, Brodeur FJ, Yutzy GG et al (1996) Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. AJR Am J Roentgenol 166:531–536

    PubMed  CAS  Google Scholar 

  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 170:747–752

    PubMed  CAS  Google Scholar 

  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 217:798–802

    PubMed  CAS  Google Scholar 

  19. Kudva YC, Young WF, Thompson GB (1999) Adrenal incidentaloma: an important component of the clinical presentation spectrum of benign sporadic adrenal phaeochromocytoma. Endocrinologist 9:77–84

    Article  Google Scholar 

  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 13:35–43

    Article  CAS  Google Scholar 

  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 15:85–92

    Article  PubMed  Google Scholar 

  22. Melicow MM (1977) One hundred cases of pheochromocytoma (107 tumors) at the Columbia-Presbyterian Medical Center, 1926–1976. Cancer 40:1987–2004

    Article  PubMed  CAS  Google Scholar 

  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 153:307–312

    PubMed  CAS  Google Scholar 

  24. Kier R, McCarthy S (1989) MR characterization of adrenal masses: field strength and pulse sequence considerations. Radiology 171:671–674

    PubMed  CAS  Google Scholar 

  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 164:637–642

    PubMed  CAS  Google Scholar 

  26. Mitchell DG, Crovello BS, Matteucci T, Petersen RO, Miettinen MM (1992) Benign adrenocortical masses: diagnosis with chemical shift MR imaging. Radiology 185:345–351

    PubMed  CAS  Google Scholar 

  27. Tsushima Y, Ishizaka H, Matsumoto M (1993) Adrenal masses: differentiation with chemical shift, fast low-angle shot MR imaging. Radiology 186:705–709

    PubMed  CAS  Google Scholar 

  28. Korobkin M, Lombardi TJ, Aisen AM et al (1995) Characterization of adrenal masses with chemical shift and gadolinium-enhanced MR imaging. Radiology 197:411–418

    PubMed  CAS  Google Scholar 

  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 165:91–95

    PubMed  CAS  Google Scholar 

  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 180:1649–1657

    PubMed  Google Scholar 

  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 165:579–583

    PubMed  CAS  Google Scholar 

  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 10:95–104

    Article  PubMed  CAS  Google Scholar 

  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 26:551–566

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cancer Imaging, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE, UK

    Audrey E. T. Jacques, Anju Sahdev, Madrika Sandrasagara, Andrea G. Rockall & Rodney H. Reznek

  2. Department of Endocrinology, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE, UK

    Rick Goldstein & Shern Chew

  3. Department of Histopathology, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE, UK

    Daniel Berney

  4. Cancer Imaging, Dominion House, 59 Bartholomew Close, London, EC1A 7ED, UK

    Audrey E. T. Jacques

Authors
  1. Audrey E. T. Jacques
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anju Sahdev
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Madrika Sandrasagara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rick Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Berney
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrea G. Rockall
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shern Chew
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rodney H. Reznek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Audrey E. T. Jacques.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jacques, A.E.T., Sahdev, A., Sandrasagara, M. et al. Adrenal phaeochromocytoma: correlation of MRI appearances with histology and function. Eur Radiol 18, 2885–2892 (2008). https://doi.org/10.1007/s00330-008-1073-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-008-1073-z

Keywords

Search

Navigation