儿童不典型肾上腺肿瘤的影像学分析

目的 分析7例儿童不典型的肾上腺肿瘤的CT和MRI表现,以提高对儿童肾上腺肿瘤的鉴别诊断水平. 资料与方法回顾性分析经手术和病理证实的儿童肾上腺肿瘤7例,复习其CT和MRI表现并与手术病理对照分析.结果 Ⅰ级神经母细胞瘤1例,CT表现为均匀稍低密度肿块;单纯肾上腺囊肿1例,表现为均匀低密度囊性肿块,无强化;囊肿伴出血1例,囊壁嗜铬母细胞增生,表现为T1WI及T2WI高信号,增强后囊壁环形强化;肾上腺髓外造血1例,表现为均匀低密度肿块,轻度强化;皮质腺瘤1例,表现为均匀软组织密度肿块,增强后动脉期明显强化,静脉期强化减弱;肾上腺皮质癌2例,1例密度不均匀,增强后肿瘤实性成分强化持续时间较长,另1例MRI表现为轻度均匀强化.结论 除单纯囊肿外,儿童肾上腺肿瘤影像学表现缺乏特异性,确诊需与临床及病理结合.     

肾上腺肿瘤的CT和MRI诊断

目的：探讨肾上腺肿瘤的CT和MRI影像学特点。方法：回顾分析经临床、手术病理证实的40例肾上腺肿瘤的CT资料和其中10例。MRI资料，观察其CT和MRI征象，提出诊断和鉴别诊断要点。结果：40例中，腺瘤16例，其中Cushing腺瘤8例，直径2．0～3．0cm的密度均匀的肿块，其信号与肝脏信号类似；Conn腺瘤6例，直径1．0～2．0cm的均一水样密度肿块；2例腺瘤无症状。皮质腺癌7例，呈巨大不规则的不均匀密度或信号肿块。嗜铬细胞瘤7例，较大的不均匀密度或信号肿块，实体部分明显强化。转移瘤8例，双侧或单侧肿块，T2WI明显高信号。髓性脂肪瘤1例，不均质肿块内有显著的脂肪组织密度或信号。淋巴管囊肿1例，不强化均一水样密度或信号的肿块。结论：肾上腺肿瘤CT和MRI表现有一定的特征，结合临床及生化检查，能对其做出定性诊断。     

机能亢进性和非机能亢进性良性肾上腺皮质病变

作者对27例CT证实有肾上腺肿块的病人进行了肾上腺的MRI研究。24例为单侧肿块,3例为双侧。包括21本非机能亢进性皮质腺瘤和9个良性机能亢进性皮质病变(2个泌醛固酮皮质腺瘤、3个泌醛固酮的结节性皮质增生、3个泌皮质类固醇腺瘤和1个泌皮质类固醇的结节性皮质增生)。非机能亢进性腺瘤的诊断由12个月以上CT扫描无增大或手术、经皮活检标本的组织病理学证实。机能     

原始永存玻璃体增生症(PHPV)的影像学

目的:探讨CT和MRI在原始永存玻璃体增生症(PHPV)诊断中的价值。方法:回顾性分析9例PHPV的影像学表现,4例行CT检查,1例行MRI检查,4例同时行CT和MRI检查。结果:影像学表现为患侧小眼球,玻璃体密度或信号增高,晶体后或眼球后极视乳头前软组织肿块增生,有条索影位于晶体后缘至视乳头前;增生软组织肿块和条索影在T1WI和T2WI均呈中等信号,增强后软组织肿块和条索影可强化。结论:小眼球、晶体后或视乳头前玻璃体内软组织肿块增生和玻璃体动脉显示为PHPV的影像学表现,CT和MRI可显示玻璃体内增生组织的形态,对PHPV的诊断和儿童眼内病变的鉴别诊断有重要参考价值。     

早期肾透明细胞癌的超声、CT和MRI诊断

目的: 研究早期肾透明细胞癌的超声、螺旋CT、MRI表现,提高其诊断水平.材料和方法: 回顾性分析经手术病理证实的13例早期肾透明细胞癌的超声、螺旋CT和9例MRI表现.结果: 13例早期肾透明细胞癌中,超声显示无回声肿块7例,厚壁型囊性肿块5例,多房囊状、分隔厚薄不一肿块1例.13例螺旋CT均显示肿块为低密度病灶,CT增强扫描示病灶均呈不均匀增强.9例MRI示肿块信号强度不均,T1WI为低信号,T2WI为不均匀性高信号,4例增强扫描均呈不均匀增强.术前超声诊断为5/13,CT为7/13,MRI为7/9,超声结合CT为13/13,超声结合CT和MRI为9/9.结论: 仅用超声或螺旋CT检查诊断早期肾透明细胞癌较困难.超声结合螺旋CT或MRI,综合影像检查能提高其诊断水平.     

