Abstract： Objective To investigate the value of enhanced CT in differential diagnosis of adrenal metastases and lipid-poor adenomas.Methods This retrospective study included one hundred and eighteen lung cancer patients with unilateral adrenal solid nodule(metastases,sixty-seven,lipid-poor adenomas,fifty-one)and all patients underwent chest or abdominal plain and biphasic enhanced CT scans.Clinical and radiological charac-teristics of two groups,such as gender,age,clinical stage of lung cancer,size,location,plain and biphasic en-hanced CT values,cystic changes/necrosis,and peak enhancement phase of adrenal nodules,were compared u-sing univariate analysis.A diagnostic model was developed using multivariable logistic regression.Areas under receiver operating characteristic curves(AUCs),sensitivity,specificity,and accuracy were used to evaluate the performances of each characteristic parameter and diagnostic model.Results CT values in plain phase of me-tastases were noticeably higher than that of adenomas(P＜0.001)and the proportions of male,irregular in shape,cystic degeneration/necrosis and Ⅲ/Ⅳ clinical stage of lung cancer were all significantly higher than adenoma group(P＜0.05).Furthermore,compared to metastases,lipid-poor adenomas showed relatively fas-ter wash-in and earlier wash-out enhancement pattern(P＜0.001).Multivariate logistic analysis revealed gen-der(AUC=0.672),CT values in plain phase(AUC=0.776),cystic degeneration/necrosis(AUC=0.580),clinical stage of lung cancer(AUC=0.671)and peak enhancement phase(AUC=0.671)were risk factors for predicting adrenal metastases in lung cancer.The diagnostic model for predicting metastases had the highest performance,with an AUC of 0.908(95％CI:0.846～0.969),and its sensitivity,specificity,and accuracy were 0.866(95％CI:0.784～0.947),0.863(95％CI:0.768～0.957),and 0.864(95％CI:0.862～0.866),respec-tively.Conclusion The diagnostic model based on enhanced CT can effectively differentiate adrenal metastases from lipid-poor adenomas in lung cancer patients.