艾滋病相关腹部淋巴瘤的临床及CT表现特征

【摘要】目的：总结分析艾滋病相关腹部淋巴瘤的CT表现特征,对比非艾滋病与艾滋病相关淋巴瘤（ARL）的临床及影像学表现异同。方法：回顾性分析28例经手术病理证实的艾滋病相关淋巴瘤患者的临床及CT表现。结果：28例艾滋病相关淋巴瘤中霍奇金病1例,非霍奇金淋巴瘤27例,受累脏器包括肝脏10例、脾脏9例、胰腺6例、肾脏5例、胃肠道8例、结内病变23例。病变器官解剖结构留存,病灶多数密度均匀,呈轻中度均匀强化,小部分病变中央出现坏死,呈环形轻中度强化。淋巴结以腹主动脉周围、腹腔干周围、肠系膜、肠系膜根部最为好发。ARL病灶侵袭性高,累及范围广,对放化疗反应性较差。结论：ARL的CT表现具有一定特征性,结合临床表现,有利于提高诊断符合率。     

类鼻疽胸部受累病人不良预后的危险因素分析

目的 回顾性分析类鼻疽胸部受累病人的临床特点、实验室结果及胸部CT特征,结合病人临床预后,探讨影响其预后不良的危险因素。方法 回顾性收集经细菌培养证实为类鼻疽感染且胸部受累的病人67例,男61例,女6例,平均年龄（53.52±13.75）岁。根据病人出院时预后状态分为预后良好组（37例）及预后不良组（30例）。采用独立样本t检验、Mann-Whitney U检验和χ2检验,比较不同预后组间临床特点、实验室结果及胸部CT特征的差异;采用单因素及多因素logistic回归分析筛选与预后相关的危险因素,并绘制受试者操作特征（ROC）曲线,采用Delong检验比较不同危险因素预测效能的差异。结果 与预后良好组相比,预后不良组入院时和入院1周时肾功能不良病人的占比较高,血红蛋白和血清总蛋白较低;CT上出现结节和空洞的占比较高,病灶累及肺段及肺叶数较多（均P<0.05）。单因素分析提示入院时及入院1周的肾功能不良,血清总蛋白、血红蛋白减低,胸部CT上可见结节、空洞、病灶累及肺段及肺叶数是类鼻疽胸部受累病人预后不良的危险因素（均P<0.05）。多因素分析显示,入院1周肾功能不良和累及肺段...     

艾滋病并发脑感染的CT表现

目的探讨艾滋病病毒中枢神经系统感染的影像学特征及诊断。方法对14例确认艾滋病合并中枢神经系统感染患者的CT影像进行分析。结果艾滋病脑炎10例,均无占位效应。脑萎缩现象5例,其中2例单独存在,3例与病灶并存。平扫病变呈片状低密度,以脑白质受累为主;6例累及双侧多个脑叶,分布不对称;2例位于左脑。其中2例增强无强化。巨细胞病毒感染1例,平扫两枕叶见片状低密度,对称分布。弓形体脑病3例,2例见等密度灶并周围水肿,1例显示脑脓肿征象。结论根据CT影像特征,结合流行病学询问,可提出本病疑似诊断。     

原发性胃淋巴瘤的多层螺旋CT诊断

目的 探讨原发性胃淋巴瘤的多层螺旋CT表现,提高对原发性胃淋巴瘤的认识及诊断水平.方法 回顾性分析经病理确诊的19例原发性胃淋巴瘤的CT影像特征.观察指标有病变部位、受累范围、胃壁厚度、强化程度、胃腔情况、黏膜及浆膜情况、胃周淋巴结及其他器官受累情况.结果 本组共19例原发性胃淋巴瘤,均为非霍奇金淋巴瘤.病变累及胃窦、体及底2个或3个部位16例,仅累及1个部位3例.所有病例均表现胃壁不均匀增厚(10～67 mm),其中弥漫性增厚9例,节段性增厚6例,局限性增厚4例.19例增厚胃壁均呈轻中度均匀强化.11例胃壁黏膜线完整,黏膜破坏8例.所有病例浆膜层光滑连续,周围脂肪间隙清晰.5例胃周淋巴结肿大.无1例肝脏、脾脏等脏器侵犯.结论 原发性胃淋巴瘤的CT表现具有一定的特征性,多层螺旋CT对其诊断和鉴别诊断具有很高的临床价值.     

