钝性肾上腺损伤的MSCT表现特征

MSCT Characteristic Findings of Blunt Adrenal Gland Trauma

目的探讨钝性肾上腺损伤(blunt adrenal gland trauma,BAGT)特征性多层螺旋CT(MSCT)表现。资料与方法回顾性分析经手术或临床随访证实的40例BAGT患者的MSCT平扫和动态增强的影像资料。采用GELightspeed多排螺旋CT机,运用薄层小螺距扫描和最大密度投影(MIP)与多平面重组(MPR)技术。结果 40例中,右侧33例,左侧6例,双侧1例。BAGT主要征象:(1)肾上腺血肿29例,MSCT像上呈圆形、卵圆形高密度血肿,三期增强扫描血肿无强化,其周围可见受压推移并张开的人字形、弧线状强化的肾上腺肢体影。(2)肾上腺肿胀8例,MSCT表现为损伤的肾上腺肿胀增粗,但仍保持线状或人字形的肾上腺基本外形,三期增强扫描肿胀的肾上腺强化密度减低。(3)肾上腺碎裂3例,肾上腺变形、碎裂,密度混杂,并被血肿淹没。(4)对比剂外溢2例,增强动脉期损伤的肾上腺肢体可见点状溢出的高密度对比剂影;门静脉期与延迟期呈糊状、结节状高密度,范围扩大。MPR、MIP重组清楚地显示肾上腺肿胀、血肿、碎裂、对比剂外溢征象。结论 BAGT具有特征性CT表现,MSCT动态增强与后处理技术能清楚地显示其各种病理改变。

Objective To investigate MSCT characteristic findings of blunt adrenal gland trauma（BAGT）. Materials and Methods The MSCT images of 40 cases of adrenal gland trauma of patients with blunt abdominal trauma were analyzed restrospectively. Results Thirty-three cases of BAGT were located on right side, six on left side and one on both sides. MSCT findings included ： （ 1 ） Adrenal hematomas in 29 cases, appeared as round or oval hyperdense in plain scan and without enhanced in dynamic contrast scan. The adrenal limbs around hematoma were pushed and splayed as curvilinear structures. （2）Swelling adrenal glands in 8 cases, which had line or herringbone shapes without hemorrhage in them. （3） Cataclastic adrenal glands in 3 cases. （4）Contrast media extravasation from blood vessel was shown in 2 case, which were active bleeding from the broken adrenal gland vessels in artery phase and more contrast media extravasation in portal phase and delayed phase. The CT findings of adrenal glands swelling, hemorrhage, cataclastic adrenal glands and contrast media extravasation were clearly displayed on MPR and MIP images. Conclusion MSCT dynamic enhancement technique with MPR and MIP can display BAGT＇ s pathological changes clearly.