1 All authors: Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Outpatient Center, 601 N Caroline St, Rm 3140D, Baltimore, MD 21287.
AJR Am J Roentgenol. 2013 Oct;201(4):834-9. doi: 10.2214/AJR.12.9753.
The purpose of this study was to compare enhancement of adrenal adenomas and pheochromocytomas during dual-phase (arterial and venous phases) CT performed with currently used MDCT protocols with the goal of defining enhancement patterns predictive of pathologic findings.
Pathologically proven pheochromocytomas were retrospectively compared with adrenal adenomas. Inclusion criteria for adenomas, collected by searching the radiology database, were confirmatory adrenal CT (unenhanced with or without washout) and absence of clinical indicators of pheochromocytoma. A fellowship-trained attending radiologist blinded to the pathologic diagnosis reviewed existing images from dual-phase IV contrast-enhanced CT examinations to measure enhancement of adrenal lesions and characterize the appearance (homogeneous versus heterogeneous). Student t test analysis was performed to compare arterial and venous phase enhancement levels.
The findings in 39 patients with 41 adenomas were compared with those in 10 patients with 12 pheochromocytomas. Mean arterial and venous enhancement of adenomas at 37 HU (-6 to 85 HU) and 60 HU (16-133 HU) was significantly lower than that of pheochromocytomas at 104 HU (42-190 HU) and 119 HU (61-195 HU) (p < 0.001). No adenoma was more than 85-HU enhancing in the arterial phase, and 58% of pheochromocytomas were more than 110-HU enhancing. Most adenomas (85%) were more enhancing in the venous phase. No adenoma was more enhancing in the arterial phase, but 25% (3/12) of pheochromocytomas were. Most (58%) pheochromocytomas were heterogeneous in appearance, compared with 22% of adenomas.
For indeterminate adrenal masses identified at dual-phase IV contrast-enhanced CT, higher enhancement during the arterial phase, arterial phase enhancement levels greater than 110 HU, and lesion heterogeneity should prompt consideration of pheochromocytoma.
本研究旨在比较目前使用的多层螺旋 CT（MDCT）方案进行双期（动脉期和静脉期）CT 增强时肾上腺腺瘤和嗜铬细胞瘤的增强情况，以确定预测病理结果的增强模式。
回顾性比较经病理证实的嗜铬细胞瘤和肾上腺腺瘤。通过检索放射学数据库收集的腺瘤纳入标准为：确认的肾上腺 CT（未增强或有增强洗脱）和无嗜铬细胞瘤的临床指标。一名接受过奖学金培训的主治放射科医生在不知道病理诊断的情况下，对双期 IV 对比增强 CT 检查的现有图像进行了回顾，以测量肾上腺病变的增强程度，并对外观（均匀与不均匀）进行特征描述。采用 Student t 检验分析比较动脉期和静脉期增强水平。
将 39 例 41 个腺瘤患者的发现与 10 例 12 个嗜铬细胞瘤患者的发现进行比较。腺瘤的平均动脉期和静脉期增强值分别为 37 HU（-6 至 85 HU）和 60 HU（16 至 133 HU），显著低于嗜铬细胞瘤的 104 HU（42 至 190 HU）和 119 HU（61 至 195 HU）（p<0.001）。没有一个腺瘤在动脉期的增强值超过 85 HU，而 58%的嗜铬细胞瘤的增强值超过 110 HU。大多数腺瘤（85%）在静脉期增强更明显。没有腺瘤在动脉期增强更明显，但有 25%（3/12）的嗜铬细胞瘤是这样。大多数（58%）的嗜铬细胞瘤在外观上不均匀，而腺瘤为 22%。
对于在双期 IV 对比增强 CT 中确定的不确定肾上腺肿块，如果在动脉期有更高的增强、动脉期增强值大于 110 HU 和病变不均匀性，应提示考虑嗜铬细胞瘤。