成人起病的脑白质病伴轴索球样变和色素胶质细胞（ALSP）的影像表现

目的 探讨成人起病的脑白质病伴轴索球样变和色素胶质细胞（ALSP）的临床及影像特征,以期提高对该病的认识及对早期影像的诊断能力。 方法 回顾性分析3例经临床诊断的ALSP病人,分析其临床表现、神经影像学特征和基因检查结果,并行文献复习。 结果 ALSP病人的临床表现多样,3例病人均有认知障碍和锥体束征,存在精神行为异常和帕金森病样表现者2例,存在癫痫、共济失调和步态异常者2例。MRI显示3例病人双侧侧脑室旁和深部白质多发病变,呈额、顶叶分布,可累及胼胝体;2例累及锥体束,均未累及脑干;3例病变均呈不对称分布,其中2例病灶呈大片状、融合分布;3例均未见病灶强化及皮质下U纤维受累;除白质病变外,3例病人均可见侧脑室扩大和病变区扩散加权成像（DWI）点片状高信号,2例病人伴脑叶萎缩。2例病人CT伴点状微小钙化灶。2例病人基因诊断发现CSF1R突变。3例病人实验室检查均未见明显异常。 结论 中青年ALSP病人可表现为认知障碍,影像表现具有一定特征,可见以额顶叶受累为主的白质异常信号,伴受累部位脑叶萎缩、胼胝体萎缩,DWI上呈高信号和/或点状钙化,结合临床、影像特征及基因检查可考虑本病。     

艾滋病相关胃肠道非霍奇金淋巴瘤的影像表现:4例报告并文献复习

目的探讨艾滋病相关消化道非霍奇金淋巴瘤的MDCT及MR表现。方法回顾性分析4例艾滋病合并消化道非霍奇金淋巴瘤的MDCT及MR表现,结合胃镜、肠镜检查及病理结果,分析其影像特征。结果 4例患者病变广泛累及除食管外的消化道各个部位,其中累及胃2例、十二指肠1例、小肠2例、结肠2例、直肠肛管1例。受累管壁局灶性或弥漫性向心性增厚,部分管腔狭窄或呈"动脉瘤样"扩张,2例患者可见溃疡形成,1例患者出现肠梗阻。增强扫描胃淋巴瘤表现为轻度均匀强化,小肠结肠及直肠肛管淋巴瘤表现为持续性中度至明显不均匀强化。多部位活检病理证实4例患者均为非霍奇金淋巴瘤。结论艾滋病相关消化道淋巴瘤多部位及少见部位受累常见,病变形态、强化程度多样化。CT及MR检查对诊断及鉴别诊断具有重要价值。     

原发性甲状腺淋巴瘤的CT表现及其病理相关性

目的探讨原发甲状腺淋巴瘤CT表现与其病理的相关性,以提高术前确诊率。方法回顾性分析13例经病理证实的B细胞来源的非霍奇金甲状腺淋巴瘤CT图像进行观察,对其病变的位置分布、形态、边缘、密度、强化及周围侵犯的情况进行统计并探讨与其病理类型的相关性。结果弥漫性大B细胞淋巴瘤表现为:双侧叶弥漫性肿大3例、单侧叶弥漫性肿大型2例、局灶结节型2例;密度均匀减低4例、不均匀减低3例;界不清6例、界清1例;7例均强化不明显或轻微强化;颈部淋巴结受累4例、累及颈部周围软组织1例。粘膜相关淋巴组织B细胞淋巴瘤表现为:甲状腺弥漫肿大1例、局灶结节3例;界清与界不清各2例;4例密度均匀、强化不明显且均未见颈部淋巴结或周围软组织受侵。粘膜相关淋巴组织B细胞淋巴瘤大细胞转化型表现为:双侧叶、单侧叶各1例均呈弥漫性肿大,界不清;密度均匀减低1例、不均匀减低1例;1例颈部淋巴结受累,2例强化均不明显,未累及周围软组织。结论甲状腺淋巴瘤的CT表现常表现为甲状腺弥漫性肿大、界清、平扫呈稍低密度、强化不明显、颈部淋巴结受累等,不同病理类型的甲状腺淋巴瘤CT表现有一定差异。     

