MSCT多期扫描对肾上腺无功能嗜铬细胞瘤的诊断及鉴别价值

发布时间：2018-04-27 14:31

本文选题：肾上腺嗜铬细胞瘤 + X线计算机断层摄影术　；参考：《山西医科大学》2013年硕士论文

【摘要】：目的：探讨肾上腺无功能嗜铬细胞瘤的CT表现特征,结合其手术病理结果进行对照研究,以提高对其诊断的准确性；分析肾上腺无功能嗜铬细胞瘤与其他无功能肾上腺肿瘤的鉴别诊断问题。研究对象与方法：收集山西医科大学第一医院2009年10月—2013年2月期间经病理证实并临床资料完整的无功能嗜铬细胞瘤14例(均经手术病理证实),肾上腺神经源性肿瘤18例(肾上腺节细胞瘤15例、神经鞘瘤2例,神经纤维瘤1例),肾上腺无功能腺瘤28例,转移瘤10例,其中4例为双侧病灶,共70例,74个病灶,其中男性患者31例,女性患者39例,年龄8-82岁,中位年龄44岁。使用Light Speed VCT64层螺旋CT扫描仪扫描,层厚0.625mm,螺距0.984mm；对所有病例均行CT平扫及随后30s、70s、3min动态增强扫描,所有病例均经手术或腹腔镜病理证实,或动态随访观察得以确诊。分析各组病灶影像表现,包括肿瘤大小、形态、边缘、位置、钙化、出血、囊变、密度均匀性等。测量各期肿瘤实质平均CT值,各组间比较并绘制成时间-密度(T-D)曲线并归类。采用SPSS13.0统计软件包对上述数据进行方差分析和卡方检验,统计学意义标准为P0.05。结果：肾上腺无功能嗜铬细胞瘤一般为类圆形,边界清楚,实质密度不均匀,部分病灶内可出现囊性变及血管穿行征与其他无功能性肾上腺肿瘤比较有统计学意义(P0.05)。肾上腺无功能嗜铬细胞瘤与其他无功能性肾上腺肿瘤在平扫及增强扫描各期CT值比较均有统计学意义(P0.05),肾上腺无功能嗜铬细胞瘤平扫密度高于节细胞神经瘤和无功能腺瘤,而在增强扫描3期均高于肾上腺节细胞神经瘤。无功能嗜铬细胞瘤的T-D曲线类型分布存在统计学差异(P0.05)。嗜铬细胞瘤多表现为D型,肾上腺节细胞瘤多表现为A型曲线,其他无功能性肿瘤表现为B、C、D型。结论：肾上腺无功能嗜铬细胞瘤无特异性儿茶酚胺增高的临床表现。其MSCT多期扫描具有一定的特点,尤其是肾上腺无功能嗜铬细胞瘤的时间-密度曲线类型对其诊断及鉴别具有重要价值；肿瘤形态、边界及瘤内囊变坏死对肿瘤鉴别诊断也可以起到一定的帮助。MSCT多期扫描能够为肾上腺无功能嗜铬细胞瘤定性诊断及治疗提供必要的影像学支持和建议。
[Abstract]:Objective: to investigate the CT features of adrenal nonfunctional pheochromocytoma and to improve the accuracy of diagnosis. To analyze the differential diagnosis between adrenal nonfunctional pheochromocytoma and other non-functional adrenal tumors. Participants and methods: 14 cases of nonfunctional pheochromocytoma confirmed by pathology and complete clinical data were collected from the first Hospital of Shanxi Medical University from October 2009 to February 2013. 18 cases of sex tumors (15 cases of adrenal ganglionoma, 15 cases of adrenal ganglioma) There were 2 cases of schwannoma, 1 case of neurofibroma, 28 cases of adrenal nonfunctional adenoma, 10 cases of metastatic tumor. Among them, 4 cases were bilateral lesions, 70 cases were bilateral lesions, 74 lesions were found, among which 31 cases were male and 39 cases were female, aged 8-82 years. The median age was 44 years. Light Speed VCT64 slice spiral CT scanner was used, the slice thickness was 0.625 mm and the pitch was 0.984mm. All cases were examined by plain CT scan and dynamic enhanced CT scan for 30 s (70 s / 3 min). All cases were confirmed by operation or laparoscopy pathology or dynamic follow-up observation. The size, shape, edge, location, calcification, hemorrhage, cystic degeneration and density homogeneity of the lesions were analyzed. The mean CT value of tumor parenchyma in each stage was measured and compared and plotted into time-density curve and classified. The variance analysis and chi-square test of the above data were carried out by SPSS13.0 statistical software package, and the statistical significance standard was P0.05. Results: the adrenal nonfunctional pheochromocytoma was generally round with clear boundary and uneven density. Cystic degeneration and vascularization sign were found in some lesions compared with other nonfunctional adrenal tumors (P 0.05). The CT values of non-functional pheochromocytoma and other non-functional adrenal tumors were significantly higher than those of ganglioneuroma and nonfunctional adenoma on plain scan and contrast-enhanced scanning (P 0.05), and the density of non-functional pheochromocytoma was higher than that of ganglioneuroma and nonfunctional adenoma. In contrast, it was higher in contrast enhanced scan than that in adrenal ganglioneuroma. There was a statistical difference in the distribution of T-D curve types in nonfunctional pheochromocytoma (P0.05). Most pheochromocytoma showed type D, adrenal ganglionoma showed type A curve, and other nonfunctional tumors showed type D. Conclusion: there is no specific elevation of catecholamine in adrenal nonfunctional pheochromocytoma. The MSCT multiphase scanning has some characteristics, especially the time-density curve type of adrenal non-functional pheochromocytoma has important value in diagnosis and differentiation. Boundary and intratumoral cystic necrosis may also be helpful for differential diagnosis. MSCT multiphase scanning can provide necessary imaging support and advice for the qualitative diagnosis and treatment of adrenal nonfunctional pheochromocytoma.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.7;R736.6

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