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     

肾上腺皮质增生与腺瘤CT诊断及评价(附53例分析)

肾上腺皮质疾病中 ,原发性醛固酮增多症及皮质醇增多症可同时发生肾上腺皮质增生和腺瘤 ,因而在影像诊断中对它们的正确分析和诊断 ,对临床治疗将会起到一个良好的帮助指导作用。本文回顾性分析经手术病理证实 5 3例功能性肾上腺皮质疾病ＣＴ表现 ,重点探讨肾上腺皮质增生与肾上腺皮质腺瘤在原发性醛固酮增多症及皮质醇增多症中的ＣＴ改变特征。1　资料与方法本组 5 3例中 ,男 19例 ,女 34例 ,年龄 2 45 5岁。肾上腺皮质腺瘤 40例 ,其中原发性醛固酮增多症 2 6例 ,皮质醇增多症14例。肾上腺皮质增生 13例 ,其中原发性醛固酮增多症 6例 ,皮质…     

肾上腺腺瘤与恶性肿瘤的CT鉴别诊断

ＣＴ扫描是肾上腺疾病影像诊断的主要方法之一。笔者通过对１０６例肾上腺瘤和恶性肿瘤的各种ＣＴ征象进行综合分析，进一步探讨ＣＴ扫描对两者的鉴别诊断价值。１　材料与方法男性７１例，女性３５例，年龄２４～７９岁，平均４８．９岁。病例包括肾上腺腺瘤５１例，其中无功能腺瘤２３例、Ｃｕｓｈｉｎｇ综合征腺瘤９例、原发性醛固酮增多症（Ｃｏｎｎ腺瘤）１９例；肾上腺皮质腺癌１２例，原发性恶性淋巴瘤１例，上述病例除５例无功能腺瘤随访半年以上无改变，１例Ｃｏｎｎ腺瘤由临床和生化证实外，其它病例都经手术病理证实；转移瘤４２…     

CT在原发性醛固酮增多症患者肾上腺结节鉴别诊断中的价值

目的 探讨CT在鉴别诊断原发性醛固酮增多症患者肾上腺结节性质中的价值.资料与方法 回顾性分析184例经手术病理证实的原发性醛固酮增多症患者共190个肾上腺结节的CT表现及非载瘤肾上腺体部及侧肢厚度,比较醛固酮腺瘤与肾上腺增生结节的CT征象的发生率.结果 醛固酮腺瘤组与肾上腺增生结节组患者性别(P=0.040)、最大径(P=0.000)和边缘环形强化发生率(P=0.000)差异有统计学意义,但两组患者年龄(P=0.957)、结节数目(P=0.607)、侧别(P=0.667)、位置(P=0.612)、平扫CT值(P=0.835)以及3min绝对廓清率(P=0.057)、5min绝对廓清率(P=0.679)和7min绝对廓清率(P=0.512)差异无统计学意义.结论 原发性醛同酮增多症患者肾上腺腺瘤与增生结节在CT表现上存在很多重叠,但结节大小和边缘有无环形强化在鉴别腺瘤与增生结节中有重要意义.     

影像学检查对肾上腺疾病诊断的价值

肾上腺疾病定位诊断方法较多,其中ＣＴ、Ｂ超和腹膜后充气造影（简称充气）最为常用。作者收集１３４例患者,全部经手术病理证实。现就ＣＴ、Ｂ超及充气检查结果与手术病理进行对照分析。临床资料本组１３４病例中,男６６例,女６８例,年龄７～７０岁,平均３６．３岁。其中嗜铬细胞瘤４６例;皮质醇增多症（柯兴）５５例,包括腺癌２５例,增生２４例,腺癌４例,转移癌２例;原发性醛固酮增多症（原醛）２５例;其中腺瘤２２例。增生３例;其它８例,包括肾上腺囊肿２例,肾上腺髓性脂肪瘤５例,肾上腺节细胞神经瘤１例。Ｂ超检查１１…     

