MSCT薄层扫描及三维重建技术在肾上腺结节样增生诊断及治疗中的应用

Application of MSCT thin slice scan and 3D reconstruction technique in the diagnosis and treatment of nodular adrenal hyperplasia

目的探讨MSCT薄层扫描结合三维重建技术在肾上腺结节样增生诊治中的应用价值。方法对117例高血压患者行MSCT薄层平扫及增强扫描，并行三维多平面重建，通过观察轴位及多平面重建图像，结合生化指标诊断并定位肾上腺结节样增生，行腹腔镜患侧肾上腺切除，随访并分析患者术后血压改善效果。结果所有患者均经MSCT薄层扫描及多平面重建清晰诊断为单侧肾上腺结节样增生，结节直径为2～18mm，CT值（8．27±14．15）Hu。术后病理证实117例患者中皮质结节样增生97例，皮质结节样增生伴微腺瘤17例，皮质伴髓质增生3例。术后患者收缩压降至（12％4±7．8）mmHg，舒张压降至（82．3±8．2）mmHg，与术前比较，P均〈0．05。随访1—37个月，62例患者高血压得到治愈，53例改善，2例无明显改善。术后3个月复查醛固酮及血钾均在正常范围内。结论MSCT薄层扫描结合三维重建技术对于肾上腺结节样增生的诊断具有重要参考价值，并可指导临床实施腹腔镜患侧肾上腺切除术进行治疗。

Objective To evaluate the clinical value of MSCT combined with 3D reconstruction technique in the diagnosis and treatment of nodular adrenal hyperplasia （NAH）. Methods A total of 117 patients with hypertension underwent contrast-enhanced MSCT and 3D reconstruction. NAH was diagnosed and orientated according to the axial and multi-planar reconstruction images accompanied by biochemical parameters. Then all patients underwent laparoseopic unilateral adrenalectomy, and the improvement of blood pressure after operation was followed up and analyzed. Results All the 117 patients were proved unilateral NAH by MSCT thin slice scan and multi-planar reconstructed images, the size of node ranged from 2 mm to 18 mm, the CT value was （8.27 ± 14.15） Hu. The postoperative pathology confirmed that among the 117 patients, 97 cases were cortical nodular hyperplasia, 17 cases were cortical nodular hyperplasia complicated with micro-adenoma, and 3 cases were cortical and medullary hyperplasia. After the operation, hypertension was improved to various de- grees in all the patients with systolic BP failing down to （127.4 ±7.8） mmHg and diastolic BP dropping to （82.3 ±8.2） mmHg, the difference was significant compared with before the operation （ all P 〈 0.05 ）. During the follow-up （ 1-37 months）, hypertension was cured in 62 patients, improved in 53 patients, and no obvious improvement in 2 patients. Hy- pokalemia and hyperaldosteronism were cured in all patients 3 months after the surgery. Conclusion MSCT thin slice scan combined with 3D reconstruction plays an important role in the diagnosis of NAH, and can be used to guide laparoscopic u- nilateral adrenaiectomy for the treatment of NAH in clinic.