能谱CT鉴别诊断不典型肾上腺嗜铬细胞瘤与肾上腺瘤

目的 探讨能谱CT在鉴别不典型肾上腺嗜铬细胞瘤与肾上腺腺瘤中的价值。方法 回顾性分析经手术病理证实的13例不典型肾上腺嗜铬细胞瘤及15例肾上腺皮质腺瘤的能谱CT资料，对所有图像均采能谱软件处理，获得肿瘤及腹主动脉的动脉期、静脉期、延迟期不同能量水平（40~140 keV）的CT值、能谱曲线、能谱曲线形态、基物质对浓度（水-碘、脂-碘、血-碘）定量参数，并对不同能量水平的CT值进行标准化，采用独立样本t检验分析能谱特征参数。结果 动脉期40、70~140 keV、静脉期70~140 keV、延迟期40~140 keV单能量下，肾上腺嗜铬细胞瘤与腺瘤标准化CT值的差异均有统计学意义（P均<0.05）。两者增强三期能谱曲线均呈下降型，嗜铬细胞瘤组始终位于腺瘤组上方。增强三期嗜铬细胞瘤的水（碘）、脂（碘）、血（碘）基物质标准化浓度均高于腺瘤组（P均<0.001）；增强三期嗜铬细胞瘤组与腺瘤组的碘（水）、碘（脂）、碘（血）基物质标准化浓度差异无统计学意义（P均>0.05）。结论 不典型肾上腺嗜铬细胞瘤与肾上腺腺瘤具有不同的单能量CT值、能谱曲线和能谱特征物质含量。能谱CT为鉴别不典型肾上腺嗜铬细胞瘤与肾上腺腺瘤提供了一种多参数的方法。

Spectral CT differential diagnosis of atypical adrenal pheochromocytoma and adrenal adenoma

Objective To investigate the value of CT spectral imaging in differential diagnosis of atypical pheochromocytoma and adrenal adenoma. Methods The energy spectrum CT data of 13 cases of atypical pheochromocytoma and 15 cases of adrenal cortical adenoma confirmed by surgery pathology were retrospectively analyzed. All images processed by spectrum software. The CT value of different energy levels (40-140 keV) in arterial, venous and delayed phase, energy spectrum curve and spectrum curve type, base material of concentration (water-iodine, grease-iodine, blood-iodine) were obtained, and the CT value of different energy were standardize in the same period. Data were compared with samples t-test. Results For arterial phase, the standardization CT values of pheochromocytoma on monochromatic images of 40 keV, 70 keV to 140 keV had statistical difference with those of adenoma (all P<0.05). For venous phase, the standardization CT values of pheochromocytoma on monochromatic images of 70 keV to 140 keV had statistical difference with those of adenoma (all P<0.05). For delayed phase, the standardization CT values of the two tumors on monochromatic image of 40 keV to 140 keV had significant difference (all P<0.05). Both the energy spectrum of the three periods of type curve was falling, pheochromocytoma always located above compared with adenoma. The standardization concentration of base materials including water (iodine), fat (iodine) and blood (iodine) of pheochromocytoma were higher than those of adenoma in three phases (all P<0.001). The standardization concentration of base materials including iodine (water), iodine (fat) and iodine (blood) had no significant difference in three phases between pheochromocytoma and adenoma (all P>0.05). Conclusion Atypical pheochromocytoma and adrenal adenoma have different spectral curve and spectrum characteristics of the material content. Spectral CT imaging provides a method of multiple parameters to identify atypical adrenal pheochromocytoma and adenoma.