CT and MRI in the Characterization and Preoperative Assessment of Adrenocortical Carcinoma: Current Concepts and Perspectives

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy arising from the adrenal cortex. This tumor shows suggestive imaging features on computed tomography (CT), which include a large size, internal heterogeneity and various degrees of internal necrosis. Accurate characterization of ACC with imaging is essential to ensure prompt and appropriate management and avoid useless biopsy or delayed surgery. Magnetic resonance imaging (MRI) provides additional information with respect to the internal content of ACC by comparison with CT. Recent studies evaluating the capabilities of radiomics have shown encouraging results in the characterization of ACC and differentiation from other adrenal masses. Surgical resection remains the primary treatment for localized ACC. Complete surgical resection (i.e., R0 resection) offers the best chance for long-term survival for patients with ACC. Preoperative planning with imaging should be performed to identify local extent of ACC into the liver, the ipsilateral kidney, and the inferior vena cava as well as to exclude distant metastases. A precise preoperative assessment is critical to anticipate the radicality of surgery and best manage potential surgical complications. This review article aims to provide a thorough overview of the current role of CT and MRI in the diagnosis and preoperative planning of ACC.