肝腺瘤性增生的病理和影像诊断

近年来影像诊断技术的发展，提高了肝硬化结节性病变的检出，这些节点病变，包括：腺瘤性增生（ＡＨ）、非典型腺瘤性增生（ＡＡＨ）、高分化化肝细胞瘤（ＨＣＣ）和经典ＨＣＣ，随恶性程度增加，门脉血供不断减少，而动脉血供不断增加，动脉门静脉造影ＣＴ和动脉造影ＣＴ、碘油ＣＴ或ＣＯ２超声血管造影结合，综合评价结节病灶的门静脉和动脉血供，及用ＭＲＩ Ｔ２ＷＩ评价病变的信号强度，对鉴别结节病灶的性质有重要价值。     

肝细胞腺瘤（三例报告和文献复习）

肝细胞腺瘤为一少见肝脏良性肿瘤。本文报道的３例中２例为无长期服用避孕药或激素类药物的妇女，１例为老年男性。作者结合文献对其发病、病理和临床表现作了阐述，并着重对其放射性核素扫描、超声扫描、ＣＴ、ＭＲＩ和肝动脉造影的表现和诊断价值以及本病与局灶性结节性增生和巨块型原发性肝癌的鉴别要点作了讨论。     

肾上腺皮质结节性增生与皮质腺瘤的CT鉴别诊断

目的:探讨肾上腺皮质结节性增生与肾上腺皮质腺瘤的CT鉴别诊断.方法:回顾性统计分析31例肾上腺皮质结节性增生与35例肾上腺皮质腺瘤的CT表现,所有病例均经手术及病理证实.结果:结节性增生组与腺瘤组在患者性别、病变位置、病变的边界及同侧肾上腺形态方面存在显著统计学差异(P＜0.05).Logistic回归分析表明,病变边界清楚与否在两者鉴别中具有重要意义.结论:在肾上腺结节性增生与肾上腺腺瘤的鉴别诊断方面CT检查可提供重要参考.结合临床及实验室检查,将会对两者的鉴别提供更大的帮助.     

小肝癌的影象诊断

本综述了小肝癌的血管造影，碘油ＣＴ，ＣＴＡＰ，ＣＯ２－ＤＵＳ和ＭＲ影象表现。以及小肝癌与肝血管瘤，肝腺瘤样增生和局限性结节性的鉴别诊断。＜２．０ｃｍ多血管型小肝癌碘油ＣＴ最敏感，高达９６％，发现少血性肝癌ＣＯ２－ＤＵＳ很有价值。ＭＲＩ显示结节内“疤痕”而使ＦＮＨ与肝癌区别。     

非功能性肾上腺肿瘤的CT诊断

本文分析了５２例非功能性肾上腺肿瘤的ＣＴ表现，着重讨论了转移瘤与无功能腺瘤的鉴别诊断。病灶ＣＴ值＞２０Ｈｕ，密度不均匀，中度至明显强化诊断转移瘤的特异性和敏感性都较高；边界不清或／和侵犯周围结构、不规则厚环状强化为转移瘤的特异性表现，网格状强化只见于无功能腺瘤。     

94例功能性肾上腺皮质疾病的CT诊断及评价

本文总结了９４例肾上腺功能性疾病临床生化、Ｂ超、ＣＴ检查结果并与手术病理对照：包括原发性醛固酮增多症６１例（皮质腺瘤４８例，皮质增生１３例），皮质醇症３３例（皮质腺瘤１８例，皮质增生１１例，腺癌４例）。用１．５￣３ｍｍ薄层扫描，醛固酮瘤ＣＴ定位准确率达９３．３％；皮质腺增生（醛固酮症１３例，皮质醇症１１例）术前定位准确率８３．３％。手术前９１％ＣＴ可鉴别腺瘤或增生。本文讨论了皮质醇腺瘤和醛固酮腺瘤     

