肝细胞癌扩散至右肾上腺的CT表现及其解剖学基础

目的分析肝细胞癌(HCC)扩散至右肾上腺的CT增强表现特征，探讨扩散的途径和解剖学基础，为临床提供全面的影像学信息，帮助选择治疗方案。资料与方法经临床、病理证实的HCC连续性病例中，回顾性分析肿瘤扩散至右肾上腺患者39例，另选择临床确诊为HCC，但右肾上腺形态、密度无异常者5例作为对照组。全部病例均采用螺旋CT动、门脉双期增强扫描。重点观察病灶部位、大小、密度，肝裸区是否受侵犯，肝内病灶与右肾上腺之间的毗邻关系，右肾上腺形态、轮廓、密度，右肾上腺区域有无软组织密度肿块及其强化特征。结果39例肝内病灶经裸区侵犯右肾上腺，其中10例右肾上腺区未形成软组织肿块，但右肾上腺与肝内肿块分界不清、正常轮廓消失，动脉期其密度低于左肾上腺，门静脉期密度不均匀；29例右肾上腺区见软组织肿块或结节且与肝内肿块分界不清，右肾上腺正常轮廓消失或完全被肿块包埋。右肾上腺区肿块，CT增强扫描动脉期呈不均匀明显强化或轻度强化，门脉期密度降低，其强化时相及特征与肝内原发病灶一致。结论HCC可通过肝裸区直接侵犯右肾上腺。根据CT增强动、门脉双期扫描右肾上腺形态、密度有无异常及右肾上腺区软组织肿块密度、强化时相和特征，可判断HCC是否扩散至右肾上腺。

Involvement of Right Adrenal Gland by Hepatocellular Carcinoma:CT Imaging Features and the Anatomic Bases

Objective To analyze the CT features of hepatocellular carcinoma (HCC) involving the right adrenal and to determine the spreading pathways and anatomic bases.Materials and Methods 39 consecutive HCC patients (33 males and 6 females) with involvement of the right adrenal gland proved histopathologically or clinically, were reviewed retrospectively. 5 HCC patients proved clinically without involvement of right adrenal gland were selected as control group.Standard hepatic dual-phase contrast-enhanced CT scanning was performed for all patients. The location, size, density of HCC lesions and its relationship to the bare area of the liver and the right adrenal were observed carefully. Special attention was paid to the shape, contour, density and enhancement patterns of the right adrenal abnormalities. Results 39 HCC lesions were shown to directly invade the right adrenal through the bare area of the liver. Among them, 29 cases had a mass or nodule in the right adrenal, which was confused with the primary HCC lesion with disappearance of the normal adrenal contour or embracement of it; in the other 10 cases, the right adrenal showed no definite mass or nodule, but the demarcation between the right adrenal and HCC mass were blurred, the normal contour of the right adrenal disappeared and appeared hypodense in arterial phase and heterogeneous in portal venous phase compared to the left side adrenal. The adrenal mass or nodule was heterogeneously enhanced either markedly or slightly in arterial phase and hypodense in portal venous phase, its enhancement pattern was similar to that of primary HCC lesion.Conclusion HCC involving right adrenal gland can directly via the bare area of the livel. According to CT imaging features,such as abnormalities of the shape, contour, soft-tissue mass with heterogeneous enhancement in dual phase, which suggests the involvement of the right adrenal by HCC.