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Incidental Adrenal Nodule Management

Interactive Tool for Management of Asymptomatic Adrenal Masses

1. Initial Assessment

Clinical Notes

Definite Benign Features

  • Myelolipoma: Contains macroscopic fat (visible fat density)
  • ≤10 HU: Unenhanced CT attenuation ≤10 HU indicates lipid-rich adenoma
  • No Enhancement: Lack of contrast enhancement suggests benign nature
  • Calcified: Peripheral or central calcification patterns
  • CS-MR Signal Drop: Signal loss on opposed-phase chemical shift MRI

Indeterminate Features

  • Size matters: Larger masses (≥4 cm) have higher malignancy risk
  • Stability: Stable for ≥1 year suggests benign nature
  • Enhancement pattern: Irregular or heterogeneous enhancement
  • Density: >10 HU on unenhanced CT requires further evaluation

Additional Considerations

  • Size >4 cm: Consider surgical evaluation
  • Functional evaluation: May be needed for symptomatic patients

Important Notes:

  • APW = Absolute Percentage Washout; RPW = Relative Percentage Washout
  • CS-MR = Chemical Shift MRI
  • F/U = Follow-up
  • Bx = Biopsy
  • This tool is for educational purposes. Clinical correlation and institutional guidelines should always be considered.

Based on ACR Appropriateness Criteria and current literature

Reference: ACR White Paper, Adrenal Nodules