Sargar Kiran M, Khanna Geetika, Hulett Bowling Rebecca
From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110.
Radiographics. 2017 Oct;37(6):1648-1664. doi: 10.1148/rg.2017170043.
The adrenal glands in children can be affected by a variety of benign lesions. The diagnosis of adrenal lesions can be challenging, but assessment of morphologic changes in correlation with the clinical presentation can lead to an accurate diagnosis. These lesions can be classified by their cause: congenital (eg, discoid adrenal gland, horseshoe adrenal gland, and epithelial cysts), vascular and/or traumatic (eg, adrenal hemorrhage), infectious (eg, granulomatous diseases), enzyme deficiency disorders (eg, congenital adrenal hyperplasia [CAH] and Wolman disease), benign neoplasms (eg, pheochromocytomas, ganglioneuromas, adrenal adenomas, and myelolipomas), and adrenal mass mimics (eg, extralobar sequestration and extramedullary hematopoiesis). Multimodality cross-sectional imaging helps to define the origin, extent, and relationship of these lesions to adjacent structures, as well as to guide treatment management. The anatomic and functional imaging modalities used to evaluate pediatric adrenal lesions include ultrasonography, computed tomography (CT), magnetic resonance imaging, and iodine 123 metaiodobenzylguanidine scintigraphy. Identifying the imaging features of nonmalignant adrenal lesions is helpful to distinguish these lesions from malignant adrenal neoplasms. Identifying characteristic imaging findings (eg, enlarged adrenal glands, with cerebriform surface, and stippled echogenicity in CAH; a T2-hyperintense mass with avid contrast enhancement in pheochromocytoma; low CT attenuation [<10 HU] and signal intensity drop on opposed-phase chemical shift images in adenoma; and enhancing suprarenal mass supplied by a systemic feeding artery in extralobar sequestration) can aid in making the correct diagnosis. In addition, clinical features (eg, ambiguous genitalia in CAH and hypertension in pheochromocytoma) can also guide the radiologist toward the correct diagnosis. RSNA, 2017.
儿童肾上腺可受到多种良性病变的影响。肾上腺病变的诊断具有挑战性，但结合临床表现评估形态学变化可实现准确诊断。这些病变可按病因分类：先天性（如盘状肾上腺、马蹄形肾上腺和上皮囊肿）、血管性和/或创伤性（如肾上腺出血）、感染性（如肉芽肿性疾病）、酶缺乏症（如先天性肾上腺增生[CAH]和沃尔曼病）、良性肿瘤（如嗜铬细胞瘤、神经节神经瘤、肾上腺腺瘤和肾上腺髓质脂肪瘤）以及肾上腺肿块类似物（如肺叶外隔离症和髓外造血）。多模态横断面成像有助于明确这些病变的起源、范围及其与相邻结构的关系，还能指导治疗管理。用于评估儿童肾上腺病变的解剖学和功能成像方式包括超声、计算机断层扫描（CT）、磁共振成像以及碘123间碘苄胍闪烁显像。识别非恶性肾上腺病变的影像学特征有助于将这些病变与恶性肾上腺肿瘤区分开来。识别特征性影像学表现（如CAH中肾上腺增大、脑回样表面及点状回声增强；嗜铬细胞瘤中T2高信号肿块且对比剂强化明显；腺瘤在CT上呈低密度[<10 HU]且在反相位化学位移图像上信号强度下降；肺叶外隔离症中肾上腺肿块由体循环供血动脉供血且强化）有助于做出正确诊断。此外，临床特征（如CAH中的生殖器模糊和嗜铬细胞瘤中的高血压）也可引导放射科医生做出正确诊断。RSNA，2017年。
