THE WIDESPREAD overuse of adrenal CT scans, revealing that more than half of these imaging studies are performed unnecessarily, has been investigated in a new study. The research evaluates how closely real-world clinical practice aligns with the American College of Radiology (ACR) guidelines for managing adrenal incidentalomas.
Adrenal incidentalomas—unexpectedly discovered adrenal lesions—often appear benign on imaging. According to the ACR’s white paper, follow-up imaging is unnecessary if a lesion exhibits benign characteristics. However, the study found that 52% of adrenal CT scans were conducted to evaluate lesions that had already been identified as benign. Furthermore, 70% of patients with these benign-appearing lesions underwent additional imaging that was not required per ACR recommendations.
The retrospective cohort study analyzed data from 130 patients who underwent 168 adrenal CTs between 2016 and 2018. Excluding cases with symptoms of adrenal hypersecretion or malignancy, researchers examined radiology reports, patient demographics, lesion characteristics, radiologist recommendations, and histology findings. Despite the high frequency of follow-up imaging, the study found that 93% of the lesions had benign imaging features, with none showing malignant transformation.
These findings highlight a significant gap between evidence-based guidelines and everyday clinical practice. The study suggests that radiologists should be more confident in following ACR recommendations and refrain from recommending additional imaging for benign-appearing adrenal lesions. By doing so, healthcare systems could reduce unnecessary radiation exposure, lower costs, and optimize resource utilization without compromising patient safety.
Reference: Ngo B et al. Imaging of Adrenal Incidentalomas: What Actually Happens in Everyday Clinical Practice? J Med Imaging Radiat Oncol. 2025. doi: 10.1111/1754-9485.13853. [Online ahead of print].
Anaya Malik | AMJ