鼻咽癌颅内侵犯途径及其CT、MRI表现

目的 :探讨鼻咽癌颅内侵犯途径及其CT、MRI表现。方法 :回顾性分析47例鼻咽癌颅内侵犯的CT和MRI图像,其中CT检查42例,MRI检查26例,同时行2种影像检查21例,观察病灶向颅内侵犯途径、累及范围,以及病灶CT及MRI征象。结果:病灶直接破坏颅底骨质侵入颅内23例,经颅底孔裂直接侵入颅内20例,经颅底淋巴环转移4例,颅底直接侵犯伴有颅底不同程度骨质破坏,颞叶受累3例。侵入颅内肿瘤组织密度或信号均匀,增强扫描病灶强化显著、均匀。结论:CT及MRI检查可准确判断鼻咽癌病灶侵犯颅内途径、病灶累及范围,为鼻咽癌的综合治疗及预后提供可靠依据。     

儿童EB病毒相关噬血细胞性淋巴组织细胞增生症中枢神经系统受累的影像学表现

目的 探究儿童EB病毒相关噬血细胞性淋巴组织细胞增生症（HLH）中枢神经系统（CNS）受累的影像学表现和可能的影响因素。资料与方法 回顾性分析2014年3月—2021年3月北京儿童医院85例EB病毒相关HLH的临床及CT、MRI资料，根据CNS是否受累分为CNS受累组30例和CNS未受累组55例，分析CNS受累患儿的影像特征，比较两组临床及实验室指标的差异。结果 两组患儿年龄、性别、血红蛋白、血小板、白细胞、中性粒细胞、纤维蛋白原、铁蛋白、甘油三酯、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、血清EB病毒-DNA等差异均无统计学意义（均P>0.05）。CNS受累组5例患儿颅脑影像无异常表现，8例仅表现为脑萎缩，17例表现为脑内异常信号，其中点状病变9例，片状病变5例，弥漫性病变2例，出血性病变1例。结论 儿童EB病毒相关HLH的CNS受累影像表现多样，一定程度上可以反映疾病严重程度，掌握其影像学表现对于患儿病情监测及预后评估具有重要价值。     

肌肉淋巴瘤的CT表现

目的：分析肌肉淋巴瘤的CT表现，了解其影像特点。资料与方法：回顾性分析经组织学或临床随诊证实的11例肌肉淋巴瘤的CT表现。非霍奇金淋巴瘤（NHL）9例，霍奇金淋巴瘤（HD）2例。9例行CT增强扫描，2例行CT平扫。结果：1例为单块肌肉受累，其余10例均为多处肌肉同时受累，其中8例为多处相连肌肉受累，2例为多处不相连肌肉受累。受累部位：髂腰肌7例，腰大肌5例，髂肌4例，腰方肌、闭孔内肌、腹壁肌肉各3例，肋间肌、背阔肌、梨状肌、臀肌各2例，胸肌、胸锁乳突肌各1例。病变形态：肌肉弥漫增大11例，肿块、多个结节融合各1例。平扫2例，病变密度与正常肌肉相似，1例均匀，另1例不均匀，内部见不规则片状低密度区。增强扫描9例，病变密度等于正常肌肉7例，轻度高于正常肌肉3例，明显高于正常肌肉1例；密度均匀4例，不均匀6例；病变内部见不规则片状密度区6例，点状钙化1例。结论：肌肉淋巴瘤的CT表现特点多为肌肉弥漫增大，常多处肌肉同时受累。平扫密度与正常肌肉相似，增强扫描可等于、轻度高于或明显高于正常肌肉。     

Significance of the initial cytomorphological and immunocytochemical findings and the correlation with the International Prognostic Index for the survival in patients with non-Hodgkin's lymphoma

BACKGROUND/AIM: Fine-needle aspiration biopsy is a quick, economical, and safe initial method in managing a patient with suspected lymphoma. According to a few reports on this preoblem, the aim of this study was to compare histological findings to cytomorphological ones in needle aspirates. We also compared these findings to the overal survival (OS) time. METHODS: We analyzed the fine-needle aspiration biopsies of peripheral lymph nodes, and the International Prognostic Index (IPI) in 81 patients with non-Hodgkin's lymphoma (NHL). We put these findings into correlation with OS time. RESULTS: According to the International Working Formulation (IWF) criteria, the dominant cell population was asfollows: 18 patients had the small cell population, 21 patients had small cleaved cells, 18 patients had the mixed cell population, 21 patients had large cell population, 2 patients had Burkitt lymphoma type, and 1 patient had the dominant lymphoblasts. On presentation, 32 patients had a low IPI index, 32 patients had a low intermediate, and 17 patients had a high intermediate IPI. We confirmed the statistical significance (Kaplan-Mayer) of cytomorphology (p = 0.013) and IPI index (p = 0.016) for survival time. During a 48-month follow-up, OS was 37.2 months for the patients with the dominant small cells, and 32 months for the patients with small cleaved cells (PH equivalent to indolent NHL). For the patients with the dominant mixed cell population, large cell population and Burkitt limphoma cell, OS were 17, 14.4, and 9.3 months, respectively (PH equivalent to aggressive NHL). Patients with low IPI had the highest OS, 36 months for the low intermediate and only 11.6 months for the high intermediate IPI index. CONCLUSION: We concluded that an initial cytological and clinical profile of patients with NHL, might give a quick and relevant information for planning an adequate therapy.     

