异位ACTH综合征:岩下窦采血结合综合影像学的诊断价值

发布时间：2018-04-14 23:01

本文选题：异位ACTH综合征 + 岩下静脉采血　；参考：《中国医学计算机成像杂志》2015年01期

【摘要】：目的:分析异位促肾上腺皮质激素(ACTH)综合征(EAS)的影像学表现,比较胸腹部多层螺旋CT(MSCT)、正电子发射断层扫描术(PET)在病灶检出中的差异,评估双侧岩下窦静脉采血(BIPSS)结合综合影像学对异位ACTH综合征的诊断价值。方法:20例根据临床症状、生化指标高度疑诊为EAS的病例,同时进行胸腹部MSCT及18F-FDG PET/CT检查,对照病理结果分析其影像学表现特点,统计不同检查方法对病灶的检出率及诊断准确性。结果:20例经综合影像学方法结合临床症状、生化指标明确为异位ACTH综合征,其中14例经手术病理证实,1例为2个病灶,13例为单发病灶。15个病灶位于纵隔9个(60%),肺部4个(26.67%),胰腺2个(13.33%);6个为圆形,2个为卵圆形,2个分叶状,5个形态不规则,直径0.6~7.0 cm,平均2.45 cm,均无钙化及出血;8个肿块境界清楚(8/15),11个肿块密度均匀(11/15),增强后9例呈轻度强化,4例呈中度强化,2例呈明显强化。病理结果显示14例为神经内分泌肿瘤,1例为胸腺瘤A型。MSCT对EAS肿块定位诊断的阳性率为80%(16/20),18F-FDG PET/CT的阳性率为68.75%(11/16)。结论:在异位ACTH综合征诊断中多种影像学的序贯检查非常重要,垂体MRI及BIPSS结合生化指标是异位ACTH综合征的定性诊断方法,胸腹部MSCT是肿瘤定位的首选方法,PET/CT是重要的补充手段,多种影像学方法结合可提高对异位内分泌肿瘤的检出率,有助于手术治疗方案的制定。
[Abstract]:Objective: to analyze the imaging features of ectopic adrenocorticotropic hormone (ACTH) syndrome and to compare the difference of MSCT and PET in detecting the lesions.To evaluate the diagnostic value of bilateral inferior petrosal sinus venous blood collection (BIPSS) combined with comprehensive imaging in the diagnosis of ectopic ACTH syndrome.Methods Twenty cases with suspected EAS according to clinical symptoms and biochemical indexes were examined with MSCT and 18F-FDG PET/CT. The imaging findings were compared with pathological results.The detection rate and diagnostic accuracy of different examination methods were analyzed.Results 20 cases were diagnosed as heterotopic ACTH syndrome by comprehensive imaging method combined with clinical symptoms.14 cases were confirmed by operation and pathology to be 2 lesions, 13 cases were single lesions, 15 lesions were located in the mediastinum, 9 lesions were located in the mediastinum, 4 lesions were located in the lungs, 4 lesions were located in the lungs, 2 lesions were located in the pancreas, and 2 lesions were oval, 2 were oval, 2 lobular, and 5 were irregular in shape, 6 cases were round, 2 oval, 2 lobular, and 5 irregular.The diameter was 0.6 ~ 7.0 cm (mean 2.45 cm) with no calcification and bleeding, 8 masses with clear boundary and 11 masses with even density of 11 / 15, 9 cases with mild enhancement and 2 cases with moderate enhancement.The pathological results showed that 14 cases were neuroendocrine tumors and 1 case was thymoma type A. MSCT was positive for the localization of EAS tumor. The positive rate of 18 F-FDG PET/CT was 68.75%.Conclusion: in the diagnosis of ectopic ACTH syndrome, the sequential examination of various imaging images is very important. Pituitary MRI and BIPSS combined with biochemical indexes are the qualitative diagnostic methods for ectopic ACTH syndrome.Chest and abdomen MSCT is the first choice method of tumor localization. Pet / CT is an important supplementary method. The combination of various imaging methods can improve the detection rate of ectopic endocrine tumors and is helpful to the formulation of surgical treatment.
【作者单位】：上海交通大学医学院附属瑞金医院放射科;
【基金】：国家临床重点专科建设项目资助上海市科委生物医药重点项目(项目编号11411952000)~~
【分类号】：R586;R816.6

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