肾上腺腺瘤与转移瘤的CT鉴别诊断

目的探讨ＣＴ对肾上腺腺瘤与转移瘤的鉴别诊断价值。方法１０９例共１３０个肾上腺腺瘤和转移瘤，分别观察肿瘤的大小、边界、内部结构及其与同侧肾上腺的关系，测量肿瘤的平扫和增强后ＣＴ值及增强程度，２０例做了像素矩阵图分析，应用接受器工作特性（ＲＯＣ）曲线对结果进行分析。结果肿瘤平扫ＣＴ值的ＲＯＣ曲线下面积是０．９０±０．０５，明显大于增强后ＣＴ值（０．８１±０．０４）、增强程度（０．７１±０．０８）和肿瘤大小（０．８０±０．０４）的ＲＯＣ曲线下面积；以肿瘤直径≤３．０ｃｍ，密度均匀，平扫ＣＴ值≤２０ＨＵ，增强后ＣＴ值≤３５ＨＵ，增强程度≤２０ＨＵ为标准，诊断腺瘤的敏感性分别是８６％、８５％、８８％、７６％、和７４％，特异性分别是６８％、６９％、９０％、７４％和５９％；肿瘤与肾上腺相连（６８％）、平扫ＣＴ值＜０ＨＵ、ＣＴ像素矩阵图上有轻度负ＣＴ值区域只见于腺瘤，边界模糊或（和）侵犯周围结构、呈不规则厚环状强化是转移瘤的特征。全组总体符合率为９３％。结论综合分析肿瘤的各种ＣＴ征象，ＣＴ能鉴别绝大多数肾上腺腺瘤和转移瘤。     

甲状腺病变的CT诊断

观察甲状腺病变的ＣＴ表现，重点研究了ＣＴ检查对病变良恶必性诊断的作用。材料一方法：总结３０例各种甲状腺病变的ＣＴ表现，并将其分为三大类型进行分析。结果：（１）局限型：８例甲状腺腺瘤，７例结节性甲状腺肿及１例甲状腺癌属此型；（２）弥漫肿大型：２例桥本甲状腺炎，１例Ｇｒａｖｅｓ病属此型；（３）混合型；６例结节性甲状腺肿，４例甲状腺癌属此型。     

结节性甲状腺肿的MRI表现及与病理分型的对照分析

【摘要】目的：探讨结节性甲状腺肿的MRI表现特征及对病理分型的鉴别诊断价值,提高结节性甲状腺肿的MRI诊断水平。方法：回顾性分析38例经手术病理证实的结节性甲状腺肿MRI表现,根据病理结果分为腺瘤样增生组和无腺瘤样增生组,观察病灶的大小、边缘、信号、强化方式、ADC值,结果与手术病理对照。结果：38例患者MRI发现51个结节性甲状腺肿病灶,病灶均呈类圆形、边界清楚（100%）。病灶T1WI以等低信号为主（68.6%）,T2WI及DWI以高信号为主（80.4%,74.5%）。早期明显强化24个,轻度到中等强化27个（52.9%）,晚期明显强化22个,轻度到中等强化29个（56.9%）。44个病灶可见假包膜（86.3%）,29个病灶可见囊变（56.9%）。动态强化曲线呈上升或平台型有24个,流出型或无强化有27个。病灶内充填样强化18个（35.3%）。51个病灶增强前后病灶大小均无变化（100%）。本组19个病灶伴腺瘤样增生,32个病灶无腺瘤样增生,单因素分析显示两组间T1WI信号（P=0.013）、DWI信号（P=0.001）、早期强化程度（P＜0.001）、晚期强化程度（P＜0.001）、动态强化曲线（P＜0.001）、充填样强化（P＜0.001）差异有统计学意义。多因素回归分析示早期强化程度（P=0.045,OR值18.692）及充填样强化（P=0.001,OR值93.269）是结节性甲状腺肿伴腺瘤样增生的独立预测因素。结论：结节性甲状腺肿的MRI表现具有一定特征,其中伴腺瘤样增生的结节性甲状腺肿具有早期高强化及充填样强化的特点,掌握其MRI表现有助于提高诊断符合率。     

结节性甲状腺肿120例的病理分析

目的：探讨甲状腺腺瘤和结节性甲状腺肿的诊断和鉴别。方法：对120例甲状腺病理活检资料进行回顾性分析。结果：复查前甲状腺腺瘤与结节性甲状腺肿之比为2.6∶1,复查后为1∶5.1。结论：经过对原诊断的重新评价,认为放松了甲状腺腺瘤的诊断而收紧了结节性甲状腺肿的诊断,造成本组腺瘤的过多诊断。     

Difficulties in the prospective diagnosis of functional adrenal diseases by CT

The accuracy of prospective diagnosis of functional adrenal disorders by computed tomography (CT) was evaluated in 65 patients strongly suspected of having such disorders. Thirty-seven patients also underwent adrenal venography and selective adrenal venous sampling. Of the 65 patients, 21 had a hyperfunctioning cortical adenoma, 25 had cortical or medullary hyperplasia, and 11 pheochromocytoma, while 10 had no functional adrenal disease. Diagnosis by CT alone was correct in 66%; diagnosis by CT and venous sampling was correct in 89%. Incorrect prospective CT diagnosis resulted most often from a normal appearance of functionally hyperplastic glands (9 cases), nodular hyperplasia simulating a focal adenoma (8 cases), or an incidental nonfunctioning mass (3 cases). This study emphasizes the need to correlate CT findings with biochemical evaluation and the usefulness of venous sampling in selected cases to avoid inappropriate surgery. When CT is interpreted in correlation with complete biochemical analysis, correct diagnosis can usually be made. A small number of cases may still require adrenal venous sampling.     

