64排螺旋CT检查在嗜铬细胞瘤/副神经节瘤诊断中的应用

Application of 64-slice spiral CT in diagnosis of pheochromocytoma or paraganglioma

目的探讨64排螺旋CT检查在嗜铬细胞瘤/副神经节瘤(PHEO/PGL)诊断中的价值。方法回顾性分析经手术及病理证实的13例嗜铬细胞瘤/副神经节瘤患者的完整临床及CT影像资料,13例患者均进行腹部、颈部CT扫描和三维重建,CT影像特征包括肿瘤部位、大小、形态、强化特征及供血动脉关系。结果13例嗜铬细胞瘤/副神经节瘤患者,其中肾上腺嗜铬细胞瘤7例,肾上腺外副神经节瘤5例,颈部副神经节瘤1例。CT表现为圆形或类圆形密度均匀或不均匀软组织肿块,动脉期明显强化软组织肿块,边界清。直径>5cm肾上腺嗜铬细胞瘤,肿块密度不均,内坏死、囊变区多见,1例病灶见散在颗粒样钙化,1例合并脑出血,1例术后复发肝脾、腰椎转移。图像重建肿瘤可显示供血动脉。结论嗜铬细胞瘤/副神经节瘤临床表现及CT表现具有一定的特征,64排螺旋CT检查有助于嗜铬细胞瘤/副神经节瘤的定位、定性以及明确肿瘤与周围组织结构的关系,对临床的诊治有重要的价值。

Objective To explore value of 64-slice spiral CT in diagnosis of pheochromocytoma or paraganglioma. Methods Complete clinical and CT radiological data of 13 patients with pheochromocytoma or paraganglioma confirmed by operation and pathology were retrospectively analyzed. 13 patients were received CT scan of abdomen and neck and three-dimensional reconstruction. CT image features included location, size, morphology, enhancement features and feeding arteries relationship of tumors. Results In 13 patients with pheochromocytoma or paraganglioma, there were 7 patients with adrenal pheochromocytoma, 5 patients with extra-adrenal paraganglioma and 1 patient with neck paraganglioma. CT findings were round or oval soft tissue mass with with homogeneous density or inhomogeneous density. Soft tissue mass was significantly enhanced in arterial phase with clear border. In adrenal pheochromocytoma with diameter of more than 5 centimeters, mass with inhomogeneous density, internal necrosis and cystic degeneration were often seen. 1 case was with lesions scattered in particle-like calcification, 1 case was complicated with cerebral hemorrhage and 1 case was with liver-spleen metastasis and lumbar metastasis. Image reconstruction of tumor showed feeding arteries. Conclusion Clinical manifestation and CT manifestation of pheochromocytoma or paraganglioma have certain specific features. 64-slice spiral CT is helpful to locate and determine nature of pheochromocytoma or paraganglioma and clarify relationship between tumor and adjacent organs and structures, which is of high value for clinical diagnosis and treatment.