肾上腺皮质癌的CT、MRI及PET/CT表现
|
摘要
目的探讨肾上腺皮质癌(ACC)的CT、MRI及~(18)F-FDG PET/CT影像学特征。方法回顾性分析经病理证实的21例ACC患者的影像学资料。CT增强扫描16例、MRI增强扫描8例、PET/CT扫描4例,分析其影像学表现。结果1)20例肿瘤单发(左侧13例、右侧7例),1例为双侧发病;直径为(10.9±3.0)cm;16例肿瘤呈分叶状,5例呈类圆形;2)CT表现:15例(15/17)平扫密度不均,2例均匀;瘤内钙化5例。16例整体呈渐进性强化方式;瘤内见血管影13例,瘤内见星芒状无明显强化区6例;假性厚壁囊肿样表现4例,内壁见壁结节样改变;边缘见包膜结构10例,呈延迟强化;3)MRI表现:8例呈T_1WI稍低、T_2WI稍高的混杂信号,DWI高信号;瘤内可见囊变5例、出血7例、瘢痕组织6例、脂质成分2例。强化方式与CT检查基本相同,对比剂扩清延迟;边缘见包膜结构6例,瘤内瘢痕组织延迟强化2例;4)PET/CT表现:4例呈FDG不均匀摄取增高,高摄取区与增强CT强化区一致,SUVmax为(7.5±4.7),假性厚壁囊肿样表现1例。结论ACC有一定的影像学特征,CT、MRI和PET/CT检查在诊断中各有优势,联合应用有助于全面反映肿瘤的病理特征。
Objective To investigate the CT,MRI and ~(18) F-FDG PET/CT features of adrenocortical carcinoma( ACC).Methods Imaging data of 21 ACC patients confirmed by histopathology were retrospectively studied. There were 16 patients with enhanced CT,and 8 cases with enhanced MRI,and18 F-FDG PET/CT was performed in 4 cases,and the imaging findings were analyzed. Results 1) Single lesion was found in 20 patients(13 cases on the left and 7 cases on the right),and bilateral side lesions in one patient. The diameters of the lesions were about( 10. 9 ± 3. 0) cm,and the shape was lobulated in 16 cases,round-like in 5 cases; 2) CT findings: on plain CT,15(15/17) cases showed inhomogeneous density,2 cases showed homogeneous density and intratumoral calcification was found in 5 cases. On enhanced CT,progressive enhancement was shown of all the16 cases. 13 cases showed intratumoral vascular shadow,6 cases showed no obvious enhancement area within the tumor; 4 cases manifested pseudo thickness cyst with wall nodular change; marginal envelope structure was shown in 10 cases with delayed enhancement; 3) MRI findings: T_1WI showed slightly lower signal and T_2WI showed slightly higher medley signal in 8 cases,DWI showed higher signal. There were 5 cases of cystic invasion,7 cases of hemorrhage,6 cases of scar tissue and 2 cases of lipid composition. The MRI enhanced pattern was similar as CT,manifested as a delayed enhancement. Marginal envelope structure was showed in 6 cases,scar tissue in tumor showed a delayed enhancement in 2 cases; 4) PET/CT findings: inhomogeneous high uptake was showed in 4 cases,and the high uptake region was consistent with the CT enhancement region,the SUVmax was about(7. 5 ± 4. 7),1 case manifested pseudo thickness cyst. Conclusion ACC shows some imaging characteristics. CT,MRI or PET/CT has each advantages in diagnosis,and the combined application is helpful to reflect the pathological features of ACC.
