Computed Tomography (CT) constitutes the basic technique for imaging of adrenal tumours and neuroendocrine tumours (NETs). The major work-load in adrenal imaging is characterisation of adrenal incidentalomas, i.e. adrenal tumours diagnosed on imaging performed for other reasons than adrenal disease. Myelolipomas, which have a typical appearance with areas of macroscopic fat, and simple cysts are easy to characterize and require no follow-up. Morphologically benign adrenal tumours (rounded, sharply delineated, homogenous internal structure) with an attenuation of ≤10HU in the native CT images are characterized as benign adrenocortical adenomas and require no additional imaging. With an attenuation ≥10HU, follow-up of tumour size is recommended for 6 months. In young (<40 years) patients this should preferably be performed by MRI. Calculation of contrast medium wash-out is no longer applied. For tumours >4 cm surgical resection is recommended unless in cases of a typical myelolipoma or cyst. CT is for NETs used for the initial localization of the primary tumour, for staging of the disease, detection of recurrence and for monitoring of therapy. It is also used in hybrid imaging in conjunction with PET (PET/CT) and SPECT (SPECT/CT). MRI is superior for imaging of liver, pancreas, brain and bone. In metastatic NETs, 68Ga-DOTA-somatostatin analogue PET/CT generally shows several additional lesions as compared to CT/MRI and small lesions such as lymph nodes may be characterized as metastatic/not metastatic lesions. Contrast-enhanced US is excellent for diagnosis and characterization of liver lesions and to guide the biopsy needle for the histopathological NET diagnosis. Endoscopic US is the best method for detection of pancreatic NETs.
20 - 23 May 2017
European Society of Endocrinology