Difficulties in the prospective diagnosis of functional adrenal diseases by CT

The accuracy of prospective diagnosis of functional adrenal disorders by computed tomography (CT) was evaluated in 65 patients strongly suspected of having such disorders. Thirty-seven patients also underwent adrenal venography and selective adrenal venous sampling. Of the 65 patients, 21 had a hyperfunctioning cortical adenoma, 25 had cortical or medullary hyperplasia, and 11 pheochromocytoma, while 10 had no functional adrenal disease. Diagnosis by CT alone was correct in 66%; diagnosis by CT and venous sampling was correct in 89%. Incorrect prospective CT diagnosis resulted most often from a normal appearance of functionally hyperplastic glands (9 cases), nodular hyperplasia simulating a focal adenoma (8 cases), or an incidental nonfunctioning mass (3 cases). This study emphasizes the need to correlate CT findings with biochemical evaluation and the usefulness of venous sampling in selected cases to avoid inappropriate surgery. When CT is interpreted in correlation with complete biochemical analysis, correct diagnosis can usually be made. A small number of cases may still require adrenal venous sampling.     

CT动态增强鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值

目的探讨CT动态增强对鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值。方法回顾性分析经手术病理证实的12例肾上腺乏脂肪腺瘤和27例肾上腺结节样增生患者的病例资料,统计两组病例各期增强CT值,利用公式灌注值P=CT静脉期-CT平扫期、廓清值C=CT静脉期-CT延迟期、绝对廓清灌注指数APC=(C/P)×100%及相对廓清灌注指数RAPC=(C/CT静脉期)×100%得到相关参数,并通过绘制受试者工作特征曲线,鉴别两者的最佳价值。结果肾上腺乏脂肪腺瘤直径较结节样增生更大;肾上腺乏脂肪腺瘤病灶各期CT值均明显高于结节样增生,且两者灌注值P、廓清值C、APC及RAPC有明显的统计学差异。年龄、性别、高血压、病灶位置、对侧肾上腺萎缩及动脉期CT值对鉴别两者无显著意义。结论CT动态增强扫描有助于鉴别肾上腺乏脂肪腺瘤和肾上腺结节样增生。     

肾上腺髓质增生和嗜铬细胞瘤的CT诊断（附19例分析）

本文报道经手术病理证实的肾上腺髓质增生６例及嗜铬细胞瘤１３例共１９例。分析了ＣＴ表现、鉴别诊断。着重讨论了肾上腺髓质增生的ＣＴ表现及ＣＴ分型、误诊原因。认为ＣＴ扫描可以鉴别肾上腺髓质增生和肾上腺嗜铬细胞瘤。     

肾上腺疾病的影像诊断与鉴别诊断

目的：提高对肾上腺疾病的影像诊断水平,方法：收集1993年1月－1999年9月经MRI检查的151例疑继发性高血压病人中有完整住院资料的46例临床,MRI,CT,B超及实验室结果,按病因分为肾上腺腺病（11例）,嗜铬细胞瘤（11例）,皮质腺癌（7例）,肾上腺增生（17例）共4组,结果：（1）大小：腺瘤体积小（原发性醛固酮增多症小于3cm,柯兴综合征小于5cm),嗜铬细胞瘤大于3cm,增生0．6－3．5cm.（2）质地：腺瘤和增生质地均匀,呈等T1,等T2信号,CT值15－25H嗜铬细胞瘤和腺癌易出血坏死液化。（3）实验室检查,原醛通常高钠低钾血症,嗜铬细胞瘤和腺癌患者尿中VMA可呈阳性,（4）肾上腺增生大小,形态及生化结果多种多样。结论：影像检查有利于明上腺疾病的检出,结合临床及实验室检查可提高病变的定性诊断。     

