MSCT动态增强对肾上腺转移性腺癌的诊断价值

Value of Dynamic Enhanced Multi-row Detector CT in the Diagnosis of Metastatic Carcinoma of Adrenal Gland

目的:分析肾上腺转移腺癌的CT平扫及动态增强特征,探讨其诊断价值。方法:搜集经病理证实的肾上腺转移腺癌57例,术前均行MSCT平扫、动脉期和门脉期扫描。回顾性分析CT扫描结果并和病理作对照分析。结果:57例肾上腺转移腺癌患者共发现93个病灶,单侧21例,双侧36例,右侧64个病灶,左侧29个病灶。病灶境界清楚79个,境界欠清14个。病灶形态圆形或椭圆形57个,不规则形36个。肿瘤直径1.1～17.3cm,其中,<5.0cm53个,5.0～10.0cm35例,>10cm5例。肿瘤呈实质性35个,不同程度坏死囊变58个,其中13例病灶坏死显著形成假囊肿样改变。平扫肿瘤CT值为15.2～43.7HU,平均32.8HU;动脉期CT值27.6～63.2HU,平均45.9HU,16个病灶内隐约可见血管影;门脉期扫描肿瘤实质成分强化更明显,强化范围扩大,实质部分CT值为49.4～96.3HU,平均72.5HU。结论:肾上腺转移腺癌大小、形态、坏死程度等征象具有一定的多样性,肿瘤密度、血液动力学等征象则相对一致。MSCT动态增强可为其诊断提供重要信息。

Objective：To evaluate the value and manifestations of plain and dynamic enhanced multi-row detector CT （MDCT） in the diagnosis of metastatic carcinoma of adrenal gland. Methods： 57 patients with metastatic carcinoma of adrenal gland confirmed by pathology were collected. Plain scan and two-phase dynamic enhanced CT scan before operation were undertaken, the CT findings were analyzed retrospectively and correlated with pathology. Results：93 lesions were revealed in these 57 patients with unilateral lesion （n= 21 ） and bilateral lesions （n=36）. Lesions located in the right adrenal gland （n=64） and in the left （n=29）. Well defined margin was showed in 79 lesions and ill defined margin in 14. There were 57 lesions appeared as round or oval and 36 lesions as irregular in shape. The diameler of the tumors ranged from 1.1～17.3cm with the diameter 〈5.0cm （n=53） ,5.0～10.0cm （n=35） and〉10cm （n=5）. Solid mass was assessed in 35 lesions and solid complicated with necrosis in 58 lesions, 13 of which showed pseudo-cystic change due to marked necrosis. The attenuation value on plain scan ranged from 15.2～43.7HU （mean.32.8HU）. After contrast administration,the attenuation value ranged from 27.6～63.2HU （mean：45.9HU） on arterial phase,intra-tumoral vessels could be faintly seen;the solid part of the mass showed more markedly enhanced on portal vein phase,wilh the attenuation ranged from 49.4～96.3HU （mean： 72.5HU） . Conclusion：The size,shape and degree of necrosis of metastatic carcinoma of the adrenal gland varied, yet the density and hemodynamic patterns of which were relatively constant, dynamic enhanced MDCT provided significant information for the diagnosis.