An adrenal mass discovered incidentally during imaging for unrelated clinical reasons is termed an “adrenal incidentaloma” (AI). AIs can be categorized as primary or metastatic, functioning or non-functioning, and benign or malignant. The primary goal of radiological evaluation is to exclude malignancy by differentiating between benign and malignant lesions. Most AIs are benign, with adenomas and macronodular bilateral adrenal hyperplasia being the most common types. Less common benign lesions include myelolipomas, pheochromocytomas, cysts, and hematomas. Malignant adrenal masses account for less than 10% of cases and often include metastases from other cancers or primary adrenal diseases, such as adrenocortical carcinoma and pheochromocytoma. Computed Tomography (CT) remains the gold standard for diagnosing adrenal incidentalomas, while Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) are utilized for indeterminate cases. Additionally, innovative imaging techniques such as texture analysis are gaining importance, as they can assess quantitative parameters that are not visible to the human eye. This review aims to provide an updated overview of malignant adrenal lesions on CT and MRI, emphasizing key imaging features suspicious for malignancy to aid in distinguishing between benign and malignant lesions. Furthermore, it highlights the growing role of radiomics as a supportive tool for radiologists.

Pancreatic cystic lesions (PCLs) are increasingly detected due to widespread use of cross-sectional imaging. They encompass a heterogeneous group of lesions, ranging from benign pseudocysts and serous cystic neoplasms (SCNs) to premalignant mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs), as well as rare malignant entities such as solid pseudopapillary epithelial neoplasm (SPENs) and cystic pancreatic neuroendocrine tumors (cystic PanNETs). Management of PCLs depends on their malignant potential; therefore, an accurate classification is essential for optimizing treatment. This narrative review summarizes current knowledge on the epidemiology, imaging characteristics, diagnosis, and management of PCLs, highlighting the role of CT, MRI, MRCP, and endoscopic ultrasound. Recent advances in radiomics for lesion characterization and risk stratification, particularly in IPMNs, are discussed.

Acute mesenteric ischemia (AMI) is a clinical condition caused by vascular insufficiency, resulting in intestinal damage. Is often underestimated, if not driven by clinical suspicion, due to the non-specific clinical symptoms (usually represented by acute abdominal pain) and the absence of reliable markers, which results in a poor prognosis and high mortality. We can identify three main forms of AMI: arterial, venous, and non-occlusive. Arterial AMI is the most frequent form, caused by occlusion of the superior mesenteric artery or one of its branches. Venous AMI is the least frequent, caused by thrombosis of the superior mesenteric vein or its branches. Non-occlusive AMI is due to a state of hypovolemia, which is frequent in patients who have undergone surgery. Given the difficulty of diagnosis based on the clinic alone, the radiologist plays a central role in identifying radiological signs of intestinal ischemia and in avoiding misdiagnosis. The radiologist’s role is mainly to identify factors predictive of necrosis, which allow us to stratify patients and direct them towards the proper management. The aim of this review is to provide indications for an adequate CT protocol, including an unenhanced phase, an arterial phase, and a venous phase, as well as to underline the features to investigate in the different forms of AMI, in order to increase the diagnostic capacity in this challenging disease.