正常肾上腺横断面MSCT影像研究

Multi-slice computed tomography imaging for cross-sectional normal adrenal studies

目的利用多排螺旋CT(MSCT)观察测量正常肾上腺,为临床提供影像解剖数据。方法回顾性分析重医附一院2011年7月至2013年1月上腹部CT平扫加增强患者220例的影像资料,观察正常肾上腺形态、位置毗邻,测量肾上腺及膈肌脚厚度和CT值。结果 1均以Ⅰ型为主,右侧65.5%(144/220)、左侧76.8%(169/220)。2肾上腺体部、内侧肢、'/'线形厚度均是左侧>右侧(P<0.01),外侧肢、'△'形厚度左右侧差异无统计学意义(P>0.05);右侧肾上腺内、外侧肢厚度差异无统计学意义(P>0.05),左侧肾上腺内侧肢厚度>外侧肢(P<0.01);膈肌脚厚度右侧>左侧(P<0.01)。以体部、侧肢大于同侧膈肌脚厚度假定异常,存在不同程度假阳性率。3正常厚度95%置信区间:左侧体部(3.0 mm,8.4 mm)、内侧肢(1.8 mm,4.5 mm)、外侧肢(1.3 mm,4.2 mm);右侧体部(2.3 mm,7.2 mm)、侧肢(1.5 mm,4.0 mm)。4双侧肾上腺平扫、动脉期、静脉期CT差异均无统计学意义(P>0.05);双侧肾上腺强化均匀。动静脉期强化程度CT值差值的散点图发现部分动脉期强化高于静脉期、部分低于静脉期,差值集中在-50~50 HU。结论 MSCT能评估正常肾上腺厚度,以其厚度大于同侧膈肌脚为异常的判断标准不可靠。肾上腺强化不具规律性,因此观察其强化是否均匀更具临床价值。

Objective To observe and measure the normal adrenal gland by the multi-slice CT(MSCT), and to provide the imaging anatomical data for clinical application. Methods The imaging data of 220 patients of plain and enhanced CT scan in the First Affiliated Hospital of Chongqing Medical University from July 2011 to January 2013 were retrospectively reviewed. Normal adrenal morphology, position and surrounding was observed, and the thickness of the adrenal gland and the diaphragm and CT value was measured. Results 1 Adrenal glands were mainly of typeⅠ, and the right side and left side were 65.5%(144/220) and 76.8%(169/220); 2 Adrenal gland body, medial limb, '/' linear thickness was left side>right side(P<0.01), and the thickness of lateral limb and '△' shape, of left and right side had no significant difference(P>0.05). The inside lateral limb thickness of the left adrenal gland >outside lateral limb thickness(P<0.01), and the right side of diaphragm thickness>left side(P<0.01). There was no significant difference in the inside and outside lateral limb thickness of right adrenal gland(P>0.05). There were different degrees of false positive rate in the adrenal body or the lateral limb thickness greater than that of the same side of the diaphragm. 3 The thickness of the adrenal about the 95% confidence interval was as follows: left adrenal body(3.0 mm, 8.4 mm), medial limb(1.8 mm,4.5 mm), lateral limb(1.3 mm, 4.2 mm), right side body(2.3 mm, 7.2 mm), limbs(1.5 mm, 4.0 mm). 4 Bilateral adrenal scan, arterial and venous phase CT value had no statistically significant differences(P=0.59, P=0.74, P=0.75). Bilateral adrenal strengthenings are uniform. The dispersion of the CT value difference of the degree of enhancement of the arterial and venous phase showed that some arterial phase enhancement was higher than the venous phase, and the part was lower than the venous phase, with the difference concentrated in-50~50 HU. Conclusion MSCT was able to assess the normal adrenal thickness, which is not reliable to judge whether the thickness of the diaphragm is greater than that of the same side of the diaphragm. There is no regularity about the strengthening, so to observe whether strengthening is uniform provides higher clinical value.