多发嗜铬细胞瘤的CT诊断价值

Multiple Pheochromocytomas:CT Features of Dynamic Enhancement

目的:分析多发嗜铬细胞瘤的影像学表现及动态增强特征,以提高其诊断准确性。方法:经手术病理证实的多发嗜铬细胞瘤9例,其中双侧肾上腺嗜铬细胞瘤7例,Von Hippel-Lindau病1例,腹膜后副神经节瘤并膀胱嗜铬细胞瘤1例。术前经螺旋CT和多层螺旋CT平扫、动脉期(30s)和门脉期(70～80s)扫描。对比剂采用欧乃派克或优维显,注射流率3ml/s。仔细复习CT扫描结果并与手术病理作回顾性对照分析。结果:9例嗜铬细胞瘤共18个病灶中,双侧肾上腺嗜铬细胞瘤7例,双侧肾上腺嗜铬细胞瘤并胰腺神经内分泌瘤和肾细胞肾癌1例(Von Hippel-Lindau病),腹膜后副神经节瘤并膀胱恶性嗜铬细胞瘤1例。良性病灶13个,恶性病灶5个。肿瘤呈圆形或椭圆形15个,不规则形3个。直径3.2～13.7cm,平均5.6cm。病灶直径<5.0cm3个,5.0～10.0cm13个,>10cm2个。肿瘤实质成分平扫CT值为34.2～53.0HU,平均42.7HU;动脉期CT值63.7～91.5HU,平均80.7HU;门脉期CT值75.1～126.4HU,平均98.1HU。8例双侧肾上腺嗜铬细胞瘤16个病灶中,6例两侧病灶大小、形态、密度、动态增强强化程度和强化方式相仿,2例两侧大小不同,坏死、囊变不同,但动态增强强化程度和强化方式相仿。结论:多发嗜铬细胞瘤包括双侧肾上腺嗜铬细胞瘤、副神经节瘤和脏器嗜铬细胞瘤,多位于双侧肾上腺,CT表现与肾上腺嗜铬细胞瘤相仿,同一病例不同肿瘤的大小、形态、坏死囊变、动态增强强化方式和强化程度相仿,少数肿瘤大小不同,坏死囊变存在差异。

Objective：To explore dynamic CT features of multiple pheochromoeytomas. Methods：Eighteen lesions of 9 patients with multiple pheochromoeytomas confirmed by surgical pathology underwent spiral CT plain scanning and two phases dynamic enhancement scanning before operation. Contrast injection was done by using nonionic omnipaque at a flow rate of 3ml/s by a power injector. The CT data were reviewed and analyzed retrospectively in comparison with surgical and pathological results. Results：Eighteen lesions of 9 cases of pheochromocytomas with 5 malignant lesions and 13 benign lesions included bilateral adrenal pheochromocytomas （14）, Von Hippel-Lindau disease （2）, paragangliomas and bladder pheochromocytomas （2） ,respectively. The diameter of the tumors was 3.2-13.7cm （of 3 cases 〈5.0cm,of 13 cases 5.0- 10. 0era and of 2 cases 〉10cm）. The attenuation of solid part of tumor on plain CT was 34.2-53. OHU （mean 42. 7HU）, on arterial phase was 63.7-91.5HU （mean 80.7HU） ,and on portal venous phase was 75.1-126.4HU （mean 98.1HU） respectively. The imaging features of different lesions in the same cases such as size, cysts, necrosis and dynamic enhancement were similar. Conclusion： The imaging features of multiple pheoehromocytomas, which include bilateral adrenal pheochromocytomas, Von Hippel-Lindau disease, paragangliomas and ectopic pheochromocytomas,are similar to those of adrenal pheochromocytomas. Most of the lesions are located at bilateral adrenal glands with similar imaging features of different tumors in the same patient.