Prognostic impact of pre-transplantation computed tomography and 67gallium scanning in chemosensitive diffuse large B cell lymphoma patients undergoing hematopoietic stem-cell transplantation

OBJECTIVE: In the present study, we evaluated computed tomography (CT) and (67)gallium scanning ((67)Ga scan) pre-transplant as prognostic factors for overall survival (OS) and event-free survival (EFS) in patients with diffuse large B cell lymphoma, undergoing high-dose chemotherapy and stem-cell transplantation. PATIENTS AND METHODS: Forty-two patients were included. Of these, 9 (21%) had both positive CT and (67)Ga scans, 17 (41%) negative results with both techniques, and 16 (38%) positive CT/negative (67)Ga scan. Whole-body planar imaging and single-photon emission computed tomography (SPECT) were performed 72 h after an intravenous administration of (67)Ga citrate measuring between 7 mCi and 10 mCi (259-370 MBq). RESULTS: Patients with positive CT/positive (67)Ga scan had a significantly worse EFS and OS at 5 years than those with negative (67)Ga scan regardless of whether it was associated with a positive or a negative CT scan (29% and 16% vs. 81% and 93% vs. 88% and 100%, respectively, P < 0.001). After a median follow-up of 43 months (range 4-130 months), no differences were observed between patients with negative CT/negative (67)Ga scan and those with positive CT/negative (67)Ga scan, with an EFS and OS at 5 years of 88% versus 81% and 100% versus 93%, respectively. In multivariate analysis, the presence of a pre-transplant positive CT/(67)Ga scans adversely influenced both EFS and OS [HR 8, 95% confidence interval (CI) (1.4-38), P = 0.03 and HR 2; 95% CI (1.3-8), P = 0.02, respectively]. CONCLUSIONS: (67)Ga scan helps to identify, in the pre-transplant evaluation, two groups with a different outcome: one group of patients with positive CT and negative (67)Ga scans pre-transplant, who showed a favorable outcome with a low rate of relapse, and the other group of patients with both positive CT and (67)Ga scans pre-transplant, who showed a poor prognosis and did not benefit from autologous stem-cell transplantation. They should have been offered other therapeutic strategies.     

A child with Burkitt lymphoma with pleural, peritoneal, mesenteric, omental, and renal involvement: diagnostics by FDG PET/CT

A 7-year-old boy presented with increasing abdominal girth and abdominal pain. Abdominal ultrasound revealed a pleural effusion and ascites. Computed tomography (CT) demonstrated a mass involving the peritoneum, mesentery, and omentum with marked ascites, mesenteric nodules, and renal involvement. Positron emission tomography (PET)/CT scan identified additional tumor within the pleura. PET/CT imaging was helpful in identifying the appropriate pleural mass biopsy site in this patient with Burkitt lymphoma.     

小儿腹部Burkitt淋巴瘤结外侵犯的MSCT表现

目的：探讨儿童腹部Burkitt淋巴瘤结外侵犯的MSCT表现及其诊断价值。方法：回顾性分析本院22例经病理证实的Burkitt淋巴瘤的腹部MSCT资料,对其结外病变进行分类和影像学表现分析。结果：Burkitt淋巴瘤可侵犯腹盆腔的多个结外脏器,包括腹部实质脏器（8/22）和胃肠道（21/22）。病变多表现为轻度强化的密度均匀的实性肿物,出血、坏死少见,钙化罕见;常伴肠系膜及腹膜后多个肿大淋巴结、大网膜广泛增厚或腹腔积液,以回肠远端浸润型和胰腺多发结节型最多见。结论：Burkitt淋巴瘤常同时侵犯腹盆腔多个结外脏器,儿童Burkitt淋巴瘤腹部结外侵犯的MSCT表现有一定特征性。     

