Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ann Surg Oncol. 2010 Mar;17(3):846-52. doi: 10.1245/s10434-009-0829-2. Epub 2009 Dec 4.
Computed tomography (CT) and magnetic resonance (MR) imaging can help diagnose benign adrenal adenomas, but prior studies rely on nonoperative follow-up as proof of a lesion's benign nature. We examined adrenalectomy tissues to determine if imaging characteristics correlate with histopathologic findings.
We retrieved data for 196 consecutive adrenalectomies in 192 patients from 2000 to 2008. Imaging results were considered to signify benign adrenal adenoma if one or more of the following was present: Hounsfield units <10 on unenhanced CT, contrast-enhanced CT quantifying absolute contrast washout of >60% or relative contrast washout of >40%, or MR with chemical-shift imaging demonstrating loss of signal intensity on out-of-phase images.
The sensitivity and specificity of preoperative imaging in predicting benign adrenal adenoma were 57 and 94%, respectively. Histopathology confirmed that all 66 adrenal masses with imaging characteristics suggesting benign adenoma were indeed benign lesions and included 61 benign adrenal adenomas and 5 benign nonadenomatous lesions (3 myelolipomas, 1 composite myelolipoma/adenoma, and 1 ganglioliponeuroma). The specificity of imaging in predicting benignity was 100%. Malignant adrenal lesions were diagnosed in 17/130 (13%) masses: 8 metastases, 7 adrenal cortical carcinomas, 1 epithelioid angiosarcoma, and 1 ganglioneuroblastoma. The sensitivity of imaging in identifying malignancy was 100%. No malignancies were diagnosed during postoperative follow-up (mean 6 months, range 0.2-67 months).
CT or MR characteristics predicted the presence of benign lesions with 100% specificity. Every adrenal malignancy had CT or MR results that were inconsistent with benign adenoma (100% sensitivity). To exclude malignancy, adrenal masses with non-benign imaging characteristics should be resected.
计算机断层扫描（CT）和磁共振（MR）成像有助于诊断良性肾上腺腺瘤，但以前的研究依赖于非手术随访作为病变良性性质的证据。我们检查了肾上腺切除术组织，以确定影像学特征是否与组织病理学发现相关。
我们从 2000 年至 2008 年检索了 192 例患者 196 例连续肾上腺切除术的数据。如果存在以下一种或多种情况，影像学结果被认为表示良性肾上腺腺瘤：平扫 CT 上的 Hounsfield 单位<10，增强 CT 定量绝对对比洗脱率>60%或相对对比洗脱率>40%，或磁共振化学位移成像显示同相位图像上信号强度丢失。
术前影像学预测良性肾上腺腺瘤的敏感性和特异性分别为 57%和 94%。组织病理学证实，所有 66 个具有提示良性腺瘤影像学特征的肾上腺肿块均为良性病变，包括 61 个良性肾上腺腺瘤和 5 个良性非腺瘤性病变（3 个骨髓脂肪瘤、1 个复合骨髓脂肪瘤/腺瘤和 1 个神经节神经母细胞瘤）。影像学预测良性的特异性为 100%。17/130（13%）个肿块诊断为恶性肾上腺病变：8 个转移瘤，7 个肾上腺皮质癌，1 个上皮样血管肉瘤和 1 个神经节神经母细胞瘤。影像学识别恶性肿瘤的敏感性为 100%。在术后随访（平均 6 个月，范围 0.2-67 个月）期间未诊断出任何恶性肿瘤。
CT 或 MR 特征以 100%的特异性预测良性病变的存在。每例肾上腺恶性肿瘤的 CT 或 MR 结果均与良性腺瘤不一致（敏感性 100%）。为了排除恶性肿瘤，应切除具有非良性影像学特征的肾上腺肿块。
