MSCT对肾上腺不典型嗜铬细胞瘤与皮质癌的鉴别诊断价值

The value of multi-slice spiral CT in differential diagnosis of atypical pheochromocytoma and adrenocortical carcinoma

目的分析肾上腺不典型嗜铬细胞瘤与皮质癌的MSCT表现,寻找两者在MSCT方面有意义的鉴别点,提高诊断能力。方法回顾性分析经过手术后病理证实,具有完整MSCT检查及术后病理资料的不典型肾上腺嗜铬细胞瘤19例,肾上腺皮质癌13例,探讨两者鉴别点。结果不典型PHEO表面多呈浅分叶状,ACC则呈不规则深分叶为主。不典型PHEO边缘多清楚,ACC病灶长径<5cm时边缘多清楚,长径>5cm时边缘模糊。ACC出现出血、钙化、囊变坏死的可能性高于不典型PHEO。ACC以中央钙化及中央星形坏死囊变为主,不典型PHEO以边缘钙化及病灶边缘不规则坏死囊变为主。动态增强扫描不典型PHEO呈动脉期明显强化,ACC则呈轻-中度强化。ACC有实性部分丝络样强化、坏死区壁结节强化等特征形态。不典型PHEO可呈环状强化与ACC鉴别,但不具特征。结论 MSCT对肾上腺不典型嗜铬细胞瘤与皮质癌鉴别诊断有一定程度的价值。

Objective To analyze the MSCT findings of adrenal atypical pheochromocytoma and adrenocortical carcinoma and to seek the significative points in MSCT for distinguishing the both disorders so as to improve the diagnostic ability. Methods A retrospective analysis on the patients with full MSCT examination and pathological data, inclusive of 19 cases of atypical pheochromocytoma （PHEO） and 13 cases of adrenocortical carcinoma （ACC）, was conducted in our hospital from October to November, 2014 and the differential points were explored in this work. Results The atypical PHEO sur- face exhibited shallow lobulated shape, while, the ACC presented mainly with irregular deep lobe. The atypical PHEO presented with distinct edges. As for the ACC lesion, if major diameter was less than 5 cm, the edge was clear, whereas, if major diameter was more than 5 cm, the edge was usually fuzzy. The possibility of the occurrence of hemorrhage, calci- fication, or cystic necrosis in ACC was higher than those at of a typical PHEO. ACC mainly presented with the central cal- cification and central star cystic necrosis, while, an atypical PHEO mainly exhibited edge irregular calcification and cystic necrosis. Dynamic enhanced scanning on the atypical PHEO showed obvious enhancement in arterial phase, but showed mild to moderate enhancement on ACC. The ACC had the filament network enhancement in solid part and nodular en- hancement in necrotic area wall, and other morphological characteristics. Atypical PHEO exhibited the ring-like enhance- ment, which was different from ACC, but with no special characteristic. Conclusion MSCT has a certain degree of value in differential diagnosis between the atypical pheochromocytoma and adrenocortical carcinoma.