肾上腺多层CT灌注成像的临床应用研究

目的:研究肾上腺多层CT灌注成像对于肾上腺病变鉴别诊断的应用价值和病理基础。材料和方法:回顾性研究一组肾上腺病变的多层CT灌注成像,GE ADW4.2后处理工作站计算其灌注参数,包括血流量(BF)、血容量(BV)、平均通过时间(MTT)和表面通透性(PS),并与临床实验室资料和病理结果对照。结果:嗜铬细胞瘤BF和PS明显大于肾上腺腺瘤、肾上腺增生、结核、淋巴瘤和转移瘤。恶性嗜铬细胞瘤PS高于良性嗜铬细胞瘤。肾上腺增生、功能性腺瘤和嗜铬细胞瘤等功能性肾上腺病变的BF、BV和PS高于肾上腺淋巴瘤、结核和转移瘤等功能下降的肾上腺病变。富脂类腺瘤和乏脂类腺瘤的灌注参数无明显差异。肾上腺病变的灌注参数和微血管密度表达有关。结论:多层CT灌注成像反映了肾上腺微血管状况,灌注参数的差异可作为肾上腺病变鉴别诊断的辅助方法。PS值的差异可能有助于良恶性嗜铬细胞瘤的鉴别。     

Adrenal masses falsely diagnosed as adenomas on unenhanced and delayed contrast-enhanced computed tomography: Pathological correlation

Objectives To assess the accuracy of CT for the diagnosis of histologically confirmed adrenal adenoma and nonadenoma using CT numbers. Materials and methods Our study included 91 adrenal masses in 83 patients; histopathological diagnoses were 45 adenomas, 31 pheochromocytomas, 6 hyperplasias, 4 metastasis, and 5 miscellaneous lesions. Unenhanced CT in 46 patients and unenhanced and delayed contrast-enhanced (DCE) CT in 37 patients were retrospectively reviewed to examine the correlation between CT findings and those on pathological examination and to obtain diagnostic accuracy. Results Sensitivity, specificity, and accuracy for adenoma were 40% (18/45), 91% (42/46), and 66% (60/91) with unenhanced CT, and 96% (24/25), 61% (11/18), and 81% (35/43) with DCE CT. Adrenal masses falsely diagnosed as adenoma on unenhanced CT included three hyperplasias and one endothelial cyst, and those falsely diagnosed as adenoma on DCE CT were five pheochromocytomas, one oncocytic coritical tumor, and one primary pigmented nodular adrenocortical dysplasia. Twenty-five lipid-poor adenomas were falsely diagnosed as nonadenomas on unenhanced CT and one degenerated adenoma both on unenhanced CT and on DCE CT. Conclusion Diagnosing adenoma merely on CT numbers can lead to misdiagnosis. The lower specificity than expected is due to pheochromocytomas presenting as false positives. An erratum to this article can be found at     

肾上腺占位病变的CT、MRI诊断(附71例报告)

目的探讨肾上腺占位病变的CT、MRI诊断价值,提高对肾上腺间质概念的认识. 资料与方法搜集1994年8月～2001年6月经手术和病理证实的肾上腺占位病变71例,46例行CT平扫,其中31例进行增强扫描;30例行MRI平扫,18例行增强扫描;共有5例行CT、MRI联合检查(平扫+增强). 结果 (1) 皮质占位36例(占50.7%),其中醛固酮腺瘤14例,皮质醇腺瘤11例,无功能腺瘤3例,皮质腺癌2例,皮质增生症6例;有1例伴性变态综合征.(2) 髓质占位29例(40.8%),其中嗜铬细胞瘤16例,成神经细胞瘤3例,节神经细胞瘤2例,转移瘤8例.(3)间质占位6例(8.5%),其中髓样脂肪瘤3例,囊肿2例,纤维脂肪瘤1例. 结论肾上腺占位病变多具有其特定的好发年龄、性别趋向及CT、MRI影像学特征,结合临床及实验室检查有助于提高占位病变诊断的准确性;但部分无功能腺瘤、转移瘤、间质肿瘤的定性诊断仍依赖于组织学检查.     

多层螺旋CT对肾上腺皮质腺瘤的诊断价值

目的：探讨多层螺旋CT对肾上腺皮质腺瘤的诊断价值。方法：回顾性分析30例经手术及病理证实的肾上腺皮质腺瘤的多层螺旋CT表现。结果：原发性醛固酮醛腺瘤21例（26个结节）,左侧肾上腺18个结节,右侧肾上腺8个结节。皮质醇腺瘤9例（9个结节）,右侧4例,左侧5例。醛固酮醛腺瘤1cm以下结节14个,大于或等于1cm的结节12个,皮质醇腺瘤最大4cm,最小1.5cm。结论：肾上腺皮质腺瘤的多层螺旋CT表现具有一定特点,多平面重组（MPR）及增强扫描有助于皮质腺瘤的定位及确定肿瘤的性质。