ACR Appropriateness Criteria® Staging and Follow-Up of Adrenal Cancer

Authors

• Silvia D. Chang, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: [email protected].
• Cassandra Jeavons, Research Author, University of British Columbia/Vancouver General Hospital, Vancouver, British Columbia, Canada; i-med Radiology Network, Brisbane, Queensland, Australia.
• Gary A. Ulaner, Hoag Family Cancer Institute, Irvine, California; University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging.
• Andrei S. Purysko, Panel Chair, Cleveland Clinic, Cleveland, Ohio.
• Melanie P. Caserta, Mayo Clinic, Jacksonville, Florida.
• Tara M. Catanzano, Baystate Health, Springfield, Massachusetts.
• Alberto Diaz De Leon, University of Texas MD Anderson Cancer Center, Houston, Texas.
• Susie Q. Lew, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; American Society of Nephrology.
• Refky Nicola, SUNY Upstate Medical University, Syracuse, New York.
• Nitya Raj, Memorial Sloan Kettering Cancer Center, New York, New York; American Society of Clinical Oncology.
• Tamer Refaat, Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois; Commission on Radiation Oncology.
• Benjamin T. Ristau, UConn Health, Farmington, Connecticut; American Urological Association.
• David Schultz, Evansville Primary Care, Evansville, Indiana; American Academy of Family Physicians.
• Carmen C. Solórzano, Vanderbilt University Medical Center, Nashville, Tennessee; Society of Surgical Oncology.
• Venkateswar R. Surabhi, University of Texas MD Anderson Cancer Center, Houston, Texas.
• Myles T. Taffel, New York University Langone Medical Center, New York, New York.
• Gaurav Khatri, Specialty Chair, University of Texas Southwestern Medical Center, Dallas, Texas.

Document Type

Journal Article

Publication Date

3-21-2026

Journal

Journal of the American College of Radiology : JACR

DOI

10.1016/j.jacr.2026.02.023

Keywords

ACC; AUC; Appropriateness Criteria; CT; DOTATATE PET; FDG-PET; MRI; adrenocortical carcinoma; appropriate use criteria; pheochromocytoma

Abstract

Primary adrenal gland malignancies include adrenocortical carcinoma (ACC) and pheochromocytoma. For initial staging and restaging or surveillance of known or suspected ACC, MRI of the abdomen and pelvis without and with contrast, CT of the abdomen and pelvis with contrast, CT of the chest with contrast, and fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT, or FDG-PET/MRI are recommended to assess for local extent and distant metastases or to evaluate for recurrence. For initial staging and restaging or surveillance of known or suspected pheochromocytoma, MRI of the abdomen and pelvis without and with contrast, CT of the abdomen and pelvis with contrast, CT of the chest with contrast, DOTATATE PET/CT, or DOTATATE PET/MRI are recommended to assess local extent and distant metastases or to evaluate for recurrence. Meta-iodobenzylguanidine (MIBG) scan whole body with single-photon emission CT (SPECT) or SPECT/CT area of interest is an acceptable alternative for initial staging of known or suspected pheochromocytoma, in particular to determine eligibility for I-131 MIBG therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

APA Citation

Chang, Silvia D.; Jeavons, Cassandra; Ulaner, Gary A.; Purysko, Andrei S.; Caserta, Melanie P.; Catanzano, Tara M.; De Leon, Alberto Diaz; Lew, Susie Q.; Nicola, Refky; Raj, Nitya; Refaat, Tamer; Ristau, Benjamin T.; Schultz, David; Solórzano, Carmen C.; Surabhi, Venkateswar R.; Taffel, Myles T.; and Khatri, Gaurav, "ACR Appropriateness Criteria® Staging and Follow-Up of Adrenal Cancer" (2026). GW Authored Works. Paper 8853.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8853

Department

Medicine