腹膜后典型及不典型副神经节瘤MSCT表现及鉴别诊断

Diagnosis and differential diagnosis between typical and atypical retroperitoneal paragangliomas on MSCT

目的:综合分析腹膜后典型及不典型副神经节瘤(PGLs)的临床和MSCT特征,提高对两者的鉴别诊断水平。方法:回顾性分析42例经病理证实的PGLs,其中典型组14例,不典型组28例,综合分析两组之间临床及MSCT特征的差异。结果:典型组PGLs患者持续性高血压症状较不典型组多见(92.9%vs 50%),两组间比较差异有统计学意义(P<0.05)。典型组与不典型组PGLs其他临床及MSCT特征差异均无统计学意义(P>0.05)。典型及不典型组PGLs发病年龄为48(16~67)岁、52(32~72)岁,患病男女比例为4/10、17/11,术中可有血压波动(35.7%vs 21.4%),病灶好发于腹主动脉右侧(64.3%vs 59.4%),多为圆形或卵圆形(85.7%vs 59.4%),易囊变(85.7%vs 90.6%),罕见钙化(14.3%vs 12.5%),肿瘤血管多见(92.9%vs 68.8%),最大径为4.8(2.5~14.0)cm、(4.9±2.3)cm。典型组PGLs病灶实质成分平扫、动脉期和静脉期平均CT值分别为(41.9±3.3)HU、(114.9±22.4)HU、(98.7±17.3)HU;不典型组分别为(39.8±5.8)HU、(128.1±45.3)HU、(106.1±27.1)HU;增强均为轻中度或明显强化,强化模式典型组PGLs持续强化多见(64.3%),不典型组快进快出多见(63.3%)。结论:持续性高血压症状在典型PGLs更多见,典型及不典型PGLs的MSCT表现趋向一致,病灶多为卵圆形或分叶状,肿瘤血管多见,易发生囊变/坏死,钙化少见,强化程度无特异性,强化模式以快进快出及持续强化为主。

Objective:To analyze the clinical and MSCT characteristics of typical and atypical retroperitoneal paragangliomas(PGLs),and to improve the differential diagnosis capability.Methods:Forty-two cases of histopathologically confirmed PGLs were retrospectively analyzed,including 14 cases in the typical group and 28 cases in the atypical group,and the differences in clinical and MSCT characteristics were compared between the two groups.Results:Sustained hypertension was more common in the typical group than in the atypical group(92.9%vs 50%,P<0.05).None differences of the other clinical and MSCT characteristics between the two groups were statistically significant(P>0.05).The median age of PGL patients in the typical and atypical groups was 48(16~67)and 52(32~72)years old,respectively.The male/female ratio was 4/10 and 17/11 in the two groups.Intraoperative blood pressure fluctuations could be observed(35.7%vs 21.4%).Lesions were mostly found on the right side of abdominal aorta(64.3%vs 59.4%),and most lesions were round or oval(85.7%vs 59.4%),prone to have cystic changes(85.7%vs 90.6%),rare calcification(14.3%vs 12.5%),and abundant tumor blood vessels(92.9%vs 68.8%).The mean maximal diameter of the mass was 4.8(2.5~14.0)and(4.9±2.3)cm.The mean CT values of tumor parenchyma in typical PGLs at unenhanced phase,arterial phase and portal phase were(41.9±3.3)HU,(114.9±22.4)HU and(98.7±17.3)HU,respectively.In the atypical group,the CT values were(39.8±5.8)HU,(128.1±45.3)HU and(106.1±27.1)HU,respectively.Compared with the atypical PGLs,the typical groups were prone to have continuous enhancement(64.3%),and rapid washin and washout was more common in the atypical group(63.3%).Conclusion:Sustained hypertension was more common in typical PGLs.The MSCT manifestations of typical and atypical PGLs tend to be similar.The lesions were mostly ovoid or lobulated,and tend to have tumor blood vessels,cystic degeneration/necrosis.Calcification was rare,and the enhancement degree was not specific.The enhancement mode was mainly rapid washin and washout or continuous enhancement.