Which imaging method is recommended for the investigation of adrenal incidentaloma?

The recommended imaging method for the investigation of adrenal incidentaloma is dedicated adrenal CT. This choice is considered the best practice because a dedicated adrenal CT scan provides high-resolution images that help in accurately characterizing adrenal masses. It allows for precise measurement of lesions, assessment of their size, and evaluation of their attenuation values, which are crucial in differentiating between benign and malignant adrenal lesions.

CT imaging is particularly useful in identifying features such as the density of the adrenal mass and the presence of any associated lymphadenopathy or metastasis, which are important for determining management strategies. Additionally, CT scans have a good sensitivity for detecting hormonal activity, which is vital for evaluating functional adrenal masses.

In contrast, MRI may be useful in certain scenarios, especially for differentiating between adenomas and other lesions, but it typically isn't the first-line imaging technique due to its longer acquisition times and less accessibility. Ultrasound is not a recommended method for detailed adrenal evaluation, as it is operator-dependent and may miss small lesions or provide incomplete information about the pathology. X-ray lacks the resolution necessary to visualize adrenal lesions effectively and is not a suitable option for this situation. Hence, dedicated adrenal CT remains the gold standard for investigating adrenal incidentalomas.