39例肾上腺皮质癌患者的CT、MRI影像特点及其诊断价值

doi:10.16150/j.1671-2870.2023.02.005

摘要/Abstract

摘要：

目的:分析肾上腺皮质腺癌(adrenocortical carcinoma, ACC)的CT、MRI表现特点，并探讨二者诊断ACC的价值。方法:回顾分析经手术及病理检查证实的39例ACC患者的CT、MRI平扫及增强检查表现及临床资料，总结对ACC有较大诊断价值的影像学征象，比较2种成像技术在ACC诊断中的价值。结果:14例患者同时完成了CT和MRI平扫加增强检查，22例患者仅接受了CT平扫加增强检查，3例患者仅接受了MRI检查。39例ACC患者中，38例肿瘤为单侧发病(左侧19例、右侧19例)，1例为双侧发病；23例肿瘤呈分叶状,16例呈类圆形；肿瘤直径为4.0~17.3 cm。CT、MRI检查中，分别有47.2%、82.4%的病例病灶内存在出血灶；91.7%、50%的病例发现肿瘤内增粗、迂曲的肿瘤血管影；77.8%、82.4%的病例提示包膜不光整。所有肿瘤均呈不均匀强化，肿瘤实性成分多呈中度增强；少量病例可见钙化、周围脏器血管受累、腹膜后淋巴结及远处肿瘤转移。14例同时完成CT和MRI平扫加增强检查的病例中，2种成像技术分别发现肿瘤灶内出血6例、12例，肿瘤内增生血管12例、6例，包膜不光整9例、12例。结论:ACC的CT、MRI表现具有一定特征性，多表现为体积较大（直径多大于4 cm），病灶呈分叶状，内多见肿瘤血管、出血坏死，肿瘤累及包膜；增强后多呈中度不均匀强化。CT在检出肿瘤血管影方面具有一定优势，而MRI在显示肿瘤内出血方面具有一定优势。

关键词: 肾上腺皮质癌, 计算机断层扫描, 磁共振成像, 影像学表现

Abstract:

Objective: To analyze CT and MRI imaging features of adrenocortical carcinoma (ACC). Methods: A retrospective analysis was conducted on the CT, MRI plain and contrast-enhanced imaging manifestations and clinical data of 39 ACC patients,and all were confirmed by surgery and pathological examination. The imaging features with significant diagnostic value for ACC were summarized, and the value of two imaging techniques for the diagnosis of ACC was explored. Results: Fourteen patients underwent both CT and MRI plain and enhanced examinations, while 22 patients underwent CT plain and enhanced examinations, and 3 patients underwent MRI examination only. Among the 39 ACC patients, 38 tumors were unilateral (19 on the left and 19 on the right), and 1 tumor was bilateral; twenty-three cases of tumors were lobulated, while 16 cases were quasi circular; the diameter of the tumor ranged from 4.0 to 17.3 cm. In CT and MRI examinations, intralesional hemorrhage was found in 47.2% and 82.4% of cases; thickened and tortuous tumor vasculature were found in 91.7% and 50% of cases; irregular capsule was found in 77.8% and 82.4% of cases. All tumors showed heterogeneous enhancement, and most of the solid components of the tumor showed moderate enhancement; a small number of cases showed calcification, involvement of surrounding organs and blood vessels, retroperitoneal lymph nodes, and distant metastasis. Among the 14 cases who completed both CT and MRI plain and enhanced examinations, 6 and 12 cases with hemorrhage of tumor, 12 and 6 cases with tumor vasculature, and 9 and 12 cases with capsule irregularities, were found respectively. Conclusions: The manifestations of CT and MRI have certain characteristics in ACC patients. Most ACCs tend to be large (diameter more than 4 cm), lobulated, and tumor vasculature, with areas of hemorrhage and necrosis, capsule irregularities, and heterogeneous enhancement. CT has advantages in evaluating tumor vasculature over MRI, while MRI has advantages in displaying intralesional hemorrhage over CT.

Key words: Adrenal cortical carcinoma, CT, MRI, Imaging feature

中图分类号:

R736.6

李卫侠, 徐学勤, 朱晓雷, 陈克敏. 39例肾上腺皮质癌患者的CT、MRI影像特点及其诊断价值[J]. 诊断学理论与实践, 2023, 22(02): 134-140.

LI Weixia, XU Xueqin, ZHU Xiaolei, CHEN Kemin. Characteristics and diagnostic value of CT and MRI in adrenocortical carcinoma: a study of 39 cases[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(02): 134-140.