腹部局限型Castleman病的CT和MRI诊断

目的：探讨腹部局限型Castleman病的CT和MRI表现及其诊断价值。方法：回顾性分析经手术病理证实的6例腹部局限型Castleman病影像资料,其中5例行CT检查,1例行MRI检查。结果：4例病变位于腹膜后,2例位于肠系膜。病理分型,透明血管型5例和浆细胞型1例。CT检查5例,平扫密度较均匀,边界清晰锐利,1例伴有钙化,1例见卫星灶,增强扫描动脉期2例肠系膜肿块以及1例肾上腺区域肿块明显强化,密度均匀,门静脉期持续强化;1例胰头后方肿块中等均匀强化,1例肾上腺区域肿块中等程度周边不规则强化,门静脉期强化范围扩大。2例肠系膜肿块以及1例胰头后方肿块内部和周边可见粗大、扭曲的血管影。MRI检查1例,肿块位于后腹膜下腔静脉旁,T1WI低信号,T2WI高信号,信号均匀,边界清晰锐利,增强扫描动脉期均匀强化,门静脉期持续强化。结论：CT是诊断腹部局限型Castleman病的重要影像学手段,影像学表现与病理类型密切相关,多数透明血管型病变具有一定的特征。     

原发性骨淋巴瘤的影像学表现

目的探讨原发性骨淋巴瘤（PLB）的MRI、CT表现特点。资料与方法回顾性分析经病理学证实的6例PLB患者的MRI、CT表现资料。结果MR检查病灶信号强度在T1WI上与肌肉类似;2例行T2WI,信号强度高于肌肉低于脂肪;在脂肪抑制T2WI上呈高信号,其中信号较均匀4例;2例行扩散加权成像（DWI）,呈明显高信号。MRI上4例可见软组织肿块,其中2例未见骨皮质破坏,CT检查1例,未见骨质破坏;另2例骨皮质明显破坏,均行CT检查,1例骨皮质部分性中断,1例骨皮质明显破坏。骨皮质内条状高信号1例。结论PLB信号较均匀,软组织肿块明显而骨皮质破坏较轻,较具有特征性。     

几种肝脏病变的MRI菲立磁增强表现及诊断价值

目的:探讨菲立磁(SPIO)增强在肝脏病变中的诊断价值。方法:16例患者行SPIO增强的MRI检查,其中6例为海绵状血管瘤,不均匀脂肪肝4例,肝细胞癌(HCC)3例,局灶结节增生(FNH)、肝腺瘤及肝转移瘤各1例。结果:与MRI平扫相比,肝内海绵状血管瘤在SPIO增强后的T1WI上信号明显增高,而在T2WI上信号强度有轻度下降;在不均匀脂肪肝的病例中,增强后兴趣区与周围肝组织的信号强度对比关系延续了增强前的表现;肝腺瘤和FNH在增强后的T2WI上有明显的信号强度下降:HCC在增强后的T2WI上常无明显信号下降,而在T1WI上却有轻度信号升高;转移瘤在T2WI上无信号下降。结论:SPIO强化MRI对肝内病变的良恶性鉴别诊断有一定的帮助。     

眼眶肿瘤的CT、MRI诊断

目的:探讨眼眶肿瘤的CT、MRI表现及其诊断价值。材料和方法:回顾性分析38例经临床病理证实的眼眶肿瘤的CT、MRI表现。结果:视神经鞘脑膜瘤9例,表现为视神经增粗1例,梭形肿块6例和软组织肿块2例,CT为软组织密度;T1WI呈等或稍低信号,T2WI呈高信号。视神经胶质瘤6例,表现为视神经弥漫性增粗2例,椭圆形肿块4例;CT为软组织肿块;T1WI呈等信号,T2WI呈高信号。海绵状血管瘤12例,CT示类圆形稍高于脑组织密度影,T1WI呈稍低信号,T2WI明显高信号。恶性淋巴瘤4例,均为弥漫性病变,CT示长条状软组织肿块,T1WI呈等信号,T2WI呈高信号。神经鞘瘤3例;CT表现密度不均肿块,T1WI呈稍低信号,T2WI呈稍高信号,信号不均匀。转移瘤4例,其中转移性腺样囊性癌1例,乳腺癌眶内转移3例。结论:CT、MRI是发现和诊断眼眶肿瘤的重要检查手段,对大多数肿瘤可以做出明确诊断。     

