Adrenal Adenoma vs. Metastasis
Benign Adrenal Adenoma
Adrenal Metastasis

In this T1-weighted image, fat and water signals are additive. Arrow = adrenal adenoma.

In this T1-weighted "opposed phase" image, fat and water signals interfere with each other. The adrenal adenoma (arrow) contains fat and water, so its signal intensity has decreased. A metastasis is therefore excluded.
In this T1-weighted image, where fat and water signals are additive, the adrenal metastasis (arrow) is slightly less intense than in the adenoma above.

In this T1-weighted "opposed phase" imager, the adrenal metastasis (arrow) has the same signal intensity as in the in-phase image to the left. This is because the metastasis does not contain fat.

References

1. Mitchell DG, Crovello M, Matteucci T, R.O. P, Miettinen MM. Benign adrenocortical masses: diagnosis with chemical shift MR imaging. Radiology 1992;185:345-351.

2. Outwater EK, Siegelman ES, Radecki PD, Piccoli CP, Mitchell DG. Distinction between benign and malignant adrenal masses: value of T1-weighted chemical shift MR imaging. AJR 1995;165:579-583.

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