肾上腺肿瘤的CT诊断与鉴别诊断
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| 时间：2009-02-03 16:44:09 来源： 作者： |
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CT diagnosis and differential diagnosis of adrenal neoplasms
XU Shao-bin. Department of Imaging Diagnosis, Nanhai Xiqiao Hospital, Foshan, Guangdong, 528211
[Abstract] Objective To investigate the correlation between CT findings and pathological results of adrenal neoplasms so as to improve the accuracy of diagnosis. Methods CT manifestations of 32 cases with pathological diagnosis adrenal neoplasms were retrospectively analyzed. The location, size, shape, density and relationship with surrounding structure were evaluated on CT image. The attenuation values at unenhanced and enhanced CT of the tumor were also recorded. Results The 32 cases adrenal neoplasms included 9 cases with aldosterone-producing adenoma, 5 hydrocortisone-producing adenomas, 1non-functional adenoma, 5 cortical hyperplasies,4 pheochromocytomas,2 adenocarcinomas, 3 metastases, 1 fibroneuroma, 1 ganglioneuroma and 1 myelolipomas. Conclusion The characteristics on CT images are associated with the pathological feature in adrenal neoplasms. With a combination of clinical date and CT findings, adrenal neoplasms can be be correctly diagnosed in most cases.
[Key words] adrenal gland neoplasms; tomography; X-ray computed
肾上腺是人体重要的内分泌器官，近年来随着医学影像检查设备，尤其是CT技术的迅猛发展，对肾上腺肿瘤的定位及定性诊断都有大大的提高。本文回顾性分析经手术及病理证实的肾上腺肿瘤病例32例，探讨其影像征象，进一步明确其CT表现及鉴别要点。
材料与方法
收集1999年至2004年经手术及病理证实的肾上腺肿瘤32例，其中男10例，女22例。发病年龄9～65岁，平均年龄39岁。其临床表现多种多样，多数患者表现为阵发性头痛、头晕、心悸、发热、多汗及向心性肥胖、多毛、皮肤紫纹，或伴有高血压，周期性软瘫，肢体麻木等症状。肾上腺皮质醛固酮及皮质醇腺瘤分别表现为Conn’综合征及Cushing’综合征，无功能性腺瘤则无任何临床表现。嗜铬细胞瘤则多表现为持续新或阵发性高血压伴周期性麻痹，皮质腺瘤多伴有Cusing’综合征，肾上腺转移瘤多伴有原发灶症状，髓性脂肪瘤、节神经瘤及神经纤维瘤偶有腹胀、腹痛或腹部包块等症状。
使用Marconi MX8000多层CT对患者进行扫描，矩阵512×512，120KV、250mA，层厚3mm，螺距1.5mm。所有患者均行平扫及团注增强扫描，造影剂为Omnipaque300mgI/ml或Ultravist300mgI/ml，造影剂用量为60～80ml，注药速度为3ml/s，动脉期延迟时间为25～30秒，静脉期70～80秒，部分患者行多平面矢状或冠状重组。分别请两位有经验的医生对32例患者的CT图象进行分析，记录病灶的大小、密度、形态、边缘及增强前后密度变化，并做出诊断，最后与手术及病理结果相对照确定CT诊断的准确性。
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