A case of non-Hodgkin’s lymphoma of the ovary: Usefulness of18F-FDG PET for staging and assessment of the therapeutic response

Primary ovarian lymphoma as the initial manifestation is rare. A 27-year-old woman presented to our hospital with the symptoms of lower abdominal fullness and pollakisuria. CT scan and MRI revealed bilateral ovarian tumors, which showed heterogeneous masses. 18F-FDG PET revealed strong uptake by the abdominal masses, and the maximum standardized uptake value (SUVmax) was 12.5. Abnormal uptake was not shown by other regions. An exploratory laparotomy was performed. Histological findings revealed diffuse large B-cell lymphoma. The clinical stage was IV according to the Ann Arbor system. International prognostic index (IPI) was 3 (high-intermediate risk). Chemotherapy was administered consisting of three courses of an R-CHOP regimen, and 18F-FDG PET and CT scan revealed no signs of involvement 3 months after initiation of the chemotherapy. 18F-FDG PET was a useful method for staging and assessment of the therapeutic response in primary ovarian lymphoma.     

胃癌与胃淋巴瘤的MSCT征象对比分析

目的:探讨胃癌与胃淋巴瘤的MSCT表现,提高对二者CT征象的认识。方法:对40例胃癌和20例胃淋巴瘤的MSCT资料进行回顾性分析,比较二者在胃受侵部位、胃壁改变、胃腔改变、黏膜改变、外周脂肪间隙、器官侵犯、淋巴结转移方面CT征象的差异。结果:胃癌组侵犯胃窦29例,同时侵犯2个部位13例,均无侵犯全胃;胃淋巴瘤组侵犯胃体16例,同时侵犯2个部位7例,侵犯全胃8例。胃癌组25例不均匀强化,25例黏膜破坏;胃淋巴瘤组4例不均匀强化,2例黏膜破坏。累及胃窦患者中,胃癌组14例可见病灶上方胃腔梗阻性扩张;胃淋巴瘤组仅1例疑似梗阻性扩张。上述征象,2组差异均有统计学意义。在其他CT征象方面,二者之间差异无统计学意义。结论:MSCT对于胃癌与胃淋巴瘤的诊断及鉴别诊断具有一定价值。     

Iliopsoas impingement on the acetabular component: radiologic and computed tomography findings of a rare hip prosthesis complication in eight cases

OBJECTIVE: To describe the radiographic and computed tomography (CT) scan features of iliopsoas impingement on the acetabular component (IPI) in total hip arthroplasty. METHOD: Eight cases of iliopsoas impingement were diagnosed and confirmed by surgical revision. The plain film radiograph findings and CT scan findings were compared with those of two control populations (8 patients with painless total hip prosthesis and 16 patients with other complications confirmed by surgical revision). RESULTS: An oversized cup was found in four hips with IPI (50%) and in one hip with another complication (6%). Coronal inclination of the acetabular cup was normal in the IPI group and in the two control groups, with a similar mean cup size. All patients with IPI had an acetabular cup overhang of more than 12 mm. Conversely, in the two control groups, the overhang, present in three and two cases, respectively, was always less than 8 mm. Iliopsoas bursal effusion was present in four hips with IPI and three hips with other complications and was never present in normal prostheses. CONCLUSION: More than a 12-mm overhang of the acetabular cup is a sensitive and specific parameter for diagnosing IPI.     

结外淋巴瘤:影像学共性特征与病理的关系

目的 分析结外淋巴瘤的影像学特征,探讨影像学对其诊断价值.资料与方法 回顾性分析57例经手术病理证实的结外淋巴瘤病例,非霍奇金病54例,霍奇金病3例,初诊时均无明确淋巴瘤病史,术前分别经常规X线、CT和MRI检查.结果 57例结外淋巴瘤中,消化道14例,骨骼9例,脑7例,肾5例,肺4例,脾4例,肾上腺4例,肝脏3例,肌肉3例,胰腺2例,睾丸1例,阴道1例.常规X线检查22例,术前诊断6例;CT检查39例,术前诊断17例;MRI检查19例,术前诊断12例.CT检查47个病灶中,41个病灶密度均匀,6个病灶有程度不等坏死.MRI检查26个病灶中,T1WI为低或等信号,25个病灶T2WI为低、等或略高信号,1个病灶为高信号;17个病灶信号均匀,9个病灶信号不均匀.动态CT和MR增强47例,除脑淋巴瘤为进行性显著持续强化外,其他部位淋巴瘤为进行性轻到中度延迟强化.结外淋巴瘤瘤内常可见脏器原有解剖结构,如血管、支气管、肾盂、肌间隙等残留.结论 结外淋巴瘤共性表现包括肿瘤密实,瘤内可见原有解剖结构残留,MR T2WI多为等或略高信号;一般轻度至中度延迟强化.掌握结外淋巴瘤的一些特征性影像学表现,有利于提高诊断准确率.     

