肾上腺结核的多层螺旋CT诊断

目的 探讨肾上腺结核的多层螺旋CT平扫及增强表现特征，以提高该病的CT诊断水平。 方法 对经临床证实的13例肾上腺结核患者的CT表现特征进行回顾性分析。 结果 13例中，男性8例，女性5例；年龄20～58岁，平均42岁。肾上腺结核累及双侧共12例，单侧1例。肾上腺肿块样增大10例，轻度或中度增大3例，轮廓完整。肾上腺密度均匀增高1例，不均匀增高12例。周边强化11例。4例患者经抗结核治疗后复查CT，其中1例双侧增大的肾上腺体积缩小或恢复正常，其内低密度消失，9例患者行手术治疗，而且术前术后进行了抗结核治疗。早期肾上腺结核 CT 表现为肾上腺体积增大，并见密度不均匀的扁圆形肿块9例，增强扫描后肿块周边强化，其内见线样明显强化的正常肾上腺组织分隔，边缘清楚。晚期肾上腺结核表现为腺体萎缩及钙化4例。8例患者伴有肾上腺外结核，包括肺结核4例、泌尿系结核2例、脊柱结核1例，同时伴有肺结核、左肾结核及脊柱结核1例。 结论 肾上腺结核的CT具有特征性表现，当发现全身多脏器结核，同时发现肾上腺上述影像变化，则要考虑肾上腺结核的诊断，为临床治疗及疗效判断提供指导。

Multislice spiral CT diagnosis of adrenal tuberculosis

Objective To explore the multi-slice spiral CT(MSCT) features of adrenal tuberculosis in order to improve the CT diagnosis level.Methods The MSCT findings of 13 patients with adrenal tuberculosis were retrospectively analyzed.Results Patients characteristics: 13 patients,8 male and 5 femal;age range from 20 to 58 years;mean age 42 years.The CT findings: bilateral adrenal tuberculosis in 12 patients,unilateral in 1 case;mass-like increase of adrenal in 10 cases,mild or moderate increase in 3 cases with intact contours;adrenal glands enlargement with uniform density in 1 case,non-uniform enlargement in 12 cases;peripheral enhancement in 11 cases.After treatment,CT scan showed that the size of bilateral adrenal glands in 1 case shrunk or returned to normal and the low-density disappeared.Nine patients received anti-TB treatment before and after surgery.Enlargement of adrenal glands and the uneven density of the flat circular mass were the features of 9 early adrenal tuberculosis cases with peripheral enhancement and marked enhancement of its internal lines and clear edge.Advanced adrenal tuberculosis of 4 cases showed atrophy of glands and calcification.Eight patients had extra-adrenal tuberculosis,including lung(4 cases),urinary(2 cases),spinal tuberculosis(1 cases) and involement with pulmonary,left kidney,and spinal(1 case).Conclusion The MSCT findings of adrenal tuberculosis are typical.If the adrenal changes present in patients with multi-organ tuberculosis should be considered the diagnosis of adrenal tuberculosis which will provide a guidence for treatment and efficacy evaluation in clinical.