Adrenal angiography, venography, positron emission tomography and MIBG scan may be used in the diagnosis of adrenocortical carcinoma. The sensitivity of FDG PET/CT was 90% for the diagnosis of metastases as compared with 88% for the diagnostic CT. FDG PET/CT is a useful modality for staging ACC and evaluating local recurrence.

Other imaging studies that may be used in the diagnosis of adrenocortical carcinoma are: ^[1]

• Adrenal angiography
• Adrenal venography
• PET scan (positron emission tomography scan)
• MIBG scan
• Bone scans are used to visualize bone metastasis

• ACC presents as a large, heterogeneous mass with intense FDG uptake.^[2]
• FDG PET/CT had a sensitivity of 100% and specificity of 88% in distinguishing benign from malignant lesions by using cut-off value above 1.45 for adrenal to liver maximum standardized uptake value (SUV).
• PET/CT cannot distinguish ACC from metastases, lymphoma, or pheochromocytoma due to the high metabolic activity of these tumors.^[2]
• FDG PET/CT is a useful modality for staging ACC and evaluating local recurrence.
• Increased uptake of FDG may be seen in benign conditions including postoperative changes.
• No significant difference in accuracy was found between visual analysis, SUV analysis, and standardized uptake ratio (defined as the ratio of adrenal SUV activity to liver SUV activity) analysis.^[3]
• The sensitivity of FDG PET/CT was 90% for the diagnosis of metastases as compared with 88% for the diagnostic CT.
• FDG PET/CT has low sensitivity for characterization of smaller lesions, particularly for those lesions less than 10 mm in diameter.^[4]
• The intensity of FDG uptake was found to be related to survival in patients with ACC, with a maximum SUV of >10 indicating a poor prognosis.^[4]