CAJ | 학술논문

目的评价螺旋CT多期扫描在腹部嗜铬细胞瘤诊断和鉴别诊断中的价值.方法回顾性分析70例患者的79个经病理证实为肾上腺嗜铬细胞瘤及腹内异位嗜铬细胞瘤的螺旋CT多期扫描表现.结果 70例患者中,有与嗜铬细胞瘤有关的内分泌症状者41例,隐匿型嗜铬细胞瘤15例,无功能嗜铬细胞瘤14例.单发63例,多发7例,共有79个病灶.肾上腺嗜铬细胞瘤60例,异位嗜铬细胞瘤8例,肾上腺嗜铬细胞瘤合并异位嗜铬细胞瘤2例.良性60例,恶性或术后复发10例.79个肿瘤病灶中,肿瘤均呈圆形或类圆形,长径2～15 cm,平均5.8 cm.6个长径≤4 cm的肿瘤病灶在扫描各时相均较均匀,25个肿瘤病灶有明显的血窦形成,48个肿瘤病灶有不同程度的出血、坏死和囊变灶,其中9个可见液-液平面.65个肿瘤为富血供,14个为中等血供.结论约40%的腹部嗜铬细胞瘤无相关的内分泌症状,但腹部嗜铬细胞瘤多有较为特征性的CT表现:小的肿瘤较均匀而富血供;较大的肿瘤有不同程度的出血、坏死和囊变灶,为富血供或中等血供,约50%的病灶内可见血窦或液-液平面,有助于与其他疾病相鉴别.
목적 평개라선CT다기소묘재복부기락세포류진단화감별진단중적개치.방법 회고성분석70례환자적79개경병리증실위신상선기락세포류급복내이위기락세포류적라선CT다기소묘표현.결과 70례환자중,유여기락세포류유관적내분비증상자41례,은닉형기락세포류15례,무공능기락세포류14례.단발63례,다발7례,공유79개병조.신상선기락세포류60례,이위기락세포류8례,신상선기락세포류합병이위기락세포류2례.량성60례,악성혹술후복발10례.79개종류병조중,종류균정원형혹류원형,장경2～15 cm,평균5.8 cm.6개장경≤4 cm적종류병조재소묘각시상균교균균,25개종류병조유명현적혈두형성,48개종류병조유불동정도적출혈、배사화낭변조,기중9개가견액-액평면.65개종류위부혈공,14개위중등혈공.결론 약40%적복부기락세포류무상관적내분비증상,단복부기락세포류다유교위특정성적CT표현:소적종류교균균이부혈공;교대적종류유불동정도적출혈、배사화낭변조,위부혈공혹중등혈공,약50%적병조내가견혈두혹액-액평면,유조우여기타질병상감별.
Objective The purpose of this study was to assess the imaging characteristics of abdominal pheochromocytoma in muhiphasic spiral CT scanning, and to determine whether these image characteristics can aid in differentiating pheochromocytoma from other types of tumors or not. Methods The image data of dynamic enhanced CT of 79 pathologically confirmed pheochromocytomas in 70 patients were retrospectively reviewed. Results Among the 70 patients, there were 41 patients with endocrine symptoms related to pbeochromocytoma, 15 had a latent pheochromocytoma and the remaining 14 cases presented with a non-functioning pheochromocytoma. There were totally 79 tumors in 70 patients, with a single lesion in 63 cases, while multiple lesions in the other 7. Sixty cases had a tumor located in the adrenal gland, while 8 in retroperitoneal space, and 2 cases had both intraadrenal and ectopic lesions simultaneously. Sixty patients had a benign pheochromocytoma, the other 10 had a malignant one or relapse after operation. The average size of the tumor was 5.8 cm (range, 2～15 cm in the longest diameter). Seventy-seven pheochromocytomas had a well defined boundary except two big ones with a unclear margin, which were finally proven to be malignant. Homogeneous enhancement was found in 6 lesions with a diameter≤4 cm. Blood sinuses were found in 25 lesions. Hemorrhage, necrosis and cystic change were detected in 48 lesions, with fluid-fluid levels in nine of these l esions . Rich blood supply was found in 65 lesions and moderate in 14. Conclusion Approximately half of the abdominal pheochromocytomas are lack of endocrine symptoms related with their tumors. However, they may display some typical CT characteristics, such as that a small lesion is often homogeneous but hypervascular, a larger tumor may present hemorrhage, necrosis, and cystic change with rich or moderate blood supply. However, when a small tumor has moderate blood supply, it should be differentiated with an adrenal adenoma; when a big one has moderate blood supply, it should be differentiated with other malignant tumors. Furthermore, a part of malignant pheochromocytomas is really difficult to be differentiated from some benign lesions by spiral CT images alone.