图/表 6

图1

图2

图3

图4

图5

图6

参考文献 13

[14]	AHMED A A, THOMAS A J, GANESHAN D M, et al. Adrenal cortical carcinoma: pathology, genomics, prognosis, imaging features, and mimics with impact on management[J]. Abdom Radiol (NY), 2020, 45(4):945-963. doi: 10.1007/s00261-019-02371-y pmid: 31894378
[15]	BENASSAI G, DESIATO V, BENASSAI G, et al. Adrenocortical carcinoma: what the surgeon needs to know. Case report and literature review[J]. Int J Surg, 2014, 12(Suppl 1):S22-S28.
[16]	ZINI L, PORPIGLIA F, FASSNACHT M. Contemporary management of adrenocortical carcinoma[J]. Eur Urol, 2011, 60(5):1055-1065. doi: 10.1016/j.eururo.2011.07.062 pmid: 21831516
[17]	ADKINS K M, LEE J T, BRESS A L, et al. Classic Cus-hing's syndrome in a patient with adrenocortical carcinoma[J]. Radiol Case Rep, 2015, 8(3):826. doi: 10.2484/rcr.v8i3.826 URL
[18]	ELSE T, KIM AC, SABOLCH A, et al. Adrenocortical carcinoma[J]. Endocr Rev, 2014, 35(2):282-326. doi: 10.1210/er.2013-1029 pmid: 24423978
[19]	BHARWANI N, ROCKALL A G, SAHDEV A, et al. Adrenocortical carcinoma: the range of appearances on CT and MRI[J]. Am J Roentgenol, 2011, 196(6):W706-W714. doi: 10.2214/AJR.10.5540 URL
[20]	SHIN Y R, KIM K A. Imaging Features of Various Adrenal Neoplastic Lesions on Radiologic and Nuclear Medicine Imaging[J]. Am J Roentgenol, 2015, 205(3):554-563. doi: 10.2214/AJR.15.14467 pmid: 26295641
[21]	RIBEIRO J, RIBEIRO R C, FLETCHER B D. Imaging findings in pediatric adrenocortical carcinoma[J]. Pediatr Radiol, 2000, 30(1):45-51. pmid: 10663510
[22]	ROWE S P, LUGO-FAGUNDO C, AHN H, et al. What the radiologist needs to know: the role of preoperative computed tomography in selection of operative approach for adrenalectomy and review of operative techniques[J]. Abdom Radiol (NY), 2019, 44(1):140-153. doi: 10.1007/s00261-018-1669-y pmid: 29967985
[23]	KAWASHIMA A, SANDLER C M, ERNST R D, et al. Imaging of nontraumatic hemorrhage of the adrenal gland[J]. Radiographics, 1999, 19(4):949-963. doi: 10.1148/radiographics.19.4.g99jl13949 pmid: 10464802
[1]	ABIVEN G, COSTE J, GROUSSIN L, et al. Clinical and biological features in the prognosis of adrenocortical cancer: poor outcome of cortisol-secreting tumors in a series of 202 consecutive patients[J]. J Clin Endocrinol Metab, 2006, 91(7):2650-2655. doi: 10.1210/jc.2005-2730 URL
[2]	SHARMA E, DAHAL S, SHARMA P, et al. The Characteristics and Trends in Adrenocortical Carcinoma: A United States Population Based Study[J]. J Clin Med Res, 2018, 10(8):636-640. doi: 10.14740/jocmr3503w pmid: 29977421
[3]	GRUBBS E, LEE J E. Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma: proposal for a revised TNM classification[J]. Cancer, 2009, 115(24):5847. doi: 10.1002/cncr.24693 pmid: 19827149
[4]	金晓龙, 袁菲, 蔚青, 等. 肾上腺肿瘤和瘤样病变1166例病理分析[J]. 诊断学理论与实践, 2003, 2(2):119-121,125.
	JIN X L, YUAN F, WEI Q, et al. Pathologically Analyzing 1166 Cases of Adrenal Tumors and Tumor-like Lesions[J]. J Diagn Concepts & Pract, 2003, 2(2):119-121,125.
[5]	MANTERO F, TERZOLO M, ARNALDI G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology[J]. J Clin Endocrinol Metab, 2000, 85(2):637-644.
[6]	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.
	ZHAO Q Y, HAN Z J, CHEN K M. Adrenocortical carcinoma:value of CT diagnosis and differential diagnosis[J]. Radiol Pract, 2012, 27(9):975-978.
[7]	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.
	WANG J H, DING Q J, MA X L, et al. Primary adrenocortical carcinoma: CT and MRI evaluation with pathological correlation[J]. Chin J Radiol, 2016, 50(11):882-885.
[8]	沃方明, 王玉涛, 张建, 等. 肾上腺皮质癌的CT、MRI及PET/CT表现[J]. 医学影像学杂志, 2018, 28(6):993-996,1000.
	WO F M, WANG Y T, ZHANG J, et al. CT, MRI and PET/CT features of adrenocortical carcinoma[J]. J Med Imaging, 2018, 28(6):993-996,1000.
[9]	茹立, 陈挺, 李盛, 等. 肾上腺皮质腺癌的CT、MR影像学特点及临床表现并文献复习[J]. 医学影像学杂志, 2019, 29(11):1985-1988.
	RU L, CHEN T, LI S, et al. CT and MR imaging features and clinical manifestations of adrenocortical carcinoma and literature review[J]. J Med Imaging, 2019, 29(11):1985-1988.
[10]	许晓琴, 姚振威, 林含舜, 等. 原发性肾上腺皮质腺癌的CT表现与病理特点[J]. 中国医学计算机成像杂志, 2019, 25(1):37-41.
	XU X Q, YAO Z W, LIN H S, et al. CT Manifestations and Pathological Features of Primary Adrenocortical Carcinoma[J]. Chin Comput Med Imaging, 2019, 25(1):37-41.
[11]	苏停停, 尚进, 袁佳, 等. 肾上腺皮质癌影像学表现[J]. 中国医学影像技术, 2020, 36(12):1839-1842.
	SU T T, SHANH J, YUAN J, et al. Imaging manifestations of adrenocortical carcinoma[J]. Chin J Med Imaging Technol, 2020, 36(12):1839-1842.
[12]	PALOKA R, GOPIREDDY D R, VIRARKAR M, et al. Multimodality imaging of adrenal gland pathologies: A comprehensive pictorial review[J]. J Clin Imaging Sci, 2022, 12:62. doi: 10.25259/JCIS_92_2022 pmid: 36601600
[13]	SHARMA E, DAHAL S, SHARMA P, et al. The Characteristics and Trends in Adrenocortical Carcinoma: A United States Population Based Study[J]. J Clin Med Res, 2018, 10(8):636-640. doi: 10.14740/jocmr3503w pmid: 29977421