Meyer S, von Mach M-A, Ivan D, Schäfer S, Habbe N, Kann B, Kann P H
Division of Endocrinology and Diabetology, University Hospital Giessen and Marburg GmbH, Philipps-University Marburg, Marburg, Germany.
J Endocrinol Invest. 2008 Oct;31(10):882-7. doi: 10.1007/BF03346436.
Imaging of the adrenals by endoscopic ultrasound (EUS) is a valuable technique for detection and localization of adrenal lesions, but endosonomorphological tumor distinction remains difficult. In this single-center study, the amount of blood flow in common adrenal lesions, such as adrenal adenomas, adrenal hyperplasia, and pheochromocytomas, was visualized by color-coded duplex EUS (CD-EUS) and was retrospectively analysed. Therefore, we reviewed our EUS database to evaluate and correlate the perfusion patterns of common adrenal lesions with histologically confirmed diagnosis, possible malignancy, and endosonomorphological features such as echogeneity, echostructure, and tumor size. CD-EUS was performed using an endosonoscope Pentax FG 32 UA with a longitudinal 7.5 MHz sector array and Hitachi EUB 525 ultrasound system. In 38 consecutive patients (male=19; female=19; age: mean 53+/-16 yr SD), perfusion patterns of 46 histologically confirmed adrenal, para- or extra-adrenal lesions of adrenal origin (adenoma: no.=20; nodular hyperplasia: no.=11; pheochromocytoma: no.=15; diameter 26+/-15 mm, range 6-70 mm) were analyzed and classified semiquantitatively as "not" (no.=24), "slightly" (no.=12), "moderately" (no.=4) or "highly" (no.=6) hypervascularized. Compared to adenomas (p=0.003) and nodular hyperplasia (p=0.047), pheochromocytomas showed a significantly higher grade of perfusion. There was no relationship between perfusion patterns and localization of pheochromocytomas (adrenal: 8; paraadrenal: 3; extra-adrenal: 4). Vascularization was not statistically associated with tumor echogeneity, echostructure, malignancy or tumor size. CD-EUS is an additional tool for adrenal endosonographic tumor distinction and seems to improve the endosonographic detection of pheochromocytomas by visualization of hypervascularization. As an overlap of perfusion patterns exists, CD-EUS findings must be interpreted in the context of clinical, laboratory and chemical results.
内镜超声（EUS）对肾上腺进行成像检查是检测和定位肾上腺病变的一项重要技术，但通过内镜超声形态学来区分肿瘤仍存在困难。在这项单中心研究中，利用彩色编码双功能EUS（CD-EUS）对肾上腺常见病变（如肾上腺腺瘤、肾上腺增生和嗜铬细胞瘤）的血流情况进行了可视化处理，并进行回顾性分析。为此，我们查阅了EUS数据库，以评估常见肾上腺病变的灌注模式，并将其与组织学确诊结果、潜在恶性程度以及内镜超声形态学特征（如回声性、回声结构和肿瘤大小）进行关联分析。使用配备纵向7.5MHz扇形阵列的Pentax FG 32 UA型内镜超声及日立EUB 525超声系统进行CD-EUS检查。对连续38例患者（男性19例；女性19例；年龄：平均53±16岁标准差）的46个经组织学确诊的肾上腺、肾上腺旁或肾上腺外起源的病变（腺瘤：20个；结节性增生：11个；嗜铬细胞瘤：15个；直径26±15mm，范围6 - 70mm）的灌注模式进行分析，并将其半定量分类为“无”（24个）、“轻度”（12个）、“中度”（4个）或“高度”（6个）血管丰富。与腺瘤（p = 0.003）和结节性增生（p = 0.047）相比，嗜铬细胞瘤的灌注分级明显更高。嗜铬细胞瘤的灌注模式与定位之间无相关性（肾上腺：8个；肾上腺旁：3个；肾上腺外：4个）。血管化与肿瘤回声性、回声结构、恶性程度或肿瘤大小在统计学上无关联。CD-EUS是肾上腺内镜超声肿瘤鉴别诊断的一项辅助工具，通过可视化血管丰富情况似乎可提高嗜铬细胞瘤的内镜超声检出率。由于存在灌注模式的重叠情况，CD-EUS检查结果必须结合临床、实验室及化学检查结果进行解读。