儿茶酚胺增多症的CT定位诊断（附33例分析）

目的：总结肾上腺内外儿茶酚胺分泌性病变的ＣＴ定位经验。材料与方法：分析３３例儿茶酚胺增多症的临床及ＣＴ扫描资料。其中３２例经手术病理证实。１例ＣＴ定位失败，手术切除左肾上腺，病理报告正常，患者１０月后死于心肾功能衰竭。结果：ＣＴ探测肾上腺内嗜铬细胞瘤的准确率为１００％（ｎ＝２３）。１例左肾上腺髓质增生未能定位。ＣＴ定位了９例肾上腺外病灶中的８例功能性副神经节瘤，其发生部位是肾门（ｎ＝４）、主动脉旁     

双侧增生和单侧醛固酮腺瘤致醛固酮增多症的区别:CT的可靠性

作者对经肾上腺CT扫描和ACTH刺激后双侧肾上腺静脉取血诊断原发性醛固酮增多症的24例病人进行了研究。男16例,女8例。年龄15～66岁。除6例CT扫描层厚3mm外,其余病例均为5mm。单侧存在低衰减结节而对侧肾上腺正常者诊为腺瘤。双侧结节、单侧多发结节或腺体正常者为增生。所有病例,不管CT所见,均经股静脉进行双侧肾上腺静脉同时插管取血,并从肘前静脉获得周围血标本,测定醛固酮(A)和皮质醇(C)基础值后,再静脉团注0.25mg的ACTH,接着4～6ml/min(250ml盐水中加ACTH0.25mg)滴注,滴注开始后15分钟获得第二次双肾上腺静脉和周围静     

口服胆囊造影CT诊断胆囊隆起性病变

目的：探讨口服碘番酸胆囊造影ＣＴ（简称ＯＣＣＴ）对良恶性胆囊隆起性病变的诊断作用。材料与方法：分析３８例手术病理证实的胆囊隆起性病变（胆固醇息肉２８例,腺瘤样息肉３例,乳头状瘤１例,腔内型胆囊癌５例和腺瘤恶变１例）的ＯＣＣＴ表现。结果：胆固醇息肉表现为胆囊内多发或单发性颗粒状充盈缺损,直径均≤０．５ｃｍ;腺瘤样息肉和乳头状腺瘤均呈单发结节,直径为０．５５～０．８ｃｍ;腺瘤恶变和腔内型胆囊癌均为体积较大的结节,直径≥１．２ｃｍ。结论：ＯＣＣＴ是诊断胆囊隆起性病变的有效方法之一;病变大小是鉴别良恶性胆囊隆起性病变的有力依据。     

CT在原发性醛固酮增多症病因诊断中的价值

目的 评价CT在诊断原发性醛固酮增多症(PA)分类中的临床应用价值.方法 回顾性分析同时行CT及肾上腺静脉取血(AVS)的17例临床诊断为PA患者的资料,以AVS结果作为金标准,进行病因分析.结果 CT诊断双肾上腺未见异常7例,单侧或双侧结节6例,单侧肾上腺增粗2例,双侧肾上腺增粗1例,一侧增粗并对侧结节1例.在15例经AVS证实为单侧或双侧肾上腺增生的患者中,7例CT表现正常,3例CT表现为单侧或双侧肾上腺增粗或结节状,经AVS证实为双侧增生,仪5例患者CT表现与AVS结果一致.17例经AVS诊断为单侧或双侧醛固酮分泌过多的患者有7例CT表现正常.结论 CT在原发性醛固酮增多症病凶诊断方而特异性较差.     

