肾上腺节细胞神经瘤和乏脂性腺瘤的CT鉴别诊断

Differentiation of Adrenal Ganglioneuroma and Lipid-Poor Adrenal Adenoma with CT

目的探讨肾上腺节细胞神经瘤(AGN)和肾上腺乏脂性腺瘤(Lp-AA)的CT鉴别诊断。方法回顾性分析经手术病理证实的19例AGN和47例Lp-AA患者的临床和CT资料,对肿瘤的大小、数目、位置、形态、囊变、钙化、出血及临床资料进行分析,并对肿瘤CT值进行测量与计算。计数资料的比较采用χ~2检验,计量资料的比较采用独立样本t检验。采用受试者工作特征(ROC)曲线分析有意义连续变量鉴别Lp-AA和AGN的效能。结果AGN组19例共计20个病灶(1例单侧2个病灶),Lp-AA组47例共计50个病灶(2例双侧和1例单侧2个病灶)。两组患者的临床资料中,性别和临床症状差异均无统计学意义(χ~2=0. 047、0. 080,P值均> 0. 05),而年龄和高血压的差异有统计学意义(统计值分别为χ~2=4. 634,t=3. 425;P值均<0. 05)。两组CT检查的分类变量中,肿瘤数目差异无统计学意义(t=0. 000,P> 0. 05),而肿瘤的位置、形态及钙化差异均有统计学意义(χ~2=5. 147、3. 259、5. 095,P值均<0. 05),连续变量中肿瘤的三期CT测量值、计算值和肿瘤大小差异均有统计学意义(t值分别为-5. 650、9. 385、13. 307、16. 119、20. 137、21. 846、-3. 959和-3. 193,P值均<0. 05)。ROC曲线分析显示当患者年龄<43. 5岁,曲线下面积、敏感性、特异性分别是0. 765、78. 9%、72. 3%;当CT测量值(动脉期和静脉期)和计算值(动脉期增幅、静脉期增幅及最大增幅)分别<49. 6、58. 1、16. 0、23. 6和28. 1 HU时,曲线下面积分别为0. 862、0. 970、0. 981、1. 000和1. 000,敏感性均为100%,特异性分别为72. 0%、82. 0%、93. 6%、100%和100%;当肿瘤最大径> 3. 0 cm、最小径> 2. 5 cm和平扫CT值> 27. 4 HU时,曲线下面积、敏感性和特异性分别为0. 723、0. 720、0. 768,80. 0%、85. 0%、66. 0%和66. 0%、60. 0%、94. 0%。结论通过对CT影像的定性和定量分析,再结合患者临床资料能够较准确的鉴别Lp-AA和AGN。

Objective To evaluate the computed tomographic(CT)features that differentiates the adrenal ganglioneuroma(AGN)from lipid-poor adrenal adenoma(Lp-AA).Methods CT images with pathological confirmation of AGN(n=19)and Lp-AA(n=47)were enrolled.The size,number,location,contour,calcification,cystic degeneration,hemorrhage and the clinical data were analyzed.CT value of tumor were measured and calculated.Among these CT findings,statistical analysis includedχ~2 test(qualitative date)and independent T-test(quantitative date).Receiver operating characteristic(ROC)curves were employed to assess the significant continuous variables to tell Lp-AA from AGN.Results Twenty AGN lesions(1 case showed unilateral with two lesions),50 Lp-AA lesions(2 cases showed bilateral and 1 case showed two lesions in the same side)were detected.Sex and clinical symptoms showed no statistical significant difference between the two groups(χ~2=0.047、0.080,all P>0.05).However,there were significant differences in age and hypertension(χ~2=4.634,t=3.425;all P<0.05).On the categorical variables by CT examination,location,contour and calcification were found to be significant variables(χ~2=5.147、3.259、5.095,all P<0.05),besides number of tumors(t=0.000,P>0.05).The CT value of three phases,and size of tumors in the continuous variables(t=-5.650、9.385、13.307、16.119、20.137、21.846、-3.959 and-3.193,all P<0.05)were also significantly different.The cutoff values of the age were less than 43.5 years,resulting in that the area under ROC curve,sensitivity and specificity were 0.765,78.9%,72.3%,respectively.In addition,the cutoff values of CT measured(arterial and venous)and calculated(arterial phase,venous phase and maximum increase)values were respective less than 49.6,58.1,16.0,23.6 and 28.1 Hounsfield units(HU),the area under the curve was 0.862,0.970,0.981,1.000 and 1.000,respectively;all the sensitivity was 100%;and the specificity was 72%,82%,93.6%,100%,100%,respectively.In contrast,the cutoff values of the maximum and minimum diameter of tumor,as well as the unenhanced CT values more than 3.0 cm,2.5 cm and 27.4 HU,the area under ROC curve,sensitivity and specificity were 0.723,80.0%and 66.0%;0.720,85.0%and 60.0%;0.768,66.0%and 94.0%,respectively.Conclusion These CT features are helpful to differentially diagnose ANG from Lp-AA.