CAJ | 학술논문

目的总结肾上腺损伤的影像学诊断特点. 方法回顾性分析29例外伤性肾上腺挫伤及形成血肿患者的影像学表现.男20例,女9例.平均年龄37岁.患者临床表现腰背部疼痛、局部叩痛及伴发伤症状.右侧肾上腺损伤25例(86%)、左侧2例(7%)、双侧2例(7%).相关内分泌检查均未见明显异常.行CT检查29例、MRI检查5例、超声检查6例,CT随访观察23例,MRI及超声复查各1例. 结果 29例患者中CT、MRI及超声首次检查符合率分别为97%(28/29)、100%(5/5)和50%(3/6).1例单纯性右侧肾上腺血肿CT未确诊,经MRI检查确诊.肾上腺挫伤CT表现为肾上腺局限性或弥漫性肿大及灶性高密度出血影;急性期血肿表现为类圆形无强化高密度影,直径1～3 cm,周围脂肪组织内可见不同程度的高密度索条影;1～26周CT复查示血肿密度逐渐减低,体积逐渐缩小至消失,无假性囊肿形成.5例亚急性及慢性期血肿MRI表现为T1WI、T2WI及DWI呈典型高信号,T2WI周边呈环形低信号,CT或MRI增强扫描时血肿不强化,与周边形成的环状高密度或高信号强化影形成特征性"坚果"样影像改变.3例肾上腺血肿超声表现为肾上腺低回声肿块,未见血流信号. 结论 CT是肾上腺挫伤及血肿首选的影像学检查方法 ,在患者病情发展转归中有其不同的影像学特点.对CT和超声诊断困难的病例MRI检查有助于正确诊断.
목적 총결신상선손상적영상학진단특점. 방법 회고성분석29예외상성신상선좌상급형성혈종환자적영상학표현.남20례,녀9례.평균년령37세.환자림상표현요배부동통、국부고통급반발상증상.우측신상선손상25례(86%)、좌측2례(7%)、쌍측2례(7%).상관내분비검사균미견명현이상.행CT검사29례、MRI검사5례、초성검사6례,CT수방관찰23례,MRI급초성복사각1례. 결과 29례환자중CT、MRI급초성수차검사부합솔분별위97%(28/29)、100%(5/5)화50%(3/6).1례단순성우측신상선혈종CT미학진,경MRI검사학진.신상선좌상CT표현위신상선국한성혹미만성종대급조성고밀도출혈영;급성기혈종표현위류원형무강화고밀도영,직경1～3 cm,주위지방조직내가견불동정도적고밀도색조영;1～26주CT복사시혈종밀도축점감저,체적축점축소지소실,무가성낭종형성.5례아급성급만성기혈종MRI표현위T1WI、T2WI급DWI정전형고신호,T2WI주변정배형저신호,CT혹MRI증강소묘시혈종불강화,여주변형성적배상고밀도혹고신호강화영형성특정성"견과"양영상개변.3례신상선혈종초성표현위신상선저회성종괴,미견혈류신호. 결론 CT시신상선좌상급혈종수선적영상학검사방법 ,재환자병정발전전귀중유기불동적영상학특점.대CT화초성진단곤난적병례MRI검사유조우정학진단.
Objective To discuss the imaging diagnostic features of adrenal injury. Methods The imaging features of the 29 patients of adrenal bruise and hernatoma (20 male and 9 females, average age 37) were retrospectively analyzed. The clinical appearances were all flank and hack pain, local sensitive to percus-sion and associated injury appearance. Among the 29 cases, 25 cases(86%) had adrenal injuries on right side, 2 cases(7%) on left side, and 2 cases(7%) on both sides, and no apparent abnormality was found in the relevant endocrine examination after injury. CT (n=29), MRI (n=5) and ultrasonography (n=6) were checked. CT follow-up were taken in 23 eases. MRI (n=1) and ultrasonography (n=l) were followed as well. Results The first-time exam coincidences of CT, MRI and sonography were 28/29 (97%), 5/5 (100%) and 3/6 (50%) respectively. One case of simple right-side adrenal hematoma 3 weeks after injury wasn't clearly diagnosed by CT, which was later diagnosed by MRI. The CT features of adrenal bruise were local or diffuse intumescence and focus high-density hemorrhage shadow. The CT appearances of acute stage adrenal hematoma were round-like high-density shadow without enhancement and the diameters were 1-3 cm. MRI appearances of 5 cases of subacute and chronic phase hematoma were typical high signal of T1WI, T2WI and DWI and toroid low signal around T2WI. Hematorna was not be enhanced when CT or MRI en-hancement scanning, and formed characteristic "nut-like" image feature with toroid high-density or high sig-nal enhanced shadow forming around. Uhrasonography appearances of 3 cases of hematoma were abnormal shadow of the adrenal gland. Conclusions CT is the prior imaging method for adrenal bruise and hemato-ma. MRI has the characteristic appearance for the few cases which are difficult to be identified by CT and ul-trasonography. Characteristic "nut-like" image feature is helpful for the diagnosis and differential diagnosis.