Beyond Adenoma: Re-evaluating the Imaging Approach to Adrenal Lesions

For decades, the radiological evaluation of adrenal lesions has revolved around a fundamental binary premise: distinguishing benign adenomas from non-adenomas. While this paradigm successfully stratifies a vast majority of routine cases, its rigid application increasingly presents diagnostic pitfalls in complex clinical practice. The reliance on a strict "adenoma versus non-adenoma" dichotomy overlooks key diagnostic nuances, including atypical heterogeneous adenomas, collision tumors, and rare benign lesions. Through a series of comparative cases, this lecture will examine lesions with overlapping imaging features.

Key learning objectives include:

Mastering problem-solving modalities - Dual-Energy CT (DECT), specialized MRI protocols, and targeted PET radiotracers
Identifying non-adenomatous benign mimics - ganglioneuromas, hemangiomas, etc.
Recognizing the new cutoff values for the definition of adrenal adenomas