肾上腺腺瘤和非腺瘤动态增强CT曲线与微血管超微结构的相关性研究

The Comparative Study of TD Curve of DCT and Microvascular Ultrastructure in Adrenal Adenomas and Nonadenomas

目的探讨肾上腺腺瘤和非腺瘤动态增强CT曲线与微血管超微结构特点的相关关系,以进一步阐明其动态增强机制。资料与方法经手术病理证实的42例46个肾上腺肿块(腺瘤23个、非腺瘤18个、增生结节5个)均行动态增强CT检查和病理学检查,而后分析肾上腺肿块动态增强CT表现特征〔时间-密度(T-D)曲线〕与微血管超微结构之间的相关关系。结果肾上腺腺瘤和非腺瘤间微血管超微结构存在显著不同。肾上腺肿块T-D曲线廓清迅速组(A、C型)与廓清缓慢组(B、D、E型)间的微血管超微结构表现特点亦不同;T-D曲线廓清迅速组微血管超微结构表现为管腔规则,无狭窄;内皮细胞吞饮泡多,窗孔多;细胞间隙增宽;基底膜菲薄,厚薄均匀,有裂口;血管外间隙窄、规则且均匀一致,基质少等,与腺瘤表现一致;由此提示动态增强CT曲线与微血管超微结构存在相关关系。结论微血管超微结构可能是导致腺瘤和非腺瘤具有不同的T-D曲线类型的主要因素之一。

Objective To analyze the correlation between the TD curve of dynamic contrast enhanced CT （DCT） and microvascular ultrastructure of adenoma and nonadenoma in order to explain enhancement mechanism. Materials and Methods 42 cases with 46 adrenal masses proven surgically and pathologically were performed DCT, included 23 adenomas, 18 nonadenomas and 5 hyperplasfic nodules. DCT features and relationship with microvascular ultrastructures were studied. Results The microvascular ultrastructures had significant difference between adenoma and nonadenoma. Meanwhile, the microvascular ultrastructures were also significantly difference between group faster wash （type A,C） and group slower wash （type B,D,E）. There were regulation and nonstenosis of lumens, more pinosome and oriticium of endothelial cells, widening of intercell space, uniformity and breakdown of basal membrane, narrowing and regulation and little stroma of extra vessel space and so on in Type A and C, which were in coincidence with adenoma, which suggested close correlation of both TD Curves of DCT and microvascular ultrastructures of adrenal masses. Conclusion Different microvascular ultrastructure is one of major reasons in different TD curve of DCT in adrenal masses.