Characterization of adrenal masses: can image replace biopsy?

This paper describes the diagnostic value of new imaging techniques in char acterization of adrenal masses and evaluates the role of adrenal biopsy. Fo r differentiation of benign and malignant adrenal lesions, sensitivities an d specificities of 85-100% can be reached by unenhanced computed tomography (CT) methods, chemical shift techniques in magnetic resonance imaging (MRI ), delayed enhanced CT techniques, and by evaluation of wash-out curves in contrast-enhanced CT. The diagnostic value of all CT techniques depends on threshold values. The value of dynamic contrast-enhanced MRI is under discu ssion and should be reevaluated by using delayed enhanced series. Biochemic al and scintigraphic methods (NP 59 iodine iodomethyl-norcholesterol and MI BG meta-iodobenzylguanidine scintigrams) are valuable for the diagnosis of functional adrenal masses; however, they do not allow differentiation of be nign and malignant tumors. According to excellent results of new imaging te chniques in characterization of adrenal masses, the indications for fine-ne edle aspiration biopsy have already regressed, as have complications associ ated with this invasive technique.