In conclusion, benign adrenal masses are common even in patients with cancer. Most of these masses are lipid rich adenomas and these can be confirmed on unenhanced CT with an attenuation value of less than 10 HU & a histogram threshold of more than 10% negative pixels. Histogram analysis is more accurate than pre contrast attenuation in detecting intra lesion fat content & is considered a useful tool in diagnosing lipid rich adenomas. The APW and RPW values are accurate discriminators of the nature of adrenal masses whether benign or malignant especially for the intermediate density masses. In the current study, the washout profile supersedes the pre contrast attenuation value of less than 10 HU and 10 % negative pixels on histogram analysis in the evaluation of an adrenal mass. Size is the lowest CT parameter discriminator with considerable overlap between benign & malignant lesions. Combining the studied CT parameters yielded a powerful diagnostic protocol in distinguishing benign from malignant adrenal masses.

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