利用CT表现鉴别肾上腺隐匿型嗜铬细胞瘤和皮质腺瘤

CT features for the differential diagnosis of the hidden pheochromocytoma and cortical adenoma

目的探讨如何利用CT表现对肾上腺隐匿型嗜铬细胞瘤和肾上腺皮质腺瘤进行鉴别诊断。方法收集2010年1月至2020年1月期间中国医科大学附属第一医院收治的177例肾上腺肿瘤患者进行回顾性分析,对比各组患者之间的一般临床资料和CT表现。结果隐匿型嗜铬细胞瘤56例、皮质醇腺瘤32例、醛固酮腺瘤44例、无功能腺瘤45例,隐匿型嗜铬细胞瘤组在肿瘤侧别上与无功能腺瘤组差异有统计学意义,在肿瘤最大直径、平扫CT值、动脉期和延迟期增强CT值上均显著大于三组肾上腺腺瘤组。以肿瘤直径≥2.95 cm诊断隐匿型嗜铬细胞瘤,曲线下面积(AUC)为0.872,敏感度为87.5%,特异性为76.0%;当平扫CT值≥24.5 Hu时,AUC为0.929,敏感度为94.0%,特异性为82.5%;当动脉期增强CT值≥89.5 Hu时,AUC为0.886,敏感度为72.7%,特异性为90.6%;当延迟期增强CT值≥82.5 Hu时,AUC为0.937,敏感度为84.6%,特异性为95.3%;联合以上四个指标时,AUC为0.981,阈值为≥0.118,敏感度为100%,特异性为90.6%。结论以肿瘤直径2.95 cm、平扫CT值24.5 Hu、动脉期增强CT值89.5 Hu和延迟期增强CT值82.5 Hu为阈值对肾上腺隐匿型嗜铬细胞瘤有较好的鉴别诊断价值。

Objective To investigate the differential diagnosis of hidden pheochromocytoma and adrenal cortical adenoma according to their CT features.Methods A total of 177 patients with adrenal tumors admitted to the First Affiliated Hospital of China Medical University from January 2010 to January 2020 were collected for retrospective analysis,and the general clinical data and CT features of patients in each group were compared.Results There were 56 cases of hidden pheochromocytoma,32 cases of cortisol adenoma,44 cases of aldosterone adenoma,45 cases of non-functional adenoma.There were statistically significant differences between the group of hidden pheochromocytoma and the group of non-functional adenoma.The tumor diameter,scan CT value,and delay arterial enhancement CT value on hidden pheochromocytoma group were significantly greater than three adrenal adenoma groups.When the tumor diameter≥2.95 cm was used to diagnose the hidden pheochromocytoma,AUC was 0.872,sensitivity was 87.5%,specificity was 76.0%.When the CT value of plain scan was≥24.5 Hu,the AUC,sensitivity and specificity were 0.929,94.0%and 82.5%respectively.When the arterial enhanced CT value≥89.5 Hu,AUC was 0.886,sensitivity was 72.7%,and specificity was 90.6%.When the enhanced CT value in the delay period was≥82.5 Hu,the AUC,sensitivity and specificity were 0.937,84.6%and 95.3%respectively.When combined with the above four indicators,the AUC was 0.981,the threshold was≥0.118,the sensitivity was 100%,and the specificity was 90.6%.Conclusion The value of 24.5 Hu in plain scan,89.5 Hu in arterial enhanced CT and 82.5 Hu in delayed enhanced CT with tumor diameter of 2.95 cm is useful for the differential diagnosis of adrenal hidden pheochromocytoma.