肾上腺腺瘤和非腺瘤的动态增强CT检查

The Study of Dynamic Contrast-Enhanced CT in Adrenal Adenomas and Nonadenomas

目的采用规范化的动态增强CT检查技术,对大样本病例进行深入地多角度评价,使肾上腺肿瘤动态增强CT检查能够在临床上广泛应用。资料与方法经手术和临床证实的70例共79个肾上腺肿块(腺瘤44个,非腺瘤35个)分别以相同的扫描条件行CT平扫和动态增强检查(静脉注入对比剂后30s开始扫描),然后延时1、2、3、5、7min扫描。剂量1.2ml/kg体重,注射流率2.5ml/s。分析评价肾上腺肿块的T-D曲线和廓清率Wash(相对廓清率Washr和绝对廓清率Washa)。结果T-D曲线分为5种类型,即A、B、C、D和E各型。腺瘤的特征曲线为A、C型,非腺瘤为B、D、E型(P=0.000)。Washr和Washa于腺瘤和非腺瘤间存在显著性差异(P=0.000),腺瘤的Washr和Washa均高于非腺瘤,并且Washr诊断效果优于Washa。7min延时点诊断价值较大,Washr≥34HU提示为腺瘤,反之提示为非腺瘤。结论肾上腺CT动态增强检查能够对腺瘤和非腺瘤尤其对乏脂性腺瘤与非腺瘤的鉴别诊断具有较大价值。

Objective To evaluate deeply dynamic contrast-enhanced CT （DCT） of a large sample of adrenal adrenoma and nonadenoma from different sides in order to be widely applied clinically. Materials and Methods 70 cases with 79 adrenal masses verified by surgical-pathologlcal were studied. These masses were consisted ot＂44 adenomas, 35 nonadenomas. Plain and enhanced CT scans were performed in all above-mentioned lesions with the same parameters （scans beginning at 0.5min. 1min. 2min. 3min, 5min, 7min after initial injection of contrast material with an injection rate of 2.5ml/s and a dose of 1.2ml/kg） . And then, characteristic features of DCT of adrenal masses including time-density curve （T-D curve） and washout rate [ Wash, relative washout rate （Washr） and absolute washout rate （Washa）] were analyzed, Results T-D cnrves were divided into type A. B, C, D and E. Type A, C were belonged to typical curves of adenoma, while type B, D and E were belonged to nonadenoma. There was significant difference in Washr and Washa between adenonm and nonadenoma （P = 0.0001 ）. Washr and Washa were higher in adenmna than thai in nonadenoma, while the effeel of diagnosis with Washr was snperior to that with Washa. especially in the delay at 7 min. It suggested adenoma when Washr was more than 34 HU, otherwise it suggested nonadenoma. Conclusion Dynamic Contrast -Enhanced CT has an important value in diagnosis of Adrenal adenoma and nonadenoma, especially in differentiation lipid-poor adenoma from nonadenoma.