双层探测器光谱CT碘密度值对不同功能状态下肾上腺的评估

Assessment of iodine density using dual-layer detector spectral CT for evaluation of adrenal glands at different functional statuses

目的探讨双层探测器光谱CT碘密度定量对肾上腺不同功能状态的评估价值。方法2018年6月~2020年8月间于我院完成肾上腺光谱CT增强扫描的检查者中,按照不同的肾上腺功能状态收集病例,分为三组:感染性休克(双侧肾上腺肿大)26例(A组);肾上腺增生(双侧或左侧)14例(B组);右侧功能性肾上腺皮质醇腺瘤(左侧肾上腺反馈抑制性萎缩)17例(C组);匹配30例无明确异常者为D组;均以左侧肾上腺为研究对象。以动脉期全息光谱图像数据重组碘密度图,测量各组左侧肾上腺及腹主动脉碘密度(ID),计算左侧肾上腺标准化碘密度(NID,NID=ID_(adrenal)/ID_(aorta))。统计分析各组动脉期ID和NID的差异。结果A组左侧肾上腺ID(2.00±0.85)mg/ml明显高于D组(ID=1.41±0.76)mg/ml,差异有显著性意义(P=0.023<0.05)。其余各组间左侧肾上腺ID两两比较均无显著性差异。A组NID(0.22±0.11)较C组(0.16±0.04)和D组(0.15±0.07)显著增高(P均<0.001),B组的NID(0.24±0.06)亦较C组和D组显著增高(P=0.01,P=0.004)。A组与B组、C组与D组的NID差异均无统计学意义。结论肾上腺标准化碘密度可在一定程度上反映肾上腺的高功能状态。

Objective To investigate the value of iodine density(ID)using dual-layer detector spectral CT for evaluating the adrenal glands at different functional statuses.Methods From June 2019 to August 2020,a series of consecutive patients who underwent enhanced adrenal CT using dual-layer spectral detector CT scanner were divided into three groups of bilateral adrenal gland swelling with septic shock(26),bilateral or left adrenal hyperplasia(16),and right adrenal adenoma with hypercortisolism and feedback inhibition atrophy of left adrenal gland(17).30 patients with normal adrenal glands were then matched as negative controls.In all patients,ID of their left adrenal glands(ID;)and aorta(ID;)were assessed in the arterial phase,and then the normalized ID(NID=ID_(adrenal)/ID_(aorta))was calculated.The arterial ID and NID between groups were compared.Results ID of bilateral adrenal gland swelling with septic shock(2.00±0.85)mg/ml was significantly higher than that of normal control(1.41±0.76)mg/ml(P=0.023<0.05).NID of bilateral adrenal gland swelling with septic shock(0.22±0.11)and bilateral or left adrenal hyperplasia(0.24±0.06)were significantly higher than that of right adrenal adenoma with hypercortisolism(0.16±0.04,P;<0.001,P;=0.01)and normal control(0.15±0.07,P;<0.001,P;=0.004).There was no significant difference in ID and NID of remaining groups.Conclusion The NID may reflect adrenal gland hyperfunction.