双源CT在鉴别诊断肾上腺乏脂肪腺瘤、小转移瘤中的应用价值

目的探究双源CT鉴别诊断肾上腺乏脂肪腺瘤、小转移瘤的应用价值。方法选取2018年3月-2019年3月本院收治65例肾上腺结节患者为对象,均接受双源CT检查。分析双源CT诊断以及确诊情况,比较两组患者肿瘤病灶扫描时CT值、能谱曲线类型、增强扫描时肿瘤病灶碘浓度值及标准化碘浓度值。结果 65例患者使用双源CT检查显示共有68个肾上腺结节,乏脂肪腺瘤27例有29个结节,小转移瘤38例共39个结节,分别归为乏脂肪腺瘤组和小转移瘤组;影像学图像显示乏脂肪腺瘤形状主要为椭圆形或者圆形,与正常健康肾上腺腺体之间界线清楚,增强扫描可观察到患者强化均匀分布;小转移瘤部分瘤体与正常健康肾上腺之间界线模糊,增强扫描图像可见病灶内部出现囊变坏形状高度密影;乏脂肪腺瘤组虚拟平扫时静脉期CT值显著高于小转移瘤组(P<0.05),而两组之间虚拟平扫动脉期CT值和平扫时CT值之间比较差异不显著(P>0.05);乏脂肪腺瘤组患者能谱曲线快速下降型比例显著低于小转移瘤组(P<0.05),两组平直下降型比例差异不显著(P>0.05),上升型比例显著高于小转移瘤组患者(P<0.05);两组患者增强扫描时动脉期碘浓度值之间比较差异不显著(P>0.05),而乏脂肪腺瘤组静脉期碘浓度值,动脉和静脉期标准化碘浓度值显著低于小转移瘤组(P<0.05)。结论双源CT能谱曲线类型和强化扫描时碘浓度值定量可以有效鉴别乏脂肪腺瘤以及小转移瘤,为两者鉴别提供更高效的方法。

Application Value of Dual-source CT in Differential Diagnosis of Adrenal Lack-fat Adenoma and Small Metastases

Objective To explore the application value of dual-source CT in differential diagnosis of adrenal lack-fat adenoma and small metastases. Methods 65 patients with adrenal nodules admitted the hospital from March 2018 to March 2019 were enrolled. All underwent double-source CT scan. The diagnosis and confirming of dual-source CT were analyzed. The CT values and the types of energy spectrum curves when scanning tumor lesions, the iodine concentration value and the standardized iodine concentration of tumor lesions at enhancement scan were compared between the two groups. Results Among thee 65 patients detected by dual-source CT, there were a total of 68 adrenal nodules. There were 29 nodules in 27 cases with lack-fat adenoma. There were 39 nodules in 38 cases with small metastases. And they were classified as lack-fat adenoma group and small metastases group, respectively. Imaging images showed that the shapes of lack-fat adenomas were mainly on elliptical or round shapes. And the boundary with the normal and healthy adrenal glands was clear. The even enhancement distribution could be observed at enhancement scan. The boundary of the small metastases partial tumors with normal and healthy adrenal glands was unclear. The cystic change highly dense shadow could be seen inside the lesions by the enhanced scan images. The CT value of the venous phase in lack-fat adenoma group was significantly higher than that in the small metastases group at virtual scan(P<0.05). There was no significant difference in the CT value of arterial phase and at scan between the two groups(P>0.05). The proportion of energy spectrum curves of rapid decline type in lack-fat adenoma group was significantly lower than that in the small metastases group(P<0.05). There was no significant difference in the proportion of the straight descending type between the two groups(P>0.05). The proportion of the ascending type was significantly higher than that in the small metastases group(P<0.05). The difference in the iodine concentration values during arterial phase at enhanced scan between the two groups was not statistically significant(P>0.05). The iodine concentration value during the venous phase, the standardized iodine concentration values during the arterial and venous phase of the lack-fat adenoma group were significantly lower than those in the small metastases group(P<0.05). Conclusion The energy spectrum curve type of dual-source CT and the quantification of iodine concentration value at enhanced scan can effectively identify lack-fat adenoma and small metastases, which provide a more efficient method for the identification of the two.