Stikkelbroeck Nike M M L, Suliman Harold M, Otten Barto J, Hermus Ad R M M, Blickman Johan G, Jager Gerrit J
Department of Paediatric Endocrinology, University Medical Centre Nijmegen, internal post 435, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Eur Radiol. 2003 Jul;13(7):1597-603. doi: 10.1007/s00330-002-1786-3. Epub 2003 Jan 18.
The purpose of this study was to investigate the prevalence of testicular adrenal rest tumours in patients with congenital adrenal hyperplasia (CAH), and to describe sonographic and MR features of these lesions. Seventeen postpubertal male CAH patients underwent scrotal sonography, with colour Doppler, and in 16 of them pre- and postcontrast enhanced T1- and T2-weighted MR images of the testes were obtained. Ultrasound revealed lesions in 16 of 17 patients (94%), bilateral in 10 patients and unilateral in 6 patients. The lesions were typically located adjacent to the mediastinum testis. The maximal diameter of the lesions varied from 2 to 40 mm. Margins were blurred in 11 of 31 lesions. Seventeen of the 20 lesions smaller than 2 cm in diameter were hypoechoic, whereas all 11 lesions larger than 2 cm showed hyperechoic reflections. On MR all lesions were isointense on T1- and hypointense on T2-weighted images and lesion margins were clearly defined. Enhancement of the lesions after intravenous contrast was seen in 13 of 15 patients. In our series the prevalence of testicular adrenal rest tumours in postpubertal CAH patients is much higher than in other reported studies. The lesions may develop from some small, hypoechoic, and multifocal nodules and coalesce to large hypoechoic lesions with hyperechoic reflections on ultrasound. As our results suggest that ultrasonography and MR show the lesions equally well, ultrasonography should be the method of first choice for detection and follow-up of these lesions, because it is the cheapest and quickest imaging technique. In case of a partial orchiectomy, MR is recommended because it shows lesion margins optimally.
本研究旨在调查先天性肾上腺皮质增生症（CAH）患者睾丸肾上腺残余瘤的患病率，并描述这些病变的超声和磁共振成像（MR）特征。17例青春期后男性CAH患者接受了阴囊超声检查及彩色多普勒检查，其中16例患者还获得了睾丸的对比增强前后的T1加权和T2加权MR图像。超声检查发现17例患者中有16例（94%）存在病变，其中10例为双侧病变，6例为单侧病变。病变通常位于睾丸纵隔附近。病变的最大直径在2至40毫米之间。31个病变中有11个边缘模糊。直径小于2厘米的20个病变中有17个为低回声，而所有11个直径大于2厘米的病变均表现为高回声。在MR图像上，所有病变在T1加权像上呈等信号，在T2加权像上呈低信号，病变边缘清晰。15例患者中有13例在静脉注射造影剂后病变有强化。在我们的系列研究中，青春期后CAH患者睾丸肾上腺残余瘤的患病率远高于其他报道的研究。这些病变可能由一些小的、低回声的多灶性结节发展而来，并在超声上融合为大的低回声病变并伴有高回声。由于我们的结果表明超声和MR对病变的显示效果相当，超声应作为这些病变检测和随访的首选方法，因为它是最便宜、最快的成像技术。在进行部分睾丸切除的情况下，建议采用MR检查，因为它能最佳地显示病变边缘。
