![]() The main role of imaging is therefore to limit the invasive management of AI, and particularly the number of surgical adrenalectomies and biopsies. Therefore, AI was described to be "a 'disease' of modern imaging technology". In older studies, the reported prevalence was much lower for both methods, with AIs found in 259 of 61,054 individuals (0.4%) using CT scans performed from 1985 to 1990, and rates of 0.1% or less using abdominal US. With state-of-the art contemporary CT examinations, AI was found in 4.4%-5% of individuals. By far the largest data sets have been collected using CT. In unselected healthy subjects and in patients with inflammatory bowel disease, a prevalence of 5% was reported using abdominal US. Bilateral AIs are found in about 10%-15% of cases. In patients with a high body mass index, diabetes mellitus, and arterial hypertension, the prevalence is even higher. The prevalence of AIs of any size with imaging is reported to be about 5%, ranging from 1% to 12% (with higher rates in older age groups) and the frequency of AIs has approached 8.7% in autopsy series. ![]() ![]() The most frequent pathology underlying an AI is a nonfunctional adenoma. Nevertheless some definitions include only adrenal mass lesions ≥10 mm, as the normal thickness of the body of the adrenal glands varies from 6 to 8 mm (☒ mm). It is possible to detect focal lesions down to 3-5 mm, in particular with transabdominal US for the right gland and with EUS for the left gland ( Figs. Conventional US and EUS both allow visualization of the normal adrenal gland and its vascularity ( Figs. Whereas the published literature is full of CT reports, comparatively little has been published for US, which is still the imaging method with the most detailed resolution. However, in patients with a known malignancy, more than 50% (9%-75%) of solid adrenal masses turn out not to be metastases. The definition of an adrenal incidentaloma (AI) encompasses any focal adrenal lesion, independent of size, discovered by any imaging method including ultrasonography (US), endoscopic ultrasonography (EUS), computed tomography (CT), or magnetic resonance imaging (MRI), in the absence of adrenal disease.ĭue to the fact that the adrenal glands are the fourth most frequent site of metastasis, independent of the location of the primary tumor (prevalence of metastases: 27%), the definition excludes adrenal lesions that are detected in patients with a suspected or established diagnosis of malignancy.
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