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。

The imaging diagnosis and differentiation of adrenal diseases

Objective：To improve the accuracy of the imaging diagnosis of theadrenal diseases.Methods：Between Jan,1993 and Sep,1999, 46 cases of 151 with suspicious secondary hypertension having clinical data,MRI,CT and ultrosound,were reviewed retrospectively.Of the 46 cases the tumor and hyperplasia of adrenal gland was proved by surgery and pathology.These cases were divided into 4 groups:adenoma(n=11),pheochromocytoma(n=11),corticoadrenal carcinoma(n=7),and cortical hyperplasia(n=17).Results：① Size:adenoma was less than 5cm in diameter (aldosteronoma＜3cm,Cushing＜5cm),pheochromocytoma greater than 3cm and hyperplasia 0.6～3.5cm.②Texture:the adenoma and hyperplasia was homogeneous isointense on T1 weighted and T2 weighted images,and the adenoma with 15～25 HU on CT scans.Pheochromocytoma and corticoadrenal carcinoma subjected to hemorrhage,necrosis and liquefaction.③Laboratory test:serum hypersodium and hypopotassium in the patient with aldosteronoma,and positive urinate VMA in the patient with phochromocytoma and corticoadrenal carcinoma.④ The hyperplasia of adrenal gland varied in size,shape,and laboratory test.Conclusion:Imaging examination is helpful to detect the lesion of adrenal gland,and will improve,together with clinical manifestation and laboratory data,the characteristic of adrenal diseases.