94例功能性肾上腺皮质疾病的CT诊断及评价

CT Imaging of Functional Adrenal Cortical Diseases Analysis of 94 Cases

本文总结了９４例肾上腺功能性疾病临床生化、Ｂ超、ＣＴ检查结果并与手术病理对照，包括原发性醛固酮增多症６１例（皮质腺瘤４８例，皮质增生１３例），皮质醇症３３例（皮质腺后１８例，皮质增生１１例，腺癌４例）．用１．５～３ｍｍ薄层扫描，醛固酮瘤ＣＴ定位准确率达９３．３％；皮质腺增生（醛固酮症１３例，皮质醇症１１例）术前定位准确率８３．３％。手术前９１％ＣＴ可鉴别腺瘤或增生。本文讨论了皮质醇腺瘤和醛固酮腺瘤、腺瘤和增生、肾上腺增生和正常肾上腺的鉴别。还讨论了肾上腺“假瘤”的鉴别。结论是高分辨率肾上腺ＣＴ结合临床生化，对功能性肾上腺皮质疾病的诊断为首选检查法，定位准确率最高，个别病例必要时可行经肾上腺静脉取血作内分泌测定。

Ninety-four cases of CT imaging of functional adrenal diseases,diagnosed by clinico-biochemical exam and proven by surgery and pathology,were analysed.Its included 61 cases of primary hyperaldosteronism(adenoma 48,cortical hyperplasia 13 ), Cushing's syndrome 33(adenoma 18,hyperplasia 11.carcinoma 4 ).The accuracy rate of localisation of aldosteroma by using high resolution CT technique and thin section 1.5～3mm thickness,was 93.3%and that of cortical hyperplasia was 83.3%.The rate of differentiation between adrenal adenoma from hyperplasia was 91%;the former needs operation and the latter could be treated only by medical methods. High resolution CT correlated to clinico-biochemical study is the method of choice of exam. In rare cases, CT imaging require further diagnostic workup,such as, selective adrenal vein catheterization for hormone analysis.