Objective To investigate the CT,MRI and ~(18) F-FDG PET/CT features of adrenocortical carcinoma( ACC).Methods Imaging data of 21 ACC patients confirmed by histopathology were retrospectively studied. There were 16 patients with enhanced CT,and 8 cases with enhanced MRI,and18 F-FDG PET/CT was performed in 4 cases,and the imaging findings were analyzed. Results 1) Single lesion was found in 20 patients(13 cases on the left and 7 cases on the right),and bilateral side lesions in one patient. The diameters of the lesions were about( 10. 9 ± 3. 0) cm,and the shape was lobulated in 16 cases,round-like in 5 cases; 2) CT findings: on plain CT,15(15/17) cases showed inhomogeneous density,2 cases showed homogeneous density and intratumoral calcification was found in 5 cases. On enhanced CT,progressive enhancement was shown of all the16 cases. 13 cases showed intratumoral vascular shadow,6 cases showed no obvious enhancement area within the tumor; 4 cases manifested pseudo thickness cyst with wall nodular change; marginal envelope structure was shown in 10 cases with delayed enhancement; 3) MRI findings: T_1WI showed slightly lower signal and T_2WI showed slightly higher medley signal in 8 cases,DWI showed higher signal. There were 5 cases of cystic invasion,7 cases of hemorrhage,6 cases of scar tissue and 2 cases of lipid composition. The MRI enhanced pattern was similar as CT,manifested as a delayed enhancement. Marginal envelope structure was showed in 6 cases,scar tissue in tumor showed a delayed enhancement in 2 cases; 4) PET/CT findings: inhomogeneous high uptake was showed in 4 cases,and the high uptake region was consistent with the CT enhancement region,the SUVmax was about(7. 5 ± 4. 7),1 case manifested pseudo thickness cyst. Conclusion ACC shows some imaging characteristics. CT,MRI or PET/CT has each advantages in diagnosis,and the combined application is helpful to reflect the pathological features of ACC.
引文
[1]王翠萍,张静,高洁,等.肾上腺皮质癌、腺瘤临床病理特征分析和表皮生长因子受体、血管内皮生长因子的表达及意义[J].中华病理学杂志,2012,41(10):686-690.
[2]Nakamura Y,Yamazaki Y,Felizola SJ,et al.Adrenocortical carcinoma review of the pathologic features,production of adrenal steroids,and molecular pathogenesis[J].Endocrinol Metab Clin North Am,2015,44(2):399-410.
[3]赵勤余,韩志江,陈克敏.肾上腺皮质癌的CT诊断及鉴别诊断[J].放射学实践.2012,27(9):975-978.
[4]齐淑玲,刘福尧,张凯,等.肾上腺皮质腺癌螺旋CT多期增强扫描的影像特点及诊断价值[J].现代医用影像学,2016,2(2):290-291,294.
[5]张伟飞,童旦君.肾上腺皮质腺癌的CT诊断评价[J].全科医学临床与教育,2014,(12)5:547-549,476.
[6]岑峰,张锋玫,覃求,等.MSCT对肾上腺不典型嗜铬细胞瘤与皮质癌的鉴别诊断价值[J].医学影像学杂志,2015,(25)7:1228-1232.
[7]范小晶,潘卫东,梁继祥,等.肾上腺皮质腺癌的CT影像诊断[J].中华全科医学,2012,10(12):1946-1948.
[8]Soon PS,Mc Donald KL,Robinson BG,et al.Molecular markers and the pathogenesis of adrenocortical cancer[J].Oncologist.2008,13(5):548-561.
[9]Allolio B,Fassnacht M.Clinical review:adrenocortical carcinoma:clinical update[J].J Clin Endocrinol Metab,2006,91(6):2027-2037.
[10]Bourdeau I,Mac Kenzie-Feder J,Lacroix A.Recent advances in adrenocortical carcinoma in adults[J].Curr Opin Endocrinol Diabetes Obes,2013,20(3):192-197.
[11]汪建华,丁前江,马小龙,等.肾上腺原发性皮质腺癌的CT与MRI表现及其病理基础[J].中华放射学杂志,2016,50(11):882-885.
[12]Zhang HM,Perrier ND,Grubbs EG,et al.CT features and quantification of the characteristics of adrenocortical carcinomason unenhanced and contrast-enhanced studies[J].Clin Radiol,2012,67(1):38-46.
[13]Nains KN,Kanthan R.Diagnostic and prognostic features in adrenocortical carcinoma:a single institution case series and review of the literature[J].World J Surg Oncol,2015,13:117.
[14]周建军,曾维新,周康策,等.原发性肾上腺皮质腺癌的CT诊断价值[J].中华放射学杂志,2006,40(10):1023-1026.
[15]Takeuchi S,Balachandran A,Habra MA,et al.Impact of18FFDG PET/CT on the management of adrenocortical carcinoma:analysis of 106 patients[J].Eur J Nucl Med Mol Imaging,2014,41(11):2066-2073.
