The probability of encountering malignant adrenal lesions is low, although the risk clearly increases in patients with a known malignancy elsewhere ( 3, 4). Benign adenomas are statistically the most common adrenal pathologic condition encountered at imaging. While these lesions may require radiologic workup, most ultimately prove to be benign and do not result in a clinically significant endocrine disturbance. Incidental adrenal masses larger than 1 cm in size are common findings, identified in approximately 5% of patients undergoing CT, with an increasing prevalence with age ( 1, 2). In cases of known endocrine activity, imaging can guide clinical management, including further investigations such as venous sampling. While imaging may not be optimal for establishing endocrine activity, there are imaging features from which radiologists may infer function. The characterization of an incidental adrenal lesion as benign or malignant does not end the role of the radiologist consideration as to whether an adrenal lesion is associated with endocrine dysfunction is required. Interpretive errors may occur when evaluating adrenal washout at CT without considering other radiologic features, including the size of adrenal nodules, the presence of fat or calcification, the attenuation of nodules, and atypical imaging features. With MRI, imaging acquisition technique and evaluation of the reference tissues used in chemical shift MRI are important considerations that can directly influence image interpretation. Technical pitfalls at CT may relate to the imaging parameters, including region of interest characteristics, tube voltage selection, and the timing of contrast material–enhanced imaging. Hence, an appreciation of the intricacies of adrenal imaging strategies and characterization is required this can be aided by understanding the pitfalls of adrenal imaging. Incorrect diagnoses may be made if radiologists are not attentive to technical parameters and interpretive factors associated with adrenal gland imaging. A number of imaging techniques can be used to characterize these, although it is not always possible to attain a definitive diagnosis radiologically. The adrenal gland may exhibit a wide variety of pathologic conditions.

Nodular adrenal gland