肾上腺肿瘤的CT诊断

作者分析了36例病理证实的肾上腺肿瘤CT表现,其中27例为肾上腺皮质腺瘤(13例临床表现为原发性醛固酮增多症,12例为Cushing氏综合征,2例为无功能腺瘤),1例皮质腺癌,8例嗜铬细胞瘤。13例临床表现为原发性醛固酮增多症的肾上腺皮质腺瘤CT值为-18～13HU(平均1.8±9.9HU)低于表现为Cushing氏综合征者的-0.4～     

多层螺旋CT对原发性肾上腺淋巴瘤的诊断价值(附4例报告并文献复习)

目的探讨原发性肾上腺淋巴瘤的CT表现。资料与方法回顾性分析4例确诊为原发性肾上腺淋巴瘤患者的CT影像学资料。结果 4例中双侧病灶3例,单侧病灶1例,共计7侧病灶;瘤体较大,长径5.6～7.8cm,平均6.3 cm;边界清晰6侧,边界不清1侧;肾上腺明显增粗伴局部肿块4侧,肾上腺轮廓消失、呈不规则形3侧;CT平扫密度均匀6侧,密度不均匀1侧;行双期增强扫描,均匀强化5侧,不均匀强化2侧,其中1侧病灶内见不规则无强化区。结论原发性肾上腺淋巴瘤的CT表现具有一定特征性,据此可提示诊断。     

The role of adrenal computerized tomography in endocrinopathies. Primary hyperaldosteronism

A review was made of the CT findings in a series of 15 patients with a clinical diagnosis of primary hyperaldosteronism. An adrenal tumour (diameter 11-68 mm) was observed in 13 cases. No adrenal involvement was noted in the other two. The initial diagnosis was confirmed either histologically or by means of a thorough clinical and instrumental follow-up in all 15 cases. High-resolution CT may thus be proposed as an initial examination in the diagnosis of primary aldosteronism. Its efficiency is such that venous sampling can be restricted to doubtful or negative cases.     

原发性乳腺淋巴瘤的CT及MR表现

目的探讨原发性乳腺淋巴瘤的CT及MR特征,提高对本病影像学表现的认识。方法回顾性分析经病理证实的14例原发性乳腺淋巴瘤患者的CT及MR资料,年龄32～77岁,中位年龄54岁。所有患者皆行CT增强扫描,其中6例行MR检查。结果14例病灶大小2．2～11．5cm。所有病变密度或信号均匀,未见毛刺及钙化。其主要有三种表现：①单发结节或肿块型：占64．3％（9/14）。增强CT除1例呈环形伴结节样强化外,其他皆均匀中等度强化。乳头未见凹陷,皮肤未见增厚,乳后间隙未见侵犯。MRI脂肪抑制T。wI表现为稍高信号,DWl显示扩散明显受限,ADC值显著降低,约0．45×10^-3m㎡/s～0．73×10^-3m㎡/s,时间～信号曲线均呈平台型（Ⅱ型）曲线;②多发肿块型：占14．3％（2/14）。病灶直径较大,为数个结节融合所致。密度信号改变同单发结节或肿块型相似,但占位效应明显,乳后问隙狭窄;③弥漫型：占21．4％（3/14）。病灶直径巨大,范围广泛,可累及两个乳腺象限至整个乳腺,占位效应最明显。病灶强化不均匀,MR脂肪抑制T2WI见高信号分隔,增强后分隔明显强化,可伴有乳后间隙受侵,皮肤广泛增厚,但乳头未见凹陷。结论原发性乳腺淋巴瘤的影像学表现具有一定的特征性。当出现乳腺内无毛刺及钙化的结节、肿块,MRIT2WI脂肪抑制序列呈稍高信号,ADC值显著降低、或伴一侧乳腺皮肤广泛增厚而无乳头凹陷,应考虑原发性乳腺淋巴瘤可能。     

CT of primary hyperaldosteronism (Conn's syndrome): the value of measuring the adrenal gland

