肾上腺皮质癌影像学表现

Imaging manifestations of adrenocortical carcinoma

目的观察肾上腺皮质癌(ACC)影像学特征。方法回顾性分析22例ACC影像学表现,22例均接受腹部CT平扫,19例接受增强CT扫描;3例接受全身PET/CT;8例接受肾动态显像。结果CT示22例13例(13/22,59.09%)ACC位于左侧、9例(9/22,49.91%)位于右侧,直径均≥5 cm,形态不规则,边界不清,内部密度不均,其中10例(10/22,45.45%)见钙化,2例(2/22,9.09%)存在局部出血和囊变;17例(17/22,77.27%)局部软组织或邻近器官侵犯,7例(7/22,31.82%)出现血管侵犯,4例(4/22,18.18%)和7例(7/22,31.82%)分别见淋巴结转移和远处转移。3例PET/CT表现与CT所见相符。8例核素肾动态显像提示患肾血流灌注不均匀,显像剂摄取高峰减低、延迟甚至消失,显像剂分布稀疏、缺损、不均匀,排泄延缓,肾小球滤过率(GFR)为(30.18±3.54)mL/(min·1.73m^2)。结论ACC影像学表现具有一定特征性,结合病理检查及肾GFR有助于制定合理治疗方案。

Objective To analyze the imaging manifestations of adrenocortical carcinoma(ACC).Methods Clinical and imaging data of 22 ACC patients were retrospectively analyzed.All 22 patients underwent abdominal CT plain scanning,19 underwent enhanced CT,3 underwent whole-body PET/CT and 8 received renal dynamic imaging.The imaging findings were observed and analyzed.Results CT showed ACC on the left side in 13 cases(13/22,59.09%)and on the right side in 9 cases(9/22,49.91%).The diameter of all lesions were≥5 cm with irregular morphology,unclear boundary and heterogeneous density.Calcifications within tumor were observed in 10 patients(10/22,45.45%),while hemorrhage and cystic degeneration were in observed in 2 cases(2/22,9.09%).Local soft tissue mass or adjacent organ invasion were detected in 17 cases(17/22,77.27%),vascular invasion,lymph node metastasis and distant metastasis were noticed in 7(7/22,31.82%),4(4/22,18.18%)and 7 cases(7/22,31.82%),respectively.PET/CT performances in 3 cases were basically consistent with those of CT.Dynamic renal imaging indicated uneven distributed blood perfusion.The peak uptake of imaging agent decreased,delayed or even disappeared,with sparse,defective and uneven distribution,and the excretion delayed.The glomerular filtration rate(GFR)value was of(30.18±3.54)mL/(min·1.73 m 2).Conclusion Imaging manifestations of ACC had certain characteristics,which were helpful to treatment planning combining with pathological examination and GFR.