下颌骨骨肉瘤影像学分析

目的:分析下颌骨骨肉瘤影像学表现,评价不同影像检查方法的优劣。方法:7例下颌骨肿块患者中均经X线和MRI检查,6例行CT并经手术病理证实为下颌骨骨肉瘤。所有病例的影像学特点和诊断价值均被分析比较。结果:X线检查有7例病变显示不清;6例呈棉絮状和不规则高密度,1例呈低密度,内有间隔;3例见骨膜反应呈“日光放射状”和“花边状”。CT平扫显示2例呈高密度,4例呈混合密度伴有骨皮质破坏、中断;5例见“日光放射状”骨膜反应;CT增强显示所有病例均有不均匀强化表现,4例伴有软组织肿块形成。平扫MRI显示5例病变T1WI上呈等、低信号,T2WI上呈高信号;2例在T1WI和T2WI上均呈等、低信号;增强MRI显示2例病灶轻度强化;2例呈边缘强化,其内强化不均。结论:CT和MRI均可清晰显示下颌骨骨肉瘤的形态和内部结构,MRI显示髓内病变范围方面优于CT。     

Changing role of imaging-guided percutaneous biopsy of adrenal masses: evaluation of 50 adrenal biopsies

OBJECTIVE: Prior series of percutaneous imaging-guided biopsies of adrenal masses before the advent of dedicated CT and MRI of the adrenal glands have shown that 40-57% of adrenal masses biopsied were adenomas-benign lesions requiring no further evaluation or treatment. This study was performed to assess the effect of dedicated adrenal imaging with CT and MRI on the rate of percutaneous imaging-guided biopsies of adrenal masses. MATERIALS AND METHODS: We reviewed 50 consecutive adrenal mass biopsies performed during a 48-month period. The patient demographics, technique of biopsy, pathology results, and results of any prior dedicated adrenal imaging with MRI or CT protocols were noted. RESULTS: Only six (12%) of 50 biopsies were adenomas. Five of these six cases were preceded by dedicated adrenal CT or MRI. Thirty-five cases were metastatic disease, four were adrenal cortical carcinoma, three were pheochromocytoma, and two biopsies were nondiagnostic. Overall, 20 of 50 cases were preceded by a dedicated adrenal CT or MRI examination to exclude an adenoma; in 21 of the remaining 30 cases, the imaging characteristics before biopsy were inconsistent with the potential diagnosis of an adenoma and dedicated adrenal CT or MRI was not recommended. CONCLUSION: The number of adrenal adenomas biopsied has declined markedly with the introduction of dedicated adrenal CT and MRI for adrenal adenomas. Percutaneous imaging-guided biopsy is useful in confirming the presence and nature of suspected metastatic deposits to the adrenal gland and in diagnosing or excluding adrenal adenomas in patients with equivocal imaging characteristics.     

Adrenal cortical adenoma causing Cushing's syndrome: correct localization by functional scintigraphy despite nonlocalizing morphological imaging studies

A 60-year-old woman with Cushing's syndrome in whom high-dose dexamethasone failed to suppress glucocorticoids was studied by ultrasound and CT. Neither of these morphological studies was interpreted as revealing any adrenal abnormality. Functional imaging with NP-59 (131-I-beta-iodomethylnorcholesterol) revealed unequivocal, intense, unilateral uptake in the left adrenal gland and subsequent surgery removed a 2.5 cm adrenocortical adenoma from this site. Following surgery the patient was temporarily adrenocortically insufficient but later returned to normal. It is unusual for adrenocortical adenomas causing Cushing's syndrome not to be correctly located by CT. NP-59 scintigraphy in addition to being highly accurate in the location of adrenocortical adenomas also has the advantage of correctly depicting bilateral cortical nodular hyperplasia in which CT will frequently reveal only the largest nodule, which may be incorrectly designated a unilateral adenoma. Furthermore, scintigraphy provides evidence of suppression of the contralateral, normal adrenal cortical tissue in Cushing's syndrome caused by an adrenal adenoma and predicts the vulnerability of such patients to postoperative adrenocortical insufficiency.     

