Maurea Simone, Imbriaco Massimo, Mollica Carmine, Pace Leonardo, Salvatore Marco
Radiologia e Medicina Nucleare, Dipartimento di Scienze Biomorfologiche Funzionali (DSBMF), Università degli Studi di Napoli Federico II, Napoli, Italy.
Nucl Med Commun. 2011 Jun;32(6):535-41. doi: 10.1097/MNM.0b013e32834319e3.
To compare norcholesterol uptake and magnetic resonance (MR) signal intensity ratios (SIRs) in characterizing adrenal adenomas to differentiate hypersecreting from nonhypersecreting lesions.
We studied 34 patients (14 males and 20 females, mean age: 47±15 years) with hypersecreting (n=19) or nonhypersecreting (n=15) adrenal adenomas; all patients underwent iodine-131 norcholesterol scintigraphy and MR studies. Pathology (n=26) or follow-up data (n=8) were obtained. Imaging studies were qualitatively evaluated to calculate diagnostic accuracy of each test; radionuclide studies were also semiquantitatively evaluated using a four-point score to measure norcholesterol uptake, whereas MR scans were quantitatively assessed for measuring SIRs of adrenal lesions. Imaging data were then compared between hypersecreting and nonhypersecreting adenomas.
The diagnostic accuracies of norcholesterol (100%) and MR (95%) scans to identify adrenal adenomas were similar; however, while a significantly (P=0.01) higher norcholesterol uptake was observed in hypersecreting (2.8±0.5 cm) adenomas compared with nonhypersecreting (2.28±0.6 cm) lesions, no significant differences in SIRs were found in this comparative analysis; in this regard, no significant difference in tumor size (centimeter) occurred between hypersecreting (2.7±0.5 cm) and nonhypersecreting (3.1±0.9 cm) adenomas.
Adrenal scintigraphy using norcholesterol and MR are both able to accurately identify cortical adenomas; however, while semiquantitative analysis of norcholesterol uptake is effective to differentiate between hypersecreting and nonhypersecreting adenomas, SIRs evaluation is not useful for this purpose; in particular, the lower norcholesterol uptake observed in nonhypersecreting adenomas might reflect the normal hormone synthesis status of these lesions and, thus, regular secretion; this finding could also reflect initial adrenal dysfunction responsible for subclinical disorders.
比较去甲胆固醇摄取和磁共振（MR）信号强度比（SIR）在肾上腺腺瘤特征性分析中区分分泌亢进与非分泌亢进病变的能力。
我们研究了34例患有分泌亢进（n = 19）或非分泌亢进（n = 15）肾上腺腺瘤的患者（14例男性和20例女性，平均年龄：47±15岁）；所有患者均接受了碘-131去甲胆固醇闪烁扫描和MR检查。获取了病理结果（n = 26）或随访数据（n = 8）。对影像学检查进行定性评估以计算每项检查的诊断准确性；放射性核素检查还采用四点评分法进行半定量评估以测量去甲胆固醇摄取，而MR扫描则进行定量评估以测量肾上腺病变的SIR。然后比较分泌亢进和非分泌亢进腺瘤之间的影像学数据。
去甲胆固醇扫描（100%）和MR扫描（95%）识别肾上腺腺瘤的诊断准确性相似；然而，与非分泌亢进（2.28±0.6 cm）病变相比，分泌亢进（2.8±0.5 cm）腺瘤的去甲胆固醇摄取显著更高（P = 0.01），但在该比较分析中未发现SIR有显著差异；在这方面，分泌亢进（2.7±0.5 cm）和非分泌亢进（3.1±0.9 cm）腺瘤之间的肿瘤大小（厘米）无显著差异。
使用去甲胆固醇的肾上腺闪烁扫描和MR均能够准确识别皮质腺瘤；然而，虽然去甲胆固醇摄取的半定量分析可有效区分分泌亢进和非分泌亢进腺瘤，但SIR评估对此目的无用；特别是，在非分泌亢进腺瘤中观察到的较低去甲胆固醇摄取可能反映了这些病变的正常激素合成状态，从而反映了正常分泌；这一发现也可能反映了导致亚临床疾病的初始肾上腺功能障碍。
