ACR Appropriateness Criteria Updated for Adrenal Cancer Staging and Surveillance

Updated ACR guidelines recommend MRI abdomen/pelvis ± contrast, contrast CT chest/abdomen/pelvis, and FDG-PET/CT or PET/MRI for adrenocortical carcinoma staging. For pheochromocytoma, DOTATATE PET/CT or PET/MRI is preferred; MIBG SPECT/CT remains acceptable, especially to assess…

• Evidence-based guideline (GRADE/RAND-UCLA methodology) from ACR multidisciplinary expert panel, reviewed annually; covers initial staging, restaging, and surveillance for both adrenocortical carcinoma (ACC) and pheochromocytoma.
• Key distinction: FDG-PET is the preferred functional imaging for ACC, while DOTATATE PET supersedes FDG for pheochromocytoma; MIBG scintigraphy with SPECT or SPECT/CT is an acceptable pheochromocytoma alternative specifically when I-131 MIBG therapy eligibility is being evaluated.
• Limitation: In scenarios with sparse or equivocal peer-reviewed literature, expert opinion serves as the primary evidentiary source, which may reduce recommendation strength; no prospective trial data comparing modalities head-to-head are cited in the snippet.

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