The two adrenal glands, located just above your kidneys, work hard to secrete and regulate vital hormones in your body. But when excessive or inhibited hormone production by these tiny organs occurs, a multitude of health issues may arise.
Benign tumors in the adrenal glands, called adrenal adenomas, have the potential to cause disruptions in the endocrine system (which regulates all biological processes in your body). Functional (activated) adrenal adenomas are usually benign, although some are capable of becoming cancerous.
Magnetic Resonance Imaging (MRI) scans, among other imaging modalities, are helpful in monitoring and diagnosing adrenal masses such as adenomas before they become malignant.
What an MRI of the Adrenal Glands Is
An MRI of the adrenal glands involves using magnetic resonance imaging to scan the patient’s abdomen and examine adrenal masses.
The scan takes about an hour. It utilizes magnetic fields and gradient-echo sequences to generate images of body structures and provide characterization of adrenal masses.
Adrenal glands and adrenal lesions are well-visualized in abdominal MRI scans. A radiologist may inject a contrast enhancement dye into the patient to enhance the imaging results.
MRI is used to both diagnose and differentiate between malignant and benign adrenal lesions, also known as adrenal adenomas. Differentiation between adrenal lesions is crucial to oncology patients, as it directly affects prognosis and treatment. An adrenal glands protocol is a set of MRI sequences that assess indeterminate lesions in the adrenal glands.
The fat surrounding the adrenal glands supports adrenal imaging by providing contrast enhancement to adrenal masses. Cross-sectional imaging, such as an axial or coronal magnetic resonance imaging scan, helps medical professionals visualize and diagnose adrenal issues.
Adrenal gland MRI for inspecting adrenal adenomas is safe and highly effective. Compared to enhanced computed tomography (CT) scans, it is often considered the first choice in imaging for young patients and breastfeeding mothers.
Did You Know?
The specific type of MRI scan used to examine adrenal masses is called chemical shift MR imaging. Chemical shift MR imaging is a fat-suppression technique used to detect the presence of intralesional fat and is complementary to routine imaging. Chemical shift MR imaging aids in diagnosing and differentiating between various musculoskeletal pathologies.
Why You Might Need To Get an MRI of the Adrenal Glands
An adrenal MRI becomes important when the results of a CT scan of the adrenal adenomas are inconclusive. Imaging findings from an MRI may be more accurate than CT scans and CT images in identifying certain cancers. This enhanced accuracy results from MR imaging’s ability to provide greater soft tissue contrast.
What an MRI of the Adrenal Glands Can Detect
MRI can evaluate adrenal lesions in symptomatic and asymptomatic patients.
Adrenal lesions, or pathological changes in the organ such as a tumor or neoplasm, may be seen as adrenal adenomas or adrenal masses on an MR image. These lesions may represent benign conditions (such as adrenal adenoma, pheochromocytoma, cyst, cystic lymphangioma, or myelolipoma) or malignant conditions (such as adrenal metastases, adrenal cortical carcinoma).
Adrenal MR imaging involves chemical shift MR imaging (CSI), which helps the radiologist detect intra-tumor fat, differentiating between lipid-poor adenomas and lipid-rich adenomas.
As gradient-echo sequencing results in more precise imaging features, high-signal intensity and low signal intensity imaging findings advance proper characterization of adrenal masses.
A study published in Radiographics suggested that MRI with a contrast agent is a helpful tool for staging cancer, suggesting that MRI may be a valuable diagnostic tool for adrenal cancer.
The reported accuracy of chemical shift imaging in differentiating between adrenal adenomas from cancerous adrenal metastases is 96% to 100%, which, the study suggests, aids in the proper diagnosis and treatment of the patient.
A 2007 study concluded that chemical shift MR has high sensitivity and specificity in diagnosing adenomas and malignant adrenal masses; however, results from atypical adenomas were less precise.
Where are the Adrenal Glands Located?
You have two adrenal glands — one located at the top of each kidney. They are small, yellowish, triangular-shaped soft tissue organs. As part of your body’s endocrine system, they produce catecholamines such as dopamine, epinephrine (adrenaline), and norepinephrine. These hormones aid in metabolism regulation, proper immune function, and blood pressure regulation.
The adrenal gland is divided into two parts. The adrenal medulla is at the center of the gland, while the adrenal cortex forms the outer part.
Disorders and Diseases of the Adrenal Glands
Adrenal gland disorders happen when either the left adrenal gland or right adrenal gland ceases to function as it should. These disorders are classified as either too much or too little hormone production.
Adrenal disorders arise from disease, genetic mutation, tumor, or infection. They can also be linked to abnormalities in other glands, such as the pituitary gland.
While genetic adrenal disorders are rare, adrenal adenomas, or benign tumors largely asymptomatic and nonfunctioning, are often incidentally found during imaging studies of patients. Adrenal adenomas found in imaging results are referred to as adrenal incidentalomas.
Both the left and right adrenal glands may develop benign or malignant lesions, such as adrenal adenomas and adrenal metastases.
An adrenal metastasis is a cancer that has spread from another primary site to one or both adrenal glands.
Did You Know?
Malignant lesions may lead to excessive production of catecholamines, which may, in turn, lead to other health issues such as pheochromocytoma. A pheochromocytoma is a rare, usually noncancerous (benign) tumor that develops in an adrenal gland. A pheochromocytoma is rarely cancerous.
The most common cause of a cancerous adrenal tumor is the transfer of cells from infected organs outside the adrenals, such as lung cancer, hepatocellular carcinoma (liver cancer), or pancreas carcinoma.
