Flynt Kelsey A, Dillman Jonathan R, Davenport Matthew S, Smith Ethan A, Else Tobias, Strouse Peter J, Caoili Elaine M
Section of Pediatric Radiology, C. S. Mott Children's Hospital, Department of Radiology, University of Michigan Health System, 1540 East Hospital Drive, Ann Arbor, MI, 48109, USA.
Pediatr Radiol. 2015 Jul;45(8):1160-8. doi: 10.1007/s00247-015-3308-x. Epub 2015 Mar 21.
There is a paucity of literature describing and comparing the imaging features of adrenocortical adenomas and carcinomas in children and adolescents.
To document the CT and MRI features of adrenocortical neoplasms in a pediatric population and to determine whether imaging findings (other than metastatic disease) can distinguish adenomas from carcinomas.
We searched institutional medical records to identify pediatric patients with adrenocortical neoplasms. Pre-treatment CT and MRI examinations were reviewed by two radiologists in consensus, and pertinent imaging findings were documented. We also recorded relevant histopathological, demographic, clinical follow-up and survival data. We used the Student's t-test and Wilcoxon rank sum test to compare parametric and nonparametric continuous data, and the Fisher exact test to compare proportions. We used receiver operating characteristic (ROC) curve analyses to evaluate the diagnostic performances of tumor diameter and volume for discriminating carcinoma from adenoma. A P-value ≤0.05 was considered statistically significant.
Among the adrenocortical lesions, 9 were adenomas, 15 were carcinomas, and 1 was of uncertain malignant potential. There were no differences in mean age, gender or sidedness between adenomas and carcinomas. Carcinomas were significantly larger than adenomas based on mean estimated volume (581 ml, range 16-2,101 vs. 54 ml, range 3-197 ml; P-value = 0.003; ROC area under the curve = 0.92) and mean maximum transverse plane diameter (9.9 cm, range 3.0-14.9 vs. 4.4 cm, range 1.9-8.2 cm; P-value = 0.0001; ROC area under the curve = 0.92). Carcinomas also were more heterogeneous than adenomas on post-contrast imaging (13/14 vs. 2/9; odds ratio [OR] = 45.5; P-value = 0.001). Six of 13 carcinomas and 1 of 8 adenomas contained calcification at CT (OR = 6.0; P-value = 0.17). Seven of 15 children with carcinomas exhibited metastatic disease at diagnosis, and three had inferior vena cava invasion. Median survival for carcinomas was 27 months.
In our experience, pediatric adrenocortical carcinomas are larger, more heterogeneous, and more often calcified than adenomas, although there is overlap in their imaging appearances.
描述和比较儿童及青少年肾上腺皮质腺瘤与癌影像学特征的文献较少。
记录儿科人群肾上腺皮质肿瘤的CT和MRI特征，并确定影像学表现（转移性疾病除外）能否区分腺瘤与癌。
我们检索机构医疗记录以识别患有肾上腺皮质肿瘤的儿科患者。两名放射科医生共同回顾治疗前的CT和MRI检查，并记录相关影像学表现。我们还记录了相关的组织病理学、人口统计学、临床随访和生存数据。我们使用学生t检验和Wilcoxon秩和检验比较参数和非参数连续数据，使用Fisher精确检验比较比例。我们使用受试者操作特征（ROC）曲线分析来评估肿瘤直径和体积对区分癌与腺瘤的诊断性能。P值≤0.05被认为具有统计学意义。
在肾上腺皮质病变中，9例为腺瘤，15例为癌，1例恶性潜能不确定。腺瘤与癌在平均年龄、性别或部位方面无差异。基于平均估计体积（581ml，范围16 - 2101ml vs. 54ml，范围3 - 197ml；P值 = 0.003；曲线下ROC面积 = 0.92）和平均最大横径（9.9cm，范围3.0 - 14.9cm vs. 4.4cm，范围1.9 - 8.2cm；P值 = 0.0001；曲线下ROC面积 = 0.92），癌明显大于腺瘤。在增强后成像中，癌也比腺瘤更不均匀（13/14 vs. 2/9；优势比[OR] = 45.5；P值 = 0.001）。13例癌中的6例和8例腺瘤中的1例在CT上有钙化（OR = 6.0；P值 = 0.17）。15例患有癌的儿童中有7例在诊断时出现转移性疾病，3例有下腔静脉侵犯。癌的中位生存期为27个月。
根据我们的经验，儿科肾上腺皮质癌比腺瘤更大、更不均匀，且钙化更常见，尽管它们的影像学表现存在重叠。
