Incidence of adrenal masses in patients referred for renal artery stenosisscreening MR

RATIONALE AND OBJECTIVES. Prior work has shown the efficacy of magnetic res onance (MR) in renal artery stenosis evaluation. The increasing role of ren al artery stenosis in the differential diagnostic evaluation of hypertensio n raises the question of whether MR should be used as a screening modality. This project evaluated the additional potential benefits of MR by determin ing the incidence of adrenal masses in this selected population. METHODS. A 2-year retrospective study analysis of patients who failed to re spond to antihypertensive medical management and were referred for renal MR for hypertension amassed 77 subjects ranging in age from 18 to 88 years. A masked analysis for adrenal masses was performed on this data set. Magneti c resonance techniques included T2-weighted turbo spin-echo (repetition tim e [TR] 2000-4000 ms, echo time [TE] 80-100 ms, turbo factor 2-16), T1-weigh ted spin-echo (TR 200-500 ms, TE 10-30 ms), gradient-echo time-of-flight (T R 26 ms, TE 6.9 ms, 40 degrees flip angle, 2 excitations), and dynamic gado pentetate dimeglumine-enhanced MR angiography (three-dimensional gradient r ecalled echo, TR 10 ms, TE 3 ms, 40 degrees flip angle, 1 excitation). RESULTS. Thirty-three patients had renal artery disease, 44 had normal rena l arteries, and 7 had adrenal masses. Forty-three percent of patients who u nderwent renal MR had disease of the renal arteries detected, and 9% of pat ients referred for MR had adrenal masses that would have been missed with s cintigraphy and/or angiography, of which 57% were responsible for hypertens ion. CONCLUSIONS. The ability to evaluate renal artery and adrenal anatomy globa lly can be useful, as exemplified in the current series, and the adrenals s hould be examined carefully in any renal MR in a hypertensive patient.