CT平扫及延迟扫描对肾上腺肿瘤的诊断价值

目的:分析CT平扫及延迟扫描对诊断肾上腺腺瘤与肾上腺嗜铬细胞瘤、皮质腺癌、转移瘤的诊断价值。方法:回顾性分析98例各类肾上腺肿瘤的CT平扫及延迟期的密度,并进行比较。结果:45例肾上腺皮质腺瘤平扫密度(7±13)Hu明显低于肾上腺嗜铬细胞瘤(38±13)Hu、皮质腺癌(34±15)Hu、转移瘤(31±15)Hu之间的差异有统计学意义(P<0.001)。虽然增强后1min密度(58±23)Hu明显低于其他三种肿瘤,与肾上腺嗜铬细胞瘤、皮质腺癌、转移瘤之间的差异有统计学意义(P<0.001),但CT值范围与其他三种肿瘤之间的差异互相重叠。增强后10min肾上腺腺瘤密度(32±23)Hu,与肾上腺嗜铬细胞瘤(89±23)Hu、皮质腺癌(78±28)Hu、转移瘤(78±26)Hu之间的差异有统计学意义(P<0.001)。结论:肾上腺CT平扫及延迟扫描对腺瘤和非腺瘤的鉴别诊断具有较大价值。

The Diagnostic and Delayed Contrast Medium-enhanced Computed Tomography (CT) in Patients with Adrenocortical Tumours

Objective To retrospectively measure the adrenal gland Attenuation at the nonenhanced and delayed contrast medium-enhanced computed tomography (CT) in patients with adrenocortical carcinomas and pheochromocytomas and to compare these data with those in patients with adenomas and metastases.Methods 11 patients with proved adrenocortical carcinoma,22 with proved pheochromocytoma,45 with adrenal adenoma,and 21 with metastasis to the adrenal gland underwent helical CT.Nonenhanced CT was followed by contrast-enhanced CT 1 minute and 10 minutes later。Attenuation were calculated.Results The mean attenuation of adenomas (7±13)Hu was significantly lower than those of pheochromocytomas (38±13)Hu,adrenocortical carcinomas (34±15)Hu,and metastases (31±15)Hu on nonenhanced CT scans (P<0.001).Although the mean attenuation values for nonadenomas (ie,adrenocortical carcinomas,pheochromocytomas,and metastases) were significantly higher than the value for adenomas on the 1-minute contrast-enhanced CT scans (P<0.001),there was more overlap in attenuation between adenomas and nonadenomas on contrast-enhanced scans than on nonenhanced scans.On the 10-minute delayed contrast-enhanced scans,the mean attenuation of adenomas (32±23)Hu was significantly lower than the mean attenuations of pheochromocytomas (89±23)Hu,carcinomas (78±28Hu),and metastases (78±26)Hu(P<0.001).Conclusion The enhancement loss in adrenocortical carcinomas and pheochromocytomas is similar to that in adrenal metastases but significantly less than that in adrenal adenomas.The percentage change in contrast material washout is a useful adjunct to absolute CT attenuation values in differentiating adrenal adenomas from adrenocortical carcinomas and pheochromocytomas.