Elsherif SB, Javadi S, Blair KJ, et al. - This study was undertaken to investigate the typical and atypical radiologic features of pathologically proven adrenal adenomas and to ascertain the correlation between the radiologic and histopathologic classification. One-hundred fifty-six pathologically proven adrenal adenomas were retrospectively examined in 154 patients from the institutional databases who have CT and/or MRI examinations before intervention. The histopathologic diagnosis (typical or atypical) was ascertained applying Weiss scoring and categorized the adenomas radiologically into typical, atypical, or indeterminate based on lesion size, precontrast CT attenuation, absolute percentage washout, calcification, and necrosis. The agreement between radiologists was evaluated using the κ statistic. The radiologic and pathological classifications were compared by using the Fisher exact test. The findings reveal that radiologically atypical lesion was significantly correlated with larger size and higher unenhanced CT attenuation. Atypical features on imaging was indicated by approximately 27% of the cases. It was shown that most radiologically atypical adrenal adenomas are pathologically typical.