心脏嗜铬细胞瘤的影像学诊断

Imaging features of cardiac pheochromocytomas

目的描述心脏嗜铬细胞瘤的影像学表现,探讨其诊断意义。方法回顾性分析4例经手术病理证实的心脏嗜铬细胞瘤,着重分析其影像学表现和意义。结果4例心脏嗜铬细胞瘤平均直径5·8cm,分别位于左房顶部、房间隔、升主动脉基部前方、主动脉弓和肺动脉之间。1例患者合并双侧颈动脉体瘤。肾上腺髓质显像1例阳性。生长抑素受体显像4例阳性。肿瘤CT平扫与心脏等密度,增强时有明显增强,均可见低增强的中心瘢痕。MRI显示与心肌相比为略短或等T1信号、长T2信号。冠状动脉造影4例显示肿物血供。结论心脏嗜铬细胞瘤主要位于左心房顶部及附近。肾上腺髓质显像和生长抑素受体显像结合可有效探查肿物位置和数目。增强CT和MR平扫可显示肿物细节,有助于手术评估。

Objective To describe imaging features of cardiac pheochromocytomas and discuss the value on diagnosis. Methods Imaging features of 4 pathologically confirmed cardiac pheochromocytomas were retrospectively studied. Results The mean diameter of the 4 tumors was 5.8 cm, and the tumors were located respectively in the roof of left atrium, in the interatrial septum in front of the base of ascending aorta, and in between the aortic arch and the pulmonary trunk. Bilateral carotid body tumors were also seen in 1 case. MIBG scintigraphy was positive in 1 case. Somatostatin receptor scintigraphy showed all tumors. The tumors were of same CT attenuation as the heart and were enhanced significantly on enhanced CT. All the tumors had central scar on enhanced CT. The tumors were of shorter or iso-signal intensity on T1WI, and of long signal intensity on T2WI. Coronary angiography depicted feeding arteries of all 4 tumors. Conclusion Cardiac pheochromocytomas are rare tumors, typically located adjacent to or involving the left atrium. For initial detection of multiple foci, MIBG scintigraphy combined with somatostatin receptor scintigraphy is recommended. MRI and enhanced CT imaging can then provide detailed anatomic delineation before surgical resection.