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.

CT and MRI Diagnosis of Adrenal Space-occupying Lesion: Reports of 71 Cases

Objective To study the value of CT and MRI in diagnosis of adrenal space occupying lesion and improve the knowledge for adrenal interstitial concept. Materials and Methods From August 1994 to June 2001,71 cases with confirmed adrenal space occupying lesions by surgery and pathology were collected. 46 cases were performed plain CT, and 31 of them added to enhanced CT. Other 30 cases underwent plain MRI and 18 of them added to enhanced MRI. The remaining 5 cases were scanned by CT and MRI. Results (1) Cortical space occupying lesion was seen in 36 cases (50.7%), including aldosterone adenoma in 14 cases, cortical adenoma in 11, non functional adenoma in 3, cortical adenocarcinoma in 2, cortical hyperplasia in 6. 1 of them had concomitant sexual perversion syndrome. (2)Medullary space occupying lesion was seen in 29 cases (40.8%), including pheochromocytoma in 16 cases, neuroblastoma in 3, ganglioma in 2 and metastasis in 8. (3)Interstitial space-occupying lesion was seen in 6 cases (8.5%), including myelolipema in 3 cases, cyst in 2 and fibrolipoma in 1. Conclusion Adrenal space occupying lesion has a preference for age, sex and characteristics of CT and MRI. Imaging features together with clinic and laboratory results are helpful to improving the accuracy for diagnosing space occupying lesion. Characterization of some of non functional adenomas, metastasizes and interstitial neoplasms, however, should be dependent on histopathology.