肾上腺血管瘤影像学表现及诊疗策略的探讨

Imaging manifestations, diagnosis and treatment strategies of adrenal hemangioma

目的:分析肾上腺血管瘤的影像学表现并探讨诊疗策略。方法:回顾性分析浙江大学医学院附属第一医院2010年1月—2020年3月经手术病理证实的肾上腺血管瘤的临床资料。结果:该组病例中男4例,女8例,平均发病年龄52(33~77)岁。12例血管瘤均位于单侧肾上腺,其中左侧9例、右侧3例;肿瘤直径1.8~8.0 cm;10例呈类圆形,2例形态不规则,均具有完整包膜,肿瘤边界清晰。CT平扫低密度8例、高密度3例、密度不均1例,内含钙化9例,增强后呈不均匀强化8例、无明显强化4例。12例均行手术治疗,其中1例因肿块较大行开腹手术,10例行腹腔镜手术,1例行达芬奇机器人手术。12例均病理证实血管瘤,其中1例呈海绵状血管瘤,1例呈吻合状血管瘤。结论:肾上腺血管瘤的常规增强CT表现多样,术前误诊率高,肿瘤常伴钙化或静脉石,增强后表现为边缘结节状、条状明显强化,动态观察强化向中心充填,MRI T2WI肿瘤边缘见结节及条状高信号是肾上腺血管瘤的特征。微创手术,包括腹腔镜手术和达芬奇机器人手术,治疗效果良好。

Objective: To analyse the imaging manifestations, diagnosis and treatment strategies of adrenal hemangioma. Methods: The clinicopathological and imaging data of adrenal hemangioma confirmed by surgical pathology in First Affiliated Hospital, Medical College of Zhejiang University from January 2010 to March 2020 were retrospectively analyzed. Results: There were 4 males and 8 females in our study. The mean age was 52 years(ranging from 33-77 years). All tumors were located in unilateral adrenal gland, including nine cases on the left side and three cases on the right side. The diameter of the tumor was 1.8-8.0 cm. Tumor of ten cases were round, and two cases were irregular. All had complete envelop, and the tumor boundary was clear. Eight cases had low density, three cases had high density, and one case had uneven density. Nine cases had calcification, eight cases had uneven enhancement, and four cases had no obvious enhancement. All patients received surgical treatment, including one open surgery due to large tumor, ten laparoscopic surgeries, and one da Vinci robotic surgery. All cases were pathologically confirmed with hemangioma, including one case with cavernous hemangioma and one case with anastomotic hemangioma. Conclusion: The routine enhanced CT manifestations of adrenal hemangioma are diverse, with high preoperative misdiagnosis rate, and the tumor is often accompanied by calcification or phlebolith. After enhancement, the tumor is significantly enhanced by peripheral nodules and striations. Dynamic observation and enhanced central filling are performed, and the nodules and striations at the tumor edge of MRI T2 WI are the characteristics of adrenal hemangioma. Minimally invasive surgeries, including laparoscopic surgery and da Vinci robotic surgery, have shown promising results.