OBJECTIVE: The objectives of our study of patients with primary hyperaldosteronism (Conn's syndrome) were to determine whether the adrenal glands are larger in patients with bilateral adrenal hyperplasia than in those with aldosterone-producing adenomas or in healthy control subjects; and whether a CT criterion based on adrenal gland size can be developed to positively diagnose bilateral adrenal hyperplasia. MATERIALS AND METHODS: A retrospective study of CT scans of 28 patients with primary hyperaldosteronism was performed. The means of two observers' measurements of adrenal gland size were recorded and compared with published normal values. In addition, a radiologist experienced in adrenal imaging and unaware of the cause of the primary hyperaldosteronism diagnosed either bilateral adrenal hyperplasia or aldosterone-producing adenoma by visual inspection. RESULTS: The adrenal glands in patients with bilateral adrenal hyperplasia were significantly (p < 0.05) larger than those in patients with aldosterone-producing adenoma or in healthy control subjects. A sensitivity of 100% was achieved when a mean limb width of greater than 3 mm was used to diagnose bilateral adrenal hyperplasia, and a specificity of 100% was achieved when the mean limb width was 5 mm or greater. Receiver operating characteristic curve analysis showed that the overall performance of the radiologist and the mean adrenal limb width in detecting bilateral adrenal hyperplasia were equivalent. CONCLUSION: In patients with primary hyperaldosteronism, adrenal limb measurements on CT can aid in differentiating bilateral adrenal hyperplasia from aldosterone-producing adenoma because the adrenal glands in bilateral adrenal hyperplasia are larger.     

肺硬化性血管瘤的CT诊断

目的：分析肺硬化性血管瘤的CT表现,以提高诊断水平。方法：回顾分析9例经病理证实的肺硬化性血管瘤的CT表现。结果：典型病灶7例,CT显示圆形或椭圆形的结节或肿块影,直径10～50mm,其中30mm以下6例,50mm1例;该7例病灶边缘均较规则,无分叶及毛刺;7例中6例病灶密度均匀,1例病灶直径50mm,密度欠均匀,CT值20～43HU;2例病灶可见粗点状钙化;2例加增强扫描,均呈明显均匀强化,CT值增加大于50HU。不典型病灶2例,CT显示病灶中心见结节影,边缘欠规则,周围见斑片影,斑片影边缘较规则,结节影与周围斑片影相连;结节周围见＂空气新月征＂;1例加增强扫描,结节无明显强化。结论：肺硬化性血管瘤的CT表现有一定特征性,认真分析影像表现,有助于术前诊断。     

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     

肾上腺淋巴瘤CT及18F-FDG PET/CT主要特征分析

 目的 探讨肾上腺淋巴瘤的CT及¹⁸F-FDG PET/CT影像学征象,以提高对该病的诊断水平。方法 回顾性分析经手术病理证实10例肾上腺淋巴瘤的临床、影像及病理资料,均行CT平扫及增强扫描及¹⁸F-FDG PET/CT检查,观察和比较肿瘤发生的一般资料(年龄、性别),MSCT表现(部位、最大径、形态、密度、边界、强化方式、腹膜后淋巴结等情况,并计算各期强化率)和计算病灶SUVmax。结果 原发性肾上腺淋巴瘤7例,继发性肾上腺淋巴瘤3例;双侧病灶者7例,单侧病灶者3例,共计17侧病灶;肿瘤最大径不等,平均5.6 cm;肿块呈椭圆形共13侧,三角形3侧,1侧呈结节状增生;13侧边界清晰,4侧边界模糊;病灶平扫CT值平均40.4 Hu;动脉期平均强化率为24.28%;静脉期平均强化率37.46%;大部分(14/17)CT平扫及(13/17)增强密度较均匀一致,动脉期呈轻中度强化,门脉期呈进行性强化;2例发现腹膜后淋巴结肿大。均表现为¹⁸F-FDG高摄取,SUVmax为8.7～23.5,平均值为12.5。结论 肾上腺淋巴瘤CT表现具有一定特征,PET/CT 可准确显示肿瘤累及的范围和淋巴结,在诊断和治疗中具有重要的价值。     

Primary hyperaldosteronism: comparison of CT, adrenal venography, and venous sampling

Twenty-nine patients with primary hyperaldosteronism were evaluated with computed tomography (CT), adrenal venous sampling, and adrenal venography. Twenty-three patients had aldosteronomas and six had bilateral adrenocortical hyperplasia. Sixteen (70%) of the adenomas were accurately located by CT. All nodules of 1.5 cm or larger diameter and 50% of nodules 1.0-1.4 cm in diameter were demonstrated. Nodules of less than 1.0 cm in diameter generally were not detected. High-resolution CT appeared more sensitive than standard CT (75% vs. 58%). Adrenal venous sampling for aldosterone assay was the most sensitive of the three methods, localizing 22 (96%) of the 23 adenomas. Eighteen (78%) of the adenomas were identified by adrenal venography, although two patients with bilateral cortical hyperplasia were mistakenly diagnosed as having a small adenoma. No such false-positive studies were encountered with CT or adrenal venous sampling.     

