CT能谱成像在鉴别肾上腺意外瘤：乏脂性腺瘤及嗜铬细胞瘤中的价值

迟  婧; 尹胜男; 丁  宁; 陈小芳; 沈  莉; 计一丁

doi:10.12117/jccmi.2019.05.005

中国临床医学影像杂志 ›› 2019, Vol. 30 ›› Issue (5) : 322-327. DOI: 10.12117/jccmi.2019.05.005

腹部影像学

CT能谱成像在鉴别肾上腺意外瘤：乏脂性腺瘤及嗜铬细胞瘤中的价值

迟婧，尹胜男，丁宁，陈小芳，沈莉，计一丁

作者信息 +

Assessment of dual-energy spectral CT for the characterization of incidental adrenal nodules: differential diagnosis of lipid-poor adrenal adenomas and pheochromocytomas

CHI Jing, YIN Shen-nan, DING Ning, CHEN Xiao-fang, SHEN Li, JI Yi-ding

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文章历史 +

摘要

目的：探讨能谱CT多参数成像在鉴别乏脂性腺瘤和嗜铬细胞瘤中的应用价值。方法：回顾性分析16例经病理证实的嗜铬细胞瘤及28例乏脂性腺瘤，均行传统CT平扫及双期能谱CT扫描，测量病灶的平扫CT值及病灶和腹主动脉的能谱参数，计算不同能量水平下病灶的标准化碘浓度（NIC），标准化最高碘浓度（NHIC），对定量参数进行两样本t检验和ROC曲线分析。结果：在不同能量水平下肾上腺嗜铬细胞瘤的CT值均高于乏脂性腺瘤（P<0.05），并且两者之间的差异随着能量水平的降低而递增。乏脂性腺瘤和嗜铬细胞瘤动脉期NIC分别为0.16±0.07，0.31±0.14（P<0.001），门脉期NIC分别为0.44±0.16，0.62±0.43（P=0.012）；动脉期NHIC分别为0.34±0.03，0.55±0.17（P<0.001），门脉期NHIC分别为0.81±0.23，1.01±0.35（P=0.055）。动脉期NIC鉴别乏脂性腺瘤和嗜铬细胞瘤的敏感性和特异性最高，分别为88%及86%，诊断性能较CT平扫相比有所提高（敏感性为100%，特异性为60%）。结论：CT能谱成像的定量分析对乏脂性腺瘤及嗜铬细胞瘤的鉴别诊断有重要的价值，较CT平扫能提高诊断的准确性。

Abstract

Objective: To assess the value of dual-energy spectral CT(DEsCT) for differentiating lipid-poor adrenal adenoma and pheochromocytoma. Materials and Methods: Forty-eight nonconsecutive patients with 16 pathologically confirmed pheochromocytomas and 28 lipid-poor adrenal adenomas underwent nonenhanced and contrast enhanced dual-energy spectral CT of the abdomen. For each adrenal nodule, nonenhanced attenuation values were recorded; material decomposition images and monochromatic image sets with photon energies from 40 to 140 keV were both reconstructed, normalized iodine concentration (NIC) and normalized high-enhancing iodine concentration(NHIC) were calculated. Quantitative parameters were compared using a two-sample t test. Results: NIC values were lower in the lipid-poor adrenal adenomas than in the pheochromocytomas: 0.16±0.07 vs. 0.31±0.14 in AP(P<0.001), and 0.44±0.16 vs. 0.62±0.43 in PP(P=0.012). The quantitative NIC during AP measurements showed a sensitivity of 88%(14 of 16 pheochromocytomas) at a specifcity of 86%(24 of 28 lipid-poor adrenal adenomas), yielding improved diagnostic performance compared with nonenhanced multidetector CT attenuation(sensitivity of 100% (16 of 16 pheochromocytomas) at a specifcity of 60%(17 of 28 lesions). Conclusion: The NIC values during AP obtained in the dual-energy spectral CT images appear optimal for discriminating a lipid-poor adrenal adenoma from a pheochromocytoma, reflecting an improved ability over nonenhanced multidetector CT.

导出引用

迟婧，尹胜男，丁宁，陈小芳，沈莉，计一丁. CT能谱成像在鉴别肾上腺意外瘤：乏脂性腺瘤及嗜铬细胞瘤中的价值[J]. 中国临床医学影像杂志. 2019, 30(5): 322-327 https://doi.org/10.12117/jccmi.2019.05.005

CHI Jing, YIN Shen-nan, DING Ning, CHEN Xiao-fang, SHEN Li, JI Yi-ding. Assessment of dual-energy spectral CT for the characterization of incidental adrenal nodules: differential diagnosis of lipid-poor adrenal adenomas and pheochromocytomas[J]. Journal of China Clinic Medical Imaging. 2019, 30(5): 322-327 https://doi.org/10.12117/jccmi.2019.05.005

中图分类号： Ｒ736.6 Ｒ814.42

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