动态增强CT联合MRI对肾上腺腺瘤与转移瘤的鉴别诊断价值

Value of dynamic contrast-enhanced CT combined with MRI in differential diagnosis of adrenal adenoma and metastatic tumor

目的探讨动态增强CT联合MRI对于肾上腺腺瘤与转移瘤鉴别诊断的临床意义。方法收集120例术前均行增强MRI和增强CT检查的肾上腺肿瘤患者为研究对象,根据术后病理检查分为肾上腺腺瘤组(86例)和肾上腺转移瘤组(34例)。比较两组时间密度曲线间差异,以肿瘤廓清率为诊断标准并运用ROC曲线对所选择诊断标准进行评价。结果肾上腺腺瘤组动态CT、动态MRI主要以A型为主,其次依次为C型、B型、D型、E型;肾上腺转移瘤组动态CT、动态MRI主要以B型为主,其次依次为D型/E型、A型、C型。两组A型、B型、C型、E型动态CT、动态MRI组间差异有统计学意义(P<0.05);两组D型动态CT、动态MRI组间差异无统计学意义(P>0.05)。动态CT在延时3、5、7 min时,肾上腺腺瘤组无校正廓清率速度均明显快于肾上腺转移瘤组,而校正廓清率速度明显低于肾上腺转移瘤组,组间差异均有统计学意义(P<0.01)。动态MRI在延时3、5、7min时,肾上腺腺瘤组无校正廓清率速度均明显快于肾上腺转移瘤组,而校正廓清率速度明显低于肾上腺转移瘤组,组间差异均有统计学意义(P<0.01);在延迟3~30 min动态扫描时,肾上腺腺瘤ROC曲线下面积(AZ)值范围为0.714~0.825,肾上腺转移瘤AZ值范围为0.872~0.965。结论肾上腺腺瘤与转移瘤患者采用动态增强CT联合MRI检查,具有时间-密度之间的差异,在延时5 min具有很高的鉴别价值。

Objective To investigate the clinical significance of dynamic contrast-enhanced computed tomography(CT)combined with magnetic resonance imaging(MRI)in differential diagnosis of adrenal adenoma and metastasis.Methods 120 patients with adrenal adenoma who were examined by enhanced MRI and enhanced CT before operation were collected.According to the pathological examination after operation,they were divided into adrenal adenoma group(86 cases)and adrenal metastasis group(34 cases).The difference of time-density curve between the two groups was compared,and the diagnostic criteria were evaluated by using receiver operating characteristic(ROC)curve.Results Dynamic CT and dynamic MRI were mainly type A,followed by type C,B,D and E.Dynamic CT and dynamic MRI were mainly type B,followed by type D/E,type A and type C.There were significant differences in type A,B,C,E dynamic CT and dynamic MRI between the two groups(P<0.05);there was no significant difference in type D dynamic CT and dynamic MRI between the two groups(P>0.05).The AZ value of adrenal adenomas ranged from 0.714 to 0.825 and that of adrenal metastasis ranged from 0.872 to 0.965 at 3-30 minutes delay.Conclusions Dynamic contrast-enhanced CT combined with MRI in patients with adrenal adenoma and metastasis has a time-density difference,5 min has high discriminant value in time lapse.