肾上腺肿瘤44例分析

目的提高对肾上腺肿瘤的诊断水平。方法肾上腺肿瘤共44例，11例行18F-氟脱氧葡萄糖（18F—FDG）PET／CT、CT及MRI检查，余行CT和18F—FDG PET／CT检查，所有病例均行高血压试验和24h尿肾上腺素2项检测，术后病理或临床随访确诊。结果18F—FDG PET／CT对肿瘤良恶性诊断的敏感性、特异性分别为93．7％、100％，肿瘤诊断准确性为82．9％。CT分别为87．5％、96．4％和77．3％。MRI的肿瘤诊断准确性为81．8％。血浆醛固酮最高浓度在各肿瘤中差异无统计学意义（P〉0．05）。髓质肿瘤与其他肾上腺肿瘤相比尿去甲基肾上腺素（NMN）、尿甲氧基肾上腺素（MN）、收缩压、舒张压差异均有统计学意义（P〈0．05）。以3．1作为SUV临界值，得出PET／CT区分肿瘤良恶性敏感性和特异性最佳，分别为100％和96．2％。结论18F—FDGPET／CT在诊断肾上腺肿瘤良恶性上优于MRI和CT。高血压和尿NMN／MN成3倍以上升高对嗜铬细胞瘤的诊断意义重大。髓脂瘤、囊肿和嗜铬细胞瘤运用CT或MRI能较好诊断，非功能性和皮质肿瘤以PET／CT诊断为佳。

Research on 44 cases of adrenal tumors

Objective To improve the diagnosis of adrenal tumors.Methods There are 44 cases of adrenal tumors.Among them,11 lesions underwent 18F-FDG PET/CT,CT and MRI scanning,and the remaining underwent 18F-FDG PET/CT and CT scanning.The aldosterone and the normetanephrine/metanephrine in 24h urine were measured in every lesion.All lesions underwent biopsy after operation or follow-up in clinic for final diagnosis.Results The sensitivity and specificity for differentiating the benign and malignant tumors with 18F-FDG PET/CT were 93.7% and 100% respectively.And the diagnostic accuracy was 82.9%.With CT,they were 87.5%,96.4%,and 77.3% respectively.And the diagnostic accuracy with MRI was 81.8%.Statistically significant differences were found in normetanephrine,metanephrine,and systolic or diastolic pressure between the medulla and other lesions(P<0.05),but not found in aldosterone level in all lesions(P>0.05).With 3.1 as the optimal SUV,the correspondent sensitivity and specificity of PET/CT were 100% and 96.2% respectively.Conclusion 18F-FDG PET/CT is better than CT and MRI in the aspect of differentiating the benign and malignant lesions.Hypertension and triple increases of normetanephrine/metanephrine in urine play a significant role in the diagnosis of pheochromocytoma.The myelolipoma,pheochromocytoma and adrenal cyst can be effectively diagnosed with CT or MRI.However,PET/CT is the best choice for diagnosing adrenal nonfunctional and cortical diseases.