[16]Tessonnier L,Ansquer C,Bournaud C,et al.(18)F-FDG uptake at initial staging of the adrenocortical cancers:a diagnostic tool but not of prognostic value[J].World J Surg,2013,37(1):107-112.
[17]Fenske W,V9lker HU,Adam P,et al.Glucose transporter GLUT1 expression is an stage-independent predictor of clinical outcome in adrenocortical carcinoma[J].Endocr Relat Cancer,2009,16(3):919-928.
[18]Cistaro A,Niccoli Asabella A,Coppolino P,et al.Diagnostic and prognostic value of18F-FDG PET/CT in comparison with morphological imaging in primary adrenal gland malignancies-a multicenter experience[J].Hell J Nucl Med,2015,18(2):97-102.
[2]Nakamura Y,Yamazaki Y,Felizola SJ,et al.Adrenocortical carcinoma review of the pathologic features,production of adrenal steroids,and molecular pathogenesis[J].Endocrinol Metab Clin North Am,2015,44(2):399-410.
[3]赵勤余,韩志江,陈克敏.肾上腺皮质癌的CT诊断及鉴别诊断[J].放射学实践.2012,27(9):975-978.
[4]齐淑玲,刘福尧,张凯,等.肾上腺皮质腺癌螺旋CT多期增强扫描的影像特点及诊断价值[J].现代医用影像学,2016,2(2):290-291,294.
[5]张伟飞,童旦君.肾上腺皮质腺癌的CT诊断评价[J].全科医学临床与教育,2014,(12)5:547-549,476.
[6]岑峰,张锋玫,覃求,等.MSCT对肾上腺不典型嗜铬细胞瘤与皮质癌的鉴别诊断价值[J].医学影像学杂志,2015,(25)7:1228-1232.
[7]范小晶,潘卫东,梁继祥,等.肾上腺皮质腺癌的CT影像诊断[J].中华全科医学,2012,10(12):1946-1948.
[8]Soon PS,Mc Donald KL,Robinson BG,et al.Molecular markers and the pathogenesis of adrenocortical cancer[J].Oncologist.2008,13(5):548-561.
[9]Allolio B,Fassnacht M.Clinical review:adrenocortical carcinoma:clinical update[J].J Clin Endocrinol Metab,2006,91(6):2027-2037.
[10]Bourdeau I,Mac Kenzie-Feder J,Lacroix A.Recent advances in adrenocortical carcinoma in adults[J].Curr Opin Endocrinol Diabetes Obes,2013,20(3):192-197.
[11]汪建华,丁前江,马小龙,等.肾上腺原发性皮质腺癌的CT与MRI表现及其病理基础[J].中华放射学杂志,2016,50(11):882-885.
[12]Zhang HM,Perrier ND,Grubbs EG,et al.CT features and quantification of the characteristics of adrenocortical carcinomason unenhanced and contrast-enhanced studies[J].Clin Radiol,2012,67(1):38-46.
[13]Nains KN,Kanthan R.Diagnostic and prognostic features in adrenocortical carcinoma:a single institution case series and review of the literature[J].World J Surg Oncol,2015,13:117.
[14]周建军,曾维新,周康策,等.原发性肾上腺皮质腺癌的CT诊断价值[J].中华放射学杂志,2006,40(10):1023-1026.
[15]Takeuchi S,Balachandran A,Habra MA,et al.Impact of18FFDG PET/CT on the management of adrenocortical carcinoma:analysis of 106 patients[J].Eur J Nucl Med Mol Imaging,2014,41(11):2066-2073.
[16]Tessonnier L,Ansquer C,Bournaud C,et al.(18)F-FDG uptake at initial staging of the adrenocortical cancers:a diagnostic tool but not of prognostic value[J].World J Surg,2013,37(1):107-112.
[17]Fenske W,V9lker HU,Adam P,et al.Glucose transporter GLUT1 expression is an stage-independent predictor of clinical outcome in adrenocortical carcinoma[J].Endocr Relat Cancer,2009,16(3):919-928.
[18]Cistaro A,Niccoli Asabella A,Coppolino P,et al.Diagnostic and prognostic value of18F-FDG PET/CT in comparison with morphological imaging in primary adrenal gland malignancies-a multicenter experience[J].Hell J Nucl Med,2015,18(2):97-102.