肾上腺无功能腺瘤与神经节细胞瘤的CT鉴别诊断

The role of CT in differentiation of adrenal adenomas from ganglioneuroma

目的探讨CT在肾上腺无功能腺瘤和神经节细胞瘤的鉴别诊断价值。方法回顾性分析我院经手术病理证实的28例肾上腺无功能腺瘤和17例肾上腺神经节细胞瘤的CT影像特点,两组患者均行CT平扫、静脉期、门脉期及延迟期扫描。结果测量值(最大径、平扫CT值、增强三期CT值)两名观察者测量的结果一致性良好,ICC值均大于0.75。神经节细胞瘤最大径、平扫CT值、增强三期CT值分别为(5.6±2.8)cm、(23±3)HU、(30±3)HU、(34±8)HU、(41±6)HU,椭圆形9例、不规则形8例,15例可见“伪足”征,总体呈轻度渐进式强化。无功能腺瘤最大径、平扫CT值、增强三期CT值分别为(2.4±1.4)cm、(12±7)HU、(37±6)HU、(52±8)HU、(31±6)HU,圆形24例,椭圆形4例,1例“伪足”征,总体呈速升速降式中度强化。神经节细胞瘤最大径、平扫CT值、延迟期CT值均大于无功能腺瘤(t=6.2,t=6.6,t=8.2,P<0.05),动脉期、门脉期CT值均小于无功能腺瘤(t=4.1,t=10.2,P<0.05)。节细胞瘤增强程度小于无功能腺瘤(t=9.9,P<0.05)。结论肾上腺无功能腺瘤和神经节细胞瘤的CT征象,对鉴别肾上腺无功能腺瘤和神经节细胞瘤有很重要的价值。

Objective To evaluate the diagnostic efficacy of CT in differentiating adrenal adenoma from ganglioneuroma.Methods Imaging findings of 17 cases of pathology proven adrenal ganglioneuroma,28 cases of pathology proven adrenaladenomas were retrospectively analyzed.All patients in the two groups underwent CT plain scan,arterial phase,vein phase and delayed phase scan.The images were independently analyzed and measured by two imaging radiologist over 5 years of experience.The region of interest(ROI)was placed in the most substantial part(avoiding bleeding,necrosis,calcification,etc.).We analyzed the tumor morphology,measured the tumor’s the maximum diameter,the CT value of plain scan and enhanced three phase.The results of two observers were measured by intra group correlation coefficient test(ICC).The average value of two measurements was analyzed.The continuous variables data met the normal distribution was analyzed by independent sample t test.The qualitative data were tested byχ~2;test.The difference was statistically significant(P<0.05),and the excel table was used to analyze the enhanced mode.Results Values of the two groups(maximum diameter,plain scan CT value,and enhanced three phase CT value)were observed in two groups.The results of the observation were good,and the ICC values were all higher than 0.75.The maximum diameter,plain scan CT value and enhanced three phase CT value of ganglion cell tumor were(5.6±2.8)cm,(23±3)HU,(30±3)HU,(34±8)HU,(41±6)HU,oval in 9 cases,irregular shape in 8 cases and 15 cases of"pseudo foot".The maximum diameter of the nonfunctional adenoma,the CT value of plain scan and the three phase CT were(2.4±1.4)cm,(12±7)HU,(37±6)HUu,(52±8)HU,(31±6)HU,round in 24 cases,4 oval in cases and 1 case of"pseudo foot".The maximum diameter,CT value and delay period of the ganglioneuroma were greater than that of non functional adenoma(t=6.2,t=6.6,t=8.2,P<0.05),and the CT values in arterial and portal phase were less than non functional adenomas(t=4.1,t=10.2,P<0.05).The enhancement of ganglioma was less than that of nonfunctioning adenoma(t=9.9,P<0.05).Conclusion Comprehensive analysis of CT features of adrenal adenomas and ganglioneuromais has great value in differentiating adrenal nonfunctioning adenoma and ganglioneuroma.