Relationship Between Dual Time Point FDG PET/CT and Clinical Prognostic Indexes in Patients with High Grade Lymphoma: a Pilot Study

Purpose

This study investigated the correlative relationship between metabolic parameters estimated from dual time point 2-deoxy-2-[¹⁸F] fluoro-D-glucose (¹⁸F-FDG) positron emission tomography/computerized tomography (PET/CT) and the clinical tools predicting the outcome of a lymphoma. We also measured metabolic and volumetric alterations between early and delayed ¹⁸F-FDG PET/CT in patients with high grade lymphoma (HGL).

Methods

The samples were 122 lymph nodes and extralymphatic lesions from 26 patients diagnosed with HGL. All patients were applied to the International Prognostic Index (IPI), Ann Arbor stage, and revised IPI as clinical prognostic parameters. ¹⁸F-FDG dual time point PET/CT (DTPFP) consisted of an early scan 1 h after ¹⁸F-FDG injection and a delayed scan 2 h after the early scan. Based on an analysis of DTPFP, we estimated the standardized uptake value (SUV) of tumors from the early and delayed scans, retention index (RI) representing the percentage change between early and delayed SUV, and metabolic volume different index (MVDI) calculated using metabolic tumor volumes (MTV).

Results

RI_max showed a multiple positive correlative relationship with stage and IPI in lesion-by-lesion analysis (p?<?0.01). In the case of IPI, the high risk group exhibited higher RI_max than the low risk group (p?=?0.004). In the case of revised IPI, the RI_max of the low risk group were significantly lower than the intermediate and high risk groups, respectively (p?<?0.01). The MVDIs of the best outcome group were decreased in comparison to the moderate outcome group (p?=?0.029). There was a significant negative correlative relationship between RI_max and MVDI, and the inclinations for decreased MVDIs were slightly associated with increased RIs.

Conclusions

RI_max extracted from DTPFP had a significant relationship to extranodal involvement, staging, IPI, and revised IPI. MVDI showed significant negative correlation with RI_max. Further large scale studies are warranted to support and extend these preliminary results.

     

Usefulness of CT scan, MRI and radiocholesterol scintigraphy for adrenal imaging in Cushing's syndrome

The aim of this study was to evaluate the sensitivity and accuracy of computed tomography (CT) scanning, 75Se-selenomethyl-norcholesterol scintigraphy (SNS) and magnetic resonance imaging (MRI) in patients with Cushing's syndrome (CS) undergoing adrenalectomy. A series of 67 patients with CS due to benign adrenal disease was reviewed. There were 11 (16.4%) men and 56 (83.6%) women, with an overall median age of 44 years (range 19-69 years). Prior to surgery all patients underwent both CT and SNS, and 58 (86.6%) underwent adrenal MRI. Thirty-five (52.2%) of the patients (group A) had histologically confirmed unilateral adrenal involvement (33 patients with a solitary adrenocortical adenoma, and two with unilateral nodular cortical hyperplasia), while 32 (47.8%) of the patients (group B) had CS caused by bilateral adrenal involvement, including two patients with multinodular adrenal hyperplasia. The sensitivity, specificity and accuracy of adrenal imaging in group A were 97.1%, 100% and 98.5% for SNS, 94.3%, 68.7% (P<0.05, chi2 test) and 82.1% for CT scan, and 92.3%, 60.0% (P<0.05) and 64.3% (P<0.05) for MRI, respectively. In group B the sensitivity, specificity and accuracy were 100%, 97.2% and 98.5% for SNS, 64.5% (P<0.05), 97.2% and 82.1% for CT scan, and 60.0% (P<0.05), 92.3% and 35.7% (P<0.05) for MRI, respectively. In conclusion, SNS represents the most sensitive and specific adrenal imaging study and should be used in all patients with confirmed biochemical diagnosis of CS undergoing adrenalectomy. The sensitivity and specificity of CT scan and MRI are similar, but the latter shows a lower accuracy, especially in patients with bilateral adrenal involvement.