超声检查与CT对肾上腺肿瘤的定位与定性诊断价值

The value of ultrasonography and computerized tomography in localization and qualitative diagnosis of adrenal masses

目的探讨超声检查与CT对肾上腺肿瘤的定位及定性诊断价值。方法回顾性分析我院经手术及病理确诊的80例肾上腺肿瘤患者84个病灶超声检查及CT检查资料,并与手术及病理诊断结果进行比较。其中4例患者2个病灶,其余76例患者肿瘤单发。84个肿瘤包括库欣皮质腺瘤13个,醛固酮皮质腺瘤22个,皮质腺癌7个,无功能皮质腺瘤6个,肾上腺转移癌22个,嗜铬细胞瘤14个。结果本组84个肾上腺肿瘤超声检查检出78个,CT检出80个,超声检查与CT定位诊断符合率分别为92.9%(78/84)、95.2%(80/84),差异无统计学意义(χ2=0.003,P>0.05);结合检出病灶超声表现、CT表现与患者临床症状、体征及实验室检查结果综合分析判断,最终超声检查及CT定性诊断符合率分别为90.5%(76/84)、88.1%(74/84),差异亦无统计学意义(χ2=0.248,P>0.05)。本组超声检查检出的78个肿瘤中,38个肾上腺皮质腺瘤及13个嗜铬细胞瘤超声声像图表现为低、弱或等回声结节与团块,境界清楚,有7个瘤体因伴液化坏死及钙化,内部回声不均匀;7个皮质腺癌及20个肾上腺转移癌表现为低、弱回声结节或团块,形态不规则,境界不清或呈浸润生长,内部回声不均匀,5个瘤体伴液化坏死及钙化。CT检出80个肿瘤中,39个肾上腺皮质腺瘤及13个嗜铬细胞瘤多表现为境界清楚、密度均匀的结节与团块,其中5个瘤体伴液化坏死及钙化密度不均匀;7个皮质腺癌及21个肾上腺转移癌CT表现为形态不规则、边界欠清或不清、密度尚均匀或不均匀的结节与团块;增强扫描13个嗜铬细胞瘤均呈明显不均匀强化,其中1个同时检出大网膜异常强化灶;7个皮质腺癌为中度或明显不均匀强化;其余多为轻-中度强化。结论超声检查和CT诊断肾上腺肿瘤的符合率均较高,但也都存在不足之处,因此应根据肾上腺肿瘤大小和患者自身情况选择合适的影像学检查方法。超声检查简便易行,且无辐射,可作为肾上腺肿瘤首选检查方法。

Objective To evaluate the clinical value of uhrasonography and computerized tomography （CT） in localization and qualitative diagnosis of adrenal masses. Methods Eighty cases with 84 adrenal masses diagnosed by uhrasonography and CT were analyzed and compared to their surgical and pathological results respectively,including 4 cases with 2 masses and 76 cases with single mass. The masses included 13 Cushing cortical adenomas, 22 aldosterone cortical adenomas, 7 cortical adenocarcinomas, 6 non-functional adenomas ,22 metastatic carcinomas and 14 adrenal gland pheoehromocytomas. Results Ultrasonography and CT detected 78 and 80 lesions, respectively. The localization accuracy of uhrasonography and CT were 92.9% （78/84） and 95.2% （80/84）, respectively. No statistical significance was found between the two methods （X： = 0. 003 ,P 〉 0.05 ）. Combining the features of detected masses by ultrasonography and CT, the clinical symptoms, signs and laboratory test results of patients, the final qualitative diagnostic accuracy of uhrasonography and CT were 90.5% （76/84）and 88.1% （74/84）, respectively. There was no statistically significant difference（x^2 = 0. 248 ,P 〉 0.05 ）. In the 78 masses detected by ultrasonography ,38 adrenocortical adenomas and 13 pheochromoeytomas were shown as hypoechoie or isoechoic nodules with clear margin, including 7 masses with uneven echogenicity because of liquefaction necrosis and calcification;7 cortical adenocarcinomas and 20 metastatic adrenal carcinomas were shown as hypoechoic nodules or masses with irregular shape, unclear margin, infiltrative growth and uneven echogenicity, including 5 tumors with liquefaction necrosis and calcification. In the 80 tumors detected by CT,39 adrenocortical adenomas and 13 pheochromocytomas were shown as uniform density nodules and masses with clear boundary, including 5 masses with uneven density because of liquefaction necrosis and calcification ;7 cortical adenocareinomas and 21 metastatic carcinomas were shown as homogeneous or heterogeneous density nodules and masses with irregular shape and clear or unclear border. In contrast-enhanced CT, 13 pheochromocytomas were heterogeneous enhanced, one case of which with abnormal enhanced lesion in the omentum ;7 adrenocortical adenocarcinomas were moderate or marked inhomogeneous enhanced, and the remainder were mostly mild to moderate enhanced. Conclusions Uhrasonography and CT can accurately diagnose most adrenal masses, but there are inadequacies, so the appropriate imaging studies should be based on the size of adrenal masses and patients＇situation. Because of simple operation and no radiation damage, uhrasonography can be used as the preferred imaging method of adrenal masses.