Human Adrenal Gland Charts within the Common Coordinate Framework from CT-based Imaging

The human adrenal gland is a critical endocrine organ that regulates physiological processes and modulates diseases progressions. However, the extent to which adrenal gland morphometrics vary by age, sex, and pathological conditions remains limited due to challenges with the adrenal gland template. Based on large cohorts (total N = 37,251) of adrenal CT, we developed artificial intelligence-enabled methods to construct an adrenal gland common coordinate framework and to provide morphological and densitometric templates for voxel-wise statistical parametric mapping analysis. We delineated sex-stratified developmental trajectories of adrenal imaging metrics across 18 to 100 years. Adrenal developmental trajectories derived from CCF-based analysis, which was validated by conventional regional analysis, showed distinct sex-specific patterns: an inverted-U shape in males and a gradual age-related increase in females. We mapped topographic patterns of the adrenal gland associated with physical/physiological measures and changes in four adrenal gland-related pathological conditions. Our findings provided a quantitative spatial reference system for comparing and correlating bilateral adrenal gland data from multiple individuals and conditions, thereby facilitating novel insights into its physiology and pathophysiology.