肾上腺损伤的CT及MRI诊断

CT and MRI diagnosis of adrenal gland injury

目的探讨肾上腺损伤的CT、MRI表现,评价其应用价值。方法回顾性分析21例经临床或随访证实的肾上腺损伤的CT、MRI检查资料,其中男性17例,女性4例,21例均行CT平扫,其中5例行CT增强扫描,2例MRI检查,9例CT随访。结果单侧肾上腺损伤19例(右侧16例,左侧3例),双侧肾上腺损伤2例。CT主要表现为肾上腺区类圆形或卵圆形血肿15例,肾上腺区弥漫出血6例,肾上腺周围脂肪内出血呈条束状或局限性密度增高16例,膈脚增粗4例,均合并其他脏器损伤。CT复查表现为肾上腺血肿密度逐渐降低,肾上腺形态逐渐恢复正常。血肿早期MRI表现为长T1、短T2信号灶,血肿吸收期呈长T1、长T2信号灶。结论CT、MRI检查能显示肾上腺损伤的多种病理解剖改变,对肾上腺损伤的诊断具有重要价值。

Objective To discuss the CT and MRI manifestations and diagnostic value of adrenal gland injury. Methods CT and MRI features of 21 cases （17 of men, 4 of women ） with adrenal gland injury proved by operation or following-up were retrospectively reviewed. 5 cases were performed with non-enhanced and enhanced CT scans, while 16 with non-enhanced CT scans, 2 cases MRI scans, 9 cases following-up CT scans. Results 19 cases were unilateral （right 16, and left 3 ）, and 2 cases were bilateral. On CT scans, 15 cases appeared as discrete round or oval masses expanding the adrenal gland, while 6 cases appeared as diffuse irregular hemorrhage obliterating the gland. 16 cases appeared as standing of the peri-adrenal fat caused by blood, and 4 cases appeared as vague margin of the crura of diaphragm. Other organ injuries were occurred in all the 21 cases. CT following up scanning showed that the density of shadow reduced from margin of hematoma and that the shapes of adrenal gland recovered gradually. Hematoma appeared as long T1 and short T2 signal intensity during the acute stage, and long T1, T2 signal intensity during the chronic stage. Conclusion CT and MRI scanning can accurately show various pathologic changes of adrenal gland injury, affording very important values for the diagnosis of adrenal injury.