原发性肾上腺皮质腺癌的影像特征表现

Imaging features of primary adrenocortical carcinoma

目的回顾性研究分析原发性肾上腺皮质腺癌(PACC)的CT及MR特征表现,提高对PACC影像特征的认识。方法回顾性分析经病理证实的15例PACC患者的影像学特点,其中12例行CT检查,7例行MR检查,4例同时行CT与MR检查。结果15例患者均为单侧发病,其中5例位于左侧,10例位于右侧。肿瘤最大径4.4~15.1(8.9±3.3)cm,形态规则呈椭圆形6例,形态不规则9例。CT表现:平扫密度均匀1例,因出血、坏死和含脂而密度不均11例,CT值范围28.8~62.0(39.2±8.5)HU;增强后动脉期轻度强化7例,中度强化4例,CT值范围32.7~83.4(52.5±14.4)HU;静脉期CT值范围43.4~86.4(61.1±15.0)HU,11例呈渐进性强化,1例无明显强化。MR表现:实性部分多表现为等T1长T2信号,弥散受限,增强后均轻中度不均匀强化6例,均匀强化1例。15例患者瘤内见血管影14例,周围组织器官受累和转移者共3例。结论PACC好发于单侧,瘤体较大,多伴囊变、出血及瘤内血管影,增强后轻中度不均匀渐进性强化。

Objective To discuss the computed tomography(CT)and magnetic resonance(MR)imaging features of primary adrenal cortical carcinoma(PACC)and improve the imaging diagnostic level of primary adrenocortical carcinoma.Methods The imaging features of 15 patients with biopsy or pathology confirmed PACC were retrospectively analiezed.There were 12 patients underwent CT examination,7 patients underwent MR examination,and 4 patients underwent CT and MR exminations.Results All of 15 PACCs were unilateral(10 on the right,5 on the left).The maximum diameters of the lesions ranged from 4.4 to 15.1(8.9±3.3)cm.The shape of the tumor was oval in 6 cases and irregular in 9 cases.CT findings:1 cases showed homogeneous density and 11 cases were heterogeneous attenuation(including 2 cases with hemorrhage and 1 case with fat)on plain scan.The CT values of triple-phase of PACC ranged from 28.8 to 62.0(39.2±8.5)HU,32.7 to 83.4(52.5±14.4)HU and 43.4 to 86.4(61.1±15.0)HU respectively.All cases showed mild(7 cases)and moderate(4 cases)gradual enhancement,only one case excluded.MRI findings:inhomogeneous mild and moderate enhancement were detected in 6 cases and homogeneneous enhancement was found in 1 case.The solid parts of PACC showed iso-signal intensity in T1WI,hyper-signal intensity in T2WI and diffusion limited in the diffusion weighted imaging(DWI).There were 14 cases of vascular shadow in 15 patients,and 3 cases of involvement and metastasis of surrounding tissues and organs.Conclusions PACC often present as a big solitary heterogenous mass with necrotic area,hemorrhage and intratumoral vascular.The mild to moderate heterogenous gradual enhancement can be seen after the contrast.