23例肾上腺结核的MRI特征分析

Analysis of 23 Cases of Adrenal Tuberculosis on MRI Features

目的观察肾上腺结核的MRI特征,并评估MRI诊断该病的应用价值。方法回顾性分析并对比23例确诊的肾上腺结核患者(病变组)与23例肾上腺转移瘤患者(对照组)的MRI信号特征。结果23例肾上腺结核患者共42个腺体受侵,双侧19例,单侧4例,40个腺体增大,2个萎缩;40个增大腺体中23个为不规则肿块状,17个保留原有轮廓。共检出49个病灶,病灶长径0.9~4.9cm。肿块样病变T1WI呈均匀稍低、等信号,T2WI呈高低混杂信号,中心见片状稍低信号,DWI呈稍低、等或高信号。增强扫描7个均匀强化,40个不均匀强化,包括环形强化和分隔样强化,延迟扫描病灶实质成分范围扩大,2个无强化。肾上腺结核中均匀强化结节、强化环壁的ADC值分别为(1.28±0.26)×10^(-3)mm^(2)/s、(1.06±0.10)×10^(-3)mm^(2)/s,均高于转移瘤,非强化中心ADC值为(1.23±0.16)×10^(-3)mm^(2)/s,低于转移瘤的坏死区。结论MRI成像可反映肾上腺结核病理变化并用于评估其活动性。

Objective To observe the MRI features of adrenal tuberculosis and evaluate the value of MRI in the diagnosis of this disease.Methods MRI features of 23 patients with adrenal tuberculosis(case group)confirmed by pathology and 23 patients with adrenal metastatic tumor(control group)were compared and retrospectively analyzed.Results Among case group,42 glands were revealed in these 23 patients with unilateral lesion(n=4)and bilateral lesions(n=19).Forty glands were enlarged,while two was atrophic.Of the 40 enlarged glands,23 were mass-like and 17 had preserved contours.49 lesions were revealed in these 23 patients.The length of the lesion ranged from 0.9 to 4.9cm.The solid mass lesion demonstrated homogeneous hypo-or iso-SI on T1WI,and the signal intensity was hypo-or hyperSI on T2WI,with few spot shape hypointense signal.The lesions demonstrated slightly hypointense,isointense or hyperintense signal on DWI.In contrast,there were 7 homogeneous enhancement and 40 inhomogeneous enhancement,including ring enhancement and septal enhancement.The range of parenchymal components of the lesions was enlarged by delayed scan,and 2 lesions no enhancement.The solid part of the lesions showed progressive enhancement on delayed phase.The ADC of the solid nodules and ring wall of adrenal tuberculosis were(1.28±0.26)×10^(-3)mm^(2)/s、(1.06±0.10)×10^(-3) mm^(2)/s,they were higher than that of the adrenal metastases.The ADC of caseous solid center of ring enhancing lesions in adrenal tuberculosis was(1.23±0.16)×10^(-3)mm^(2)/s,it was lower than that of the necrosis center of adrenal metastases.Conclusion MRI could reflect certain pathological changes of adrenal tuberculosis and be used to assess the activity of tuberculosis.