儿茶酚胺增多症的CT定位诊断(附33例分析)

CT in the Localization of the Intra and Extra Adrenal Catecholamine Secreting Lesions: Report of 33 Cases

目的：总结肾上腺内外儿茶酚胺分泌性病变的ＣＴ定位经验。材料与方法：分析３３例儿茶酚胺增多症的临床及ＣＴ扫描资料。其中３２例经手术病理证实。１例ＣＴ定位失败，手术切除左肾上腺，病理报告正常，患者１０月后死于心肾功能衰竭。结果：ＣＴ探测肾上腺内嗜铬细胞瘤的准确率为１００％（ｎ＝２３）。１例左肾上腺髓质增生未能定位。ＣＴ定位了９例肾上腺外病灶中的８例功能性副神经节瘤，其发生部位是肾门（ｎ＝４）、主动脉旁（ｎ＝２）、盆腔（ｎ＝１）、膀胱（ｎ＝１）。肾上腺外肿瘤占２７％。作者观察到肾上腺外因素所致的某些高血压患者中，双侧肾上腺可以有中度的增大。结论：肾上腺外儿茶酚胺分泌性病变可发生于颅底至副睾间的任何部位，有时ＣＴ定位非常困难，因此对于有临床生化证据的儿茶酚胺增多症患者，在认真搜寻可能存在的肾上腺外副神经节瘤之前。

Objective: To summarize experience in CT localization diagnosis of intra and extra adrenal catecholamine secreting lesion.Materials and Methods:The clinical and CT information of 33 cases were analysed, which 32 cases were proved by surgery and pathology. CT localization failed in one, and then the left adrenal resection was performed, but the pathological examination of the speciman was normal. This patient died of renal and heart failure ten months later.Results:The accuracy rate of CT localization for intraadrenal pheochromocytoma was 100% (n=23). One patient with the left adrenal medullary could not be recognized. Of the extraadrenal lesions, 8 paragangliomas were detected by CT. These tumors located renal hilum (n=4), paraaorta (n=2), pevils (n=1), bladder wall (n=1). The extraadrenal tumors account for 27 percent in this group. The auther had observed moderate enlarged of bilateral adrenal in some patients with hypertension because of nonadrenal factors.Conclusion: The extra adrenal catecholamine secreting tumor may originate any where from the base of the brain to the epididymus. Sometimes CT localization is very difficult. Therefore, a hasty diagnosis of adrenal medullary hyperplasia should be avoided before a probable extraadrenal tumor is searched carefully with clinical and biochemical evidence of excessive release of catecholamine.