Pathologic/high-resolution CT correlation of focal lung lesions 5 mm or less in diameter: detection and identification by multidetector-row CT

PURPOSE: To clarify the limitations of multidetector-row CT (MDCT) in detecting focal lung lesions of 5 mm or less in diameter by pathologic/high-resolution CT (HRCT) correlation. MATERIALS AND METHODS: Twenty-two patients who underwent both preoperative HRCT of the entire lobe using MDCT (MD-HRCT) and lobectomy for primary (n = 21) or metastatic (n = 1) lung tumor were studied. The author attempted to locate any focal lung lesions other than the main tumor throughout the resected and sliced specimens and to identify the opacities corresponding to the macroscopic lesions on MD-HRCT before histopathologic evaluation. Then two observers without pathologic information attempted to detect the lesions on MD-HRCT. RESULTS: Ninety-one lesions of 5 mm or less in diameter were found in 15 patients. Histopathologically, 13 lesions were classified as bronchioloalveolar carcinoma (BAC), 38 as atypical adenomatous hyperplasia (AAH), 9 as reactive hyperplasia (RH), 19 as inflammatory lesion (INF), 8 as solid lesion (SL), and 4 as showing no organizing change. The author, who had knowledge of the gross pathologic examinations, identified the opacities at rates of 100%, 82%, 56%, 42%, and 88% for BAC, AAH, RH, INF, and SL, respectively. The rates of lesion detection in the absence of knowledge of the pathologic examinations were 85%, 58%, 22%, 32%, and 75% for BAC, AAH, RH, INF, and SL, respectively. The rates of identification and detection of lesions more than 3 mm in diameter were 90% and 57%, respectively, while those of lesions less than 2 mm in diameter were 71% and 35%, respectively. CONCLUSIONS: MD-HRCT proved to be useful in detecting focal lung lesions of 5 mm or less in diameter; however, it is still difficult to detect lesions of less than 2 mm in diameter.     

18F-FDG PET in evaluation of adrenal lesions in patients with lung cancer.

The purpose of this study was to assess the role of PET with (18)F-FDG in differentiating benign from metastatic adrenal masses detected on CT or MRI scans of patients with lung cancer. METHODS: This retrospective study analyzed (18)F-FDG PET scans of patients with lung cancer who were found to have an adrenal mass on CT or MRI scans. One hundred thirteen adrenal masses (75 unilateral and 19 bilateral; size range, 0.8-4.7 cm) were evaluated in 94 patients. PET findings were interpreted as positive if the (18)F-FDG uptake of the adrenal mass was greater than or equal to that of the liver. PET findings were interpreted as negative if the (18)F-FDG uptake of the adrenal mass was less than that of the liver. All studies were reviewed independently by 3 nuclear medicine physicians, and the results were then correlated with clinical follow-up or biopsy results when available. RESULTS: PET findings were positive in 71 adrenal masses. Sixty-seven of these were eventually considered to be metastatic adrenal disease. In the remaining 4, no changes in lesion size were noted on follow-up examinations. PET findings were negative in 42 adrenal masses, of which 37 eventually proved to be benign. Among the 5 adrenal masses that were false-negative, one was a large necrotic metastasis; 1 was a 2.4-cm lesion with central hemorrhaging, and the remaining 3 were lesions of less than 11 mm. The sensitivity, specificity, and accuracy for detecting metastatic disease were 93%, 90%, and 92%, respectively. CONCLUSION: (18)F-FDG PET is an accurate, noninvasive technique for differentiating benign from metastatic adrenal lesions detected on CT or MRI in patients with lung cancer. In addition, PET has the advantage of assessing the primary cancer sites and detecting other metastases.