CT鉴别诊断乏脂性肾上腺腺瘤和嗜铬细胞瘤的价值

Value of CT for the differential diagnosis of lipid-poor adrenal adenoma and pheochromocytoma

目的探讨CT鉴别诊断乏脂性肾上腺腺瘤(LPA)和嗜铬细胞瘤(PHEO)的临床价值。方法选取2017年7月至2020年7月间锦州医科大学附属第一医院收治的经手术及病理证实并行CT检查的50例LPA患者和28例PHEO患者,比较不同CT征象诊断两组患者的临床价值。结果两组患者均为单发,共78个病灶。两组患者肿瘤最大径、囊变、平扫CT值、动脉期CT值、静脉期CT值和延迟期CT值比较,差异均有统计学意义(均P<0.05)。囊变、平扫CT值和延迟期CT值对鉴别LPA和PHEO有价值,差异有统计学意义(χ^(2)=82.17,P<0.05),应用ROC曲线得出诊断模型的敏感度为100.0%,特异度为94.0%,AUC为0.990,诊断点为0.253。囊变、平扫CT值和延迟期CT值均有较高的敏感度和特异度。结论囊变、平扫CT值和延迟期CT值是鉴别LPA与PHEO的三个特征性预测指标,Logistic回归模型有利于LPA与PHEO的鉴别。

Objective To comprehensively analyze the value of CT for the differential diagnosis of lipid-poor adrenal adenoma( LPA) and pheochromocytoma( PHEO). Methods Fifty patients with LPA and 28 patients with PHEO who were pathologically confirmed during the surgery were enrolled in this study between July 2017 and July 2020. The differences of CT characteristics were compared between two groups and the value of them for differential diagnostic ability was analyzed. Results Tumors were solitary in LPA and PHEO groups and there were 78 lesions in total. There were significant differences in maximum diameter,cystic lesions,plain CT scan value,and value of arterial,venous and delay phases between the two groups( all P<0.05). Cystic lesions,plain CT scan value,and value of delay phases were significant for differential diagnosis of LPA and PHEO( all P<0.05). Using receiver operating characteristic( ROC)curve,sensitivity was 100% and specificity was 94. 0%,area under the curve( AUC) was 0. 990 and diagnosis point was 0. 253. Cystic lesions,plain CT scan value,and value of delay phases had high sensitivity and specificity. Conclusion Cystic lesions,plain CT scan value,and value of delay phases are three characteristic predictive factors for the differential diagnosis of LPA or PHEO. Moreover,Logistic regression model is useful in differentiating LPA and PHEO.