肾上腺囊肿的CT、MRI诊断

目的:探讨肾上腺囊肿的CT、MRI表现,以提高诊断的准确率。方法:回顾性分析手术病理证实的9例肾上腺囊肿的CT、MRI表现。结果:9例肾上腺囊肿,5例行CT检查:1例呈圆形,2例呈椭圆形,2例呈分叶状。平扫囊肿密度均匀,CT值15~35HU,3例囊壁有钙化;增强扫描囊内均无强化,2例囊壁呈环形强化,3例囊壁无强化。4例行MR平扫:均呈长T1长T2异常信号,并且囊内可见分隔,分隔与液体相比呈短T1短T2异常信号,厚薄均匀,边缘光滑。结论:CT、MRI是肾上腺囊肿定位、定性诊断较为可靠和准确的方法。     

Magnetic resonance imaging of the adrenal

Magnetic resonance imaging (MRI) of the adrenals was performed on 50 subjects: 5 normal volunteers, 6 Cushing patients with bilateral adrenal hyperplasia, 14 patients with adrenal adenomas, 3 with adrenal carcinomas, 15 with pheochromocytomas and 7 with metastatic disease to the adrenal. The normal and hyperplastic adrenal glands were imaged in all cases. Using the signal intensity of the adrenals on a T2 weighted image, various forms of adrenal pathology could be differentiated. A ratio of signal intensity of the adrenal mass to the liver was utilized and allowed the differentiation of adrenal adenomas from adrenal carcinomas, pheochromocytomas and metastases. Using the same ratio, metastases could be distinguished from pheochromocytomas as well. MRI appears to be particularly valuable in distinguishing clinically silent adrenal metastases from nonfunctioning adrenal adenomas.     

Value of various imaging modalities for diagnostic work-up of tumors of the adrenal gland

OBJECTIVE: This paper describes the value of various imaging modalities for diagnostic work-up of tumors of the adrenal gland. METHODS: Results of the literature are reviewed. An optimized examination protocol for computed tomography (CT) and magnetic resonance imaging (MRI) is shown for assessment and differentiation of unclear lesions of the adrenal gland. RESULTS: Measurements of attenuation in the native examination as well as delayed enhancement are the cornerstones in the CT diagnostics of tumors of the adrenal gland. In MRI, chemical-shift imaging and evaluation of signal characteristics in T1- and T2-weighted images are most important for characterization even in unclear cases. CONCLUSION: CT and MRI play the major role in imaging of adrenal gland tumors.Whereas CT is less expensive and widely available,MRI provides advantages in unclear cases because of the excellent tissue contrast and the superior characterization.     

Large degenerated adrenal adenomas: radiologic-pathologic correlation

PURPOSE: To correlate the radiologic and pathologic findings and differential diagnosis of large, degenerated adrenal adenomas. MATERIALS AND METHODS: The authors reviewed the radiologic and pathologic characteristics of 30 large adenomas with cystic regions or areas of heterogeneity that were either intrinsic or demonstrated at contrast material-enhanced computed tomography (CT) or magnetic resonance (MR) imaging. Images of 24 adrenocortical carcinomas were also reviewed to determine whether differentiating characteristics existed. RESULTS: Most of the adrenocortical adenomas were in asymptomatic women. Ten adenomas contained calcification. Pathologic examination revealed good correlation between heterogeneity and liquefied regions. Histologic examination confirmed regions of adenomatous tissue with areas of hemorrhage, amorphous degenerated material, calcification, and fibrosis. Some tumors contained myelolipomatous foci. Although some clinical and imaging findings differed between the groups, no features could be found that enabled the radiologic differentiation of adenomas from carcinomas. CONCLUSION: A subgroup of adrenal adenomas are larger, more heterogeneous, and more frequently calcified than those with the usual imaging findings. Central necrosis, hemorrhage, or both are responsible for many of the imaging features. Differentiation of these lesions from other large adrenal masses, including adrenal carcinoma, cannot be made by means of imaging alone; resection is required for the definitive diagnosis.     