Most benign adenomas are generally smaller, well-defined, and uniform (homogenous) in appearance compared to cancerous adrenal adenomas (found in patchy [heterogeneous] cystic and necrotic areas).
Common or well-known diseases of the adrenals include
- Cushing’s syndrome: Resulting from an adrenal, pituitary, or ectopic tumor leading to abnormal levels of cortisol hormone production. Symptoms of this disease may include skin problems such as acne, upper-body obesity, high blood pressure, and muscular weakness. This is also known as hypercortisolism.
- Pheochromocytoma: A tumor that develops in the adrenal medulla, pheochromocytoma causes high levels of adrenaline production, leading to headaches, excessive sweating, tremors of the hands, or even psychiatric disturbances. According to a 2008 study, about 10% of these tumors can become cancerous and spread to other parts of the body.
- Adrenocortical Carcinoma: This refers to tumors forming in the cortex of the adrenal glands, the part of your adrenals producing hormones that control male and female traits and body functions. Functioning tumors in the adrenal cortex may lead to Conn’s syndrome or other hormonal imbalance-based health issues. A coronal magnetic resonance imaging scan of the adrenal glands may help diagnose this disease.
- Addison’s disease: Also known as adrenal insufficiency, Addison’s disease occurs when the adrenals produce too little cortisol or too little aldosterone. Symptoms typically include weight loss, extreme fatigue, patches of darker skin, and depression. Acute adrenal failure can lead to sudden, life-threatening shock, though most symptoms develop over several months.
- Myelolipoma: Adrenal myelolipoma consists of benign tumors, or myelolipomas, made of bone marrow elements. These are easy to recognize through MR imaging techniques because of the presence of macroscopic fat.
- Conn’s syndrome: Properly known as primary aldosteronism, this disorder occurs when the adrenal glands overproduce aldosterone. As aldosterone regulates sodium and potassium in the blood, symptoms of Conn’s syndrome may include numbness and muscle weakness.
Additional Testing for Adrenal Disorders
Besides an MRI scan, other diagnostic and imaging tests may aid the characterization of adrenal masses.
Each radiographic modality can be helpful in the examination of non-adenoma adrenal masses, attenuation of adrenal adenomas, and inspection of adrenal nodules that may hint at various conditions.
- Blood and Urine tests: Used to screen for pheochromocytoma (adrenal medulla tumors), Cushing’s syndrome, and primary hyperaldosteronism (Conn’s syndrome), your health practitioner may request a blood test or urine test to determine whether adrenal hormones are produced normally. Excess catecholamines build up easily in the arterial or renal vessels. Blood tests for adrenal insufficiency may involve an ACTH stimulation test, an insulin tolerance test, or a CRH stimulation test. Venous phase imaging may also highlight abnormalities in the endocrine system.
- X-ray: A doctor may request an X-ray to determine whether cancer may have spread to the surrounding chest area or blood vessels and to aid the characterization of adrenal masses.
- Laparoscopy: During this procedure, an instrument with a camera (a laparoscope) is inserted into the patient, allowing the doctor to view the adrenal glands and lymph nodes without having to do surgery.
CT scan: A CT scan examines for cancerous lesions throughout the body, locates areas of calcification in the adrenal glands, and may help determine whether surgery for adrenal cancer is necessary. CT scan results are less clear than MRI imaging techniques because of the intracellular lipid in the adrenal glands, which is more easily picked up by MRI.
- Ultrasound: This soundwave-based scan is used wherever a CT scan is inadvisable. It inspects metastatic adrenal nodules for malignancy and spread.
- PET/CT: Positron emission tomography (PET) may help determine whether a metastatic adrenal tumor is benign or malignant.
- Biopsy: By inspecting a tissue sample from the adrenal glands, a doctor may be able to determine the cause of adrenal cancer.
MRI of the Adrenal Gland: Diagnosis vs. Prevention
Unfortunately, you cannot prevent cancer. The good news is that screening tests can find some cancers early.
The difference between cancer diagnosis and cancer prevention is the difference between finding out whether something has happened and trying to prevent that something from happening.
Making healthy lifestyle choices and conducting regular checkups of the whole body leads to long-lasting health.
- Primary: Reversing or inhibiting the carcinogenic process through modifications in the patient’s diet and/or lifestyle.
- Secondary: Screening and testing to detect cancer at the earliest possible stage. This is where MRI, CT, and other radiology testing come in. Ezra’s full-body MRI exam is an example of this prevention stage.
- Tertiary: For patients who have already been diagnosed with cancer and are candidates for screening for secondary malignancies.
Cancer diagnosis happens in the secondary and tertiary levels of cancer prevention, where a medical professional verifies that a patient has malignant lesions in a specific organ.
A patient would be moved to diagnostic care only when a preventive care procedure demonstrates abnormal results.
Investing in primary and secondary cancer prevention steps — crafting a healthy lifestyle for yourself and regularly screening for cell carcinoma — may drastically lower the possibility of undergoing tertiary prevention or surgery.
Preventive care enables you to stay healthy long term and could even save your life.
MRI for Your Adrenal Glands: A Vital Step in Your Routine Care
Your adrenal glands are small yet vital organs.
Ezra’s full-body MRI screens your adrenal glands and 13 other organs in less than an hour. If you’re interested in a screening, consider booking an ezra full-body MRI.
Repeat screenings help health professionals monitor a patient’s body across time, allowing them to follow up on a patient’s well-being, and detect abnormalities in the adrenal glands and surrounding organs early. These proactive measures may lead to lifesaving consequences.
Gift a scan to a family member or friend.