嗜铬细胞瘤及副神经节瘤不同生化表型的CT征象对比研究

Computed tomography signs of pheochromocytomas and paragangliomas with different biochemical phenotypes:a comparative study

目的:分析生化阴性嗜铬细胞瘤及副神经节瘤(pheochromocytomas and paragangliomas,PPGLs)的电子计算机断层扫描(computed tomography,CT)征象是否有别于生化阳性PPGLs,同时了解生化阳性PPGLs不同表型的CT征象是否存在差异。方法:回顾性分析131例PPGLs患者的术前腹部增强CT图像,包括肿瘤位置、大小、形态、囊变坏死、液-液分层、钙化、向心结节状强化、肿瘤内粗大血管、强化包膜、绝对廓清率及相对廓清率。根据生化水平,将患者分为生化阳性组和阴性组,阳性组进一步分为去甲肾上腺素型、肾上腺素型及多巴胺型。比较各组及各表型间的CT征象差异。结果:相较于生化阴性组,阳性组PPGLs更大(Z=-2.064,P=0.039)、囊变坏死(χ2=6.610,P=0.010)及向心结节状强化(χ2=3.909,P=0.048)的比例更高;相较于去甲肾上腺素型,肾上腺素型PPGLs更大(Z=-2.036,P=0.042)、强化包膜比例更高(χ2=7.242,P=0.007)。结论:肿瘤大小、囊变坏死及向心结节状强化的CT征象有助于术前诊断生化阴性PPGLs,肿瘤大小及强化包膜有助于解释去甲肾上腺素型及肾上腺素型PPGLs不同临床表现产生的机制。

Objective:To investigate whether the computed tomography(CT)signs of biochemically negative paragangliomas and pheo⁃chromocytomas(PPGLs)differ from those of biochemically positive PPGLs and whether there are differences in CT signs between dif⁃ferent phenotypes of biochemically positive PPGLs.Methods:A retrospective analysis was performed for the preoperative abdominal contrast-enhanced CT images of 131 patients with PPGLs,including tumor location,size,shape,cystic change and necrosis,fluidfluid stratification,calcification,nodular centripetal enhancement,large blood vessels in tumor,enhancing capsule,absolute percentage washout,and relative percentage washout.According to biochemistry,the patients were divided into biochemically positive group and biochemically negative group,and the biochemically positive group was further divided into norepinephrine phenotype group,adrena⁃line phenotype group,and dopamine phenotype group.CT signs were compared between each group and different phenotypes.Results:Compared with the biochemically negative group,the biochemically positive group had significantly larger PPGLs(Z=-2.064,P=0.039)and a significantly higher proportion of patients with cystic change and necrosis(χ2=6.610,P=0.010)or nodular centripetal en⁃hancement(χ2=3.909,P=0.048),and compared with the norepinephrine phenotype group,the epinephrine phenotype group had signifi⁃cantly larger PPGLs(Z=-2.036,P=0.042)and a significantly higher proportion of patients with enhancing capsule(χ2=7.242,P=0.007).Conclusion:The CT signs of tumor size,cystic change and necrosis,and nodular centripetal enhancement can help with the di⁃agnosis of biochemically negative PPGLs before surgery,and tumor size and enhancing capsule can help to explain the mechanism of different clinical manifestations of PPGLs with norepinephrine phe⁃notype or epinephrine phenotype.