肾上腺畸胎瘤的影像诊断

目的　探讨肾上腺畸胎瘤影像表现 ,提高对本病的认识。方法　报告 4例经手术病理证实的肾上腺畸胎瘤的影像所见 ,IVP检查 2例 ,B超 3例、CT检查 4例 ,MRI和肾动脉造影各 1例。结果　 4例均位于右侧肾上腺 ,IVP示肾上腺区钙化灶 ,CT表现为右肾上腺显示不清。肿瘤分别表现为以水样密度、脂肪密度或实性密度为主的混合密度块 ,增强扫描肿瘤实质部分、包膜及分隔有强化 ,MRIT1、T2 WI均显示肿瘤为不均质性高信号。B超显示肾上腺区不均质强光团和多种成分回声。结论　CT、MRI对肾上腺畸胎瘤诊断和鉴别诊断优于IVP和B超。     

肾上腺皮质结节性增生与皮质腺瘤的CT鉴别诊断

目的:探讨肾上腺皮质结节性增生与肾上腺皮质腺瘤的CT鉴别诊断.方法:回顾性统计分析31例肾上腺皮质结节性增生与35例肾上腺皮质腺瘤的CT表现,所有病例均经手术及病理证实.结果:结节性增生组与腺瘤组在患者性别、病变位置、病变的边界及同侧肾上腺形态方面存在显著统计学差异(P＜0.05).Logistic回归分析表明,病变边界清楚与否在两者鉴别中具有重要意义.结论:在肾上腺结节性增生与肾上腺腺瘤的鉴别诊断方面CT检查可提供重要参考.结合临床及实验室检查,将会对两者的鉴别提供更大的帮助.     

Imaging of adrenal masses.

Adrenal pathology may be discussed based on hormonal functionality of the adrenals, appearances on imaging modality, or pathological determination. There are three main categories of adrenal function. Hyperfunctional states include Conn's or Cushing's syndrome. Lesions with normal function may be detected incidentally. Hypofunctional states may occur from idiopathic Addison's disease or some bilateral adrenal pathology. The most common modalities for characterization of adrenal pathology are non-enhanced CT, often followed by contrast CT or chemical shift MRI. The common appearance on non-enhanced CT is a well-defined homogeneous lesion with low-density due to the microscopic fat present and adrenal adenomas. When density criteria are not met, many of these may be characterized as adenomas by washed out of contrast or signal decrease using in phase and out-of-phase MRI sequences. Other non-invasive modalities may incidentally discover adrenal lesions, but are not typically used in the work-up. NP-59 is an uncommonly used nuclear medicine technique which is very specific for adenoma when correlated with pathology on other imaging studies. In the rare cases where non-invasive imaging is non-specific, fine needle aspiration or core biopsies may be necessary. However, biopsies have associated risks including infection and hemorrhage. The imaging appearance of an adrenal lesion is often specific such that further imaging is not necessary. These lesions include adrenal adenoma, pheochromocytoma, myelolipoma, adrenal cyst, and some large adrenocortical carcinomas. However, the findings in lesions such as metastasis, smaller primary adrenal carcinomas, lymphoma, granulomatous disease, and many adenomas are not as specific. In the proper clinical situation, follow-up imaging may be necessary, or biopsy may be warranted.     

肾上腺恶性肿瘤的CT、MRI表现及其病理基础

目的：分析肾上腺恶性肿瘤(MAT)的 CT 和 MRI 表现,提高对本病的认识和影像诊断水平。方法收集、分析经临床病理证实的17例 MAT 的 CT、MRI 表现。CT 平扫17例,其中增强扫描14例;MRI 平扫3例,其中增强扫描2例;3例同时进行CT 和 MRI 扫描。结果肾上腺原发性恶性肿瘤8例,其中肾上腺皮质腺癌3例,神经母细胞瘤2例,恶性嗜铬细胞瘤、淋巴瘤、平滑肌肉瘤各1例;肾上腺转移瘤9例。肾上腺恶性肿瘤的平扫表现(肿块形态、大小、边缘、密度及信号)、增强(强化程度、方式)等特征有助于其诊断与鉴别诊断。结论部分 MAT 具有一定特征性的 CT、MRI 表现,结合相关临床资料,可在术前做出正确诊断。