Figure 7.

A 60-year-old man with multifocal hepatocellular carcinoma and a left adrenal mass. The T1-weighted in-phase (A) and out-of-phase (B) images in the axial plane show an enlarged left adrenal gland (arrow) without a signal drop between the in-phase (signal intensity = 243) and out-of-phase (signal intensity = 236) images, consistent with absent intracellular fat content. (C) The unenhanced CT image in the axial plane reveals a 66-mm, well limited and homogeneous left adrenal mass (arrow), with a mean attenuation value of 31 Hounsfield units (HU). (D) The contrast-enhanced CT images obtained at 60 s after intravenous administration of iodinated contrast material in the axial plane show a homogeneously enhanced adrenal mass with a mean attenuation value of 55 HU. The mean attenuation values were 48 HU at 60 s, 40 HU at 5 min and 38 HU at 10 min. The absolute washout percentage was 59% and the relative washout percentage was 21%. These findings are not typical of a benign adrenal mass and are consistent with a malignant adrenal lesion. (E) The ¹⁸F-FDG PET/CT image in the axial plane shows increased uptake of ¹⁸F-FDG by the left adrenal mass (arrow), with a SUVmax of 5.2. The SUVmax of hepatic parenchyma was 4.8, resulting in a liver to adrenal ratio of 1.1. (F) The ¹⁸F-choline PET/CT image in the axial plane shows an increased uptake of ¹⁸F-FDG by the left adrenal gland with a SUVmax of 14.8. ¹⁸F-choline is a radio tracer that shows high uptake by hepatocellular carcinoma. The discordance between the low ¹⁸F-FDG uptake and the marked ¹⁸F-choline uptake is common for poorly differentiated hepatocellular carcinoma metastases. Histopathological analysis of the tissue sample obtained by percutaneous biopsy confirmed adrenal metastasis from hepatocellular carcinoma.