肾上腺肿瘤影像学诊断策略分析.pptVIP

* This is a adnomas showed obvious SI loss on opposed phase images * And Adrenal metastastes donot loss SI * There are exception, Lipid-poor adenoma do not have SI loss, too * So the final imaging model is Functional imaging, they are Washout ratio by DCE CT/MRI, CT perfusion ,PET-CT, MR spectrography and diffusion weighted is under investigated * IV contrast medium “wash out” much faster for adenomas than nonadenomas Percentage washout ratios APW(absolute percentage washout ) (Enhanced CT value- Delayed CT value)/(Enhanced CT value- unenhanced CT value) ×100% RPW relative percentage washout RPW =(Enhanced CT value- Delayed CT value)/ Enhanced CT × 100% Most accepted threshold 15-minute delayed scan 40% for RPW or 60% for APW Also recommended 10-minute delay scan RPW 50% Nearly 100% sensitive and specific ! * Type I Delayed enhanced Neurogenic tumors Type II Rapid washout Adenomas Type III Moderate washout Intimidate Type IV Slow washout Malignant tumors * BV can be used differentiating adenomas from nonadenomas BV can be used differentiating adenomas from nonadenomas * * 肾上腺皮质癌罕见 临床表现：腹痛、腹部肿块、cushing综合征（50%） CT表现：常大于5cm；不均匀密度及强化肿块，中心坏死多见，20-30%可见钙化 典型肾上腺皮质癌呈巨大不均匀肿块，中心钙化 （四）原发性肾上腺皮质癌 恶性肿瘤病人尸检肾上腺转移发生率约为27%，以肺癌、乳腺癌最为常见 癌症病人检出肾上腺转移很重要 转移性肿瘤致双侧肾上腺弥漫增大和不均匀强化，累及周围脂肪间隙 （五）肾上腺转移性肿瘤 大多数肿瘤经血行（肺、肝和骨）及淋巴途径转移 转移至同侧肾上腺，双侧肾上腺同时转移亦可见 右侧肾上腺小肾癌侵犯下腔静脉，形成癌栓 结肠癌肝转移部分肝叶切除术后，左侧肾上腺转移 弥漫性肾上腺出血可发生于任何年龄，可发生于手术、化脓感染、烧伤、高血压等 慢性肾上腺出血 出血 （六）其它肿瘤样病变 大多为单侧，可以任意大小 病理上包括上皮的、内皮的、寄生虫性、假性囊肿 大多数病灶薄壁，无强化 肾上腺囊肿 囊肿 小结 1、肾上腺影像检查技术：超声、CT、MRI 2、肾上腺解剖特征：叶形，密度均匀，强 化均匀，径线小于10mm 3、肾上腺增大、肾上腺破坏、肾上腺肿块：区分肾上腺组织的异质性是诊断的关键 4、肾上腺肿瘤的诊断，临床及实验室检查很重要，影像学的价值在于病变定位及良恶性的区分。 Chest x-ray: wash out measurement This site provides a calculator to measure the wash-out of adrenal masses for differentiation of benign masses (usually adenomas) from malignant lesions (usually metastases). Imaging of Adrenal Incidentalomas: Current Status N. Reed Dunnick and Melvyn KorobkinAm. J. Roentgenol., Sep 2002; 179: 559 - 568.