ACR Incidental Adrenal · Adrenal

ACR Incidental Adrenal ACR incidental adrenal mass management

vigente

Management pathway for incidentally detected adrenal masses based on imaging features and size.

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Escala de categorias

benign-features indeterminate macroscopic-fat large-mass prior-malignancy

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Procedência e vigência

Órgão emissor: American College of Radiology
Versão: 2017
Ano: 2017
Família: achado incidental
Tipo de lógica: flat
Modalidade: CT, MRI
Fonte primária: Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee · doi:10.1016/j.jacr.2017.05.001
Última verificação: 2026-06-22
Última checagem: 2026-06-22

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Size thresholds and management endpoints pending sourcing.

Mostrar a lógica estruturada (JSON)

{
  "categories": [
    "benign-features",
    "indeterminate",
    "macroscopic-fat",
    "large-mass",
    "prior-malignancy"
  ]
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
benign-features	Benign imaging features Adrenal mass with diagnostic benign imaging features. Unenhanced CT density at or below 10 HU, or signal loss versus spleen between in-phase and opposed-phase chemical-shift MRI, indicates a lipid-rich adenoma at any size. A mass that shows no enhancement (under a 10 HU change between pre- and post-contrast images) represents a cyst or hemorrhage. A benign calcified mass (e.g., old hematoma or granulomatous calcification) also qualifies.	No additional workup or follow-up imaging is needed once benign features are established. The paper also now advises considering biochemical evaluation for most incidentally discovered adrenal masses, acknowledging the literature support for this is limited.	—	okfonte Fig. 1 algorithm; 'Reporting Considerations' (low CT density 10 HU) and 'Overview of the Algorithm' subsection 'Masses With Diagnostic Benign Imaging Features'; 'Adrenal CT Protocol' (nonenhancement defined as <10 HU change)
indeterminate	Indeterminate mass Mass without diagnostic benign features, indeterminate attenuation (above 10 HU on unenhanced CT), typically 1 to under 4 cm. High-density adenomas above ~20-30 HU on unenhanced CT may stay indeterminate on chemical-shift MRI.	Characterize with a dedicated adrenal CT washout protocol, which assesses density and washout in one exam, or with chemical-shift MRI as an alternative. An absolute washout of 60% or more, or a relative washout of 40% or more when no unenhanced phase is available, indicates an adenoma. If the mass still cannot be characterized and there is no prior imaging or cancer history, 1 to 2 cm masses can be followed at 12 months to confirm stability, and masses over 2 to under 4 cm warrant a dedicated adrenal CT at detection. Stability for a year or more indicates a benign mass needing no further imaging.	—	okfonte Fig. 1 algorithm; 'Overview of the Algorithm' subsection 'Masses Without Diagnostic Features (1 to <4 cm)'; 'Adrenal CT Protocol' (washout formulas and 60% APW / 40% RPW thresholds); 'CS-MRI'
macroscopic-fat	Macroscopic fat (myelolipoma) Mass containing macroscopic (gross) fat, diagnostic of a myelolipoma; one of the explicitly listed diagnostic benign imaging features (along with cyst and hemorrhage).	No additional workup or follow-up imaging is needed.	—	okfonte Fig. 1 algorithm; 'Reporting Considerations' (macroscopic fat listed as a diagnostic imaging feature); 'Overview of the Algorithm' subsection 'Masses With Diagnostic Benign Imaging Features'
large-mass	Large mass Isolated adrenal mass 4 cm or larger in size with no benign diagnostic features and no history of cancer.	Surgical resection (without biopsy) is recommended to treat a possible primary adrenal cortical carcinoma; the paper also advises considering biochemical assays to determine functional status and exclude pheochromocytoma before any biopsy or resection.	—	okfonte Fig. 1 algorithm and footnote (1); 'Overview of the Algorithm' subsection 'Masses Without Diagnostic Features (>=4 cm)'
prior-malignancy	Known prior malignancy Patient with a known malignancy and an indeterminate adrenal mass (no benign diagnostic features / priors), including an enlarging adrenal mass, an indeterminate mass on adrenal CT, or a mass 4 cm or larger.	First refer to available prior imaging to assess stability. A dedicated adrenal CT protocol (without and with contrast) is recommended because contrast-enhanced CT alone cannot reliably separate benign from malignant. If the mass shows central necrosis, is enlarging, remains indeterminate on adrenal CT, or is 4 cm or larger, proceed with PET/CT or image-guided biopsy because the presumed diagnosis is metastatic disease (metastases tend to be more FDG-avid than adenomas, and PET/CT can also detect occult extra-adrenal metastases). Biopsy is reserved predominantly to confirm a suspected metastasis; if pheochromocytoma is suspected, obtain plasma metanephrines/normetanephrines before biopsy.	—	okfonte Fig. 1 algorithm; 'Overview of the Algorithm' subsection 'Masses Without Diagnostic Features (1 to <4 cm)' (cancer history pathway); 'PET/CT' and 'Adrenal Mass Biopsy' sections

Referências cruzadas

fronteira compartilhadaACR Incidental Pancreatic Cyst. ACR incidental pancreatic cyst managementBoth are ACR Incidental Findings Committee white papers in the same series.

Histórico de versões

Data	Evento	Detalhe	Situação
2017-08-01	published	ACR Incidental Findings Committee adrenal white paper published. evidência	confirmado

Quickstart da APIGET /api/v1/systems/acr-incidental-adrenal-2017aberto

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