摘要
目的 对比分析肾上腺区嗜铬细胞瘤与肾上腺皮脂腺瘤CT特征,以提高肾上腺区嗜铬细胞瘤及副神经节瘤诊断水平。方法 回顾性分析2008年1月-2018年1月于解放军总医院第一医学中心内分泌科就诊的肾上腺区占位患者的临床及影像学资料。依据病理结果,以皮质腺瘤为对照组,分析嗜铬细胞瘤CT影像学资料,包括肿瘤形态、密度、直径、平扫CT值及增强后CT值,并采用ROC曲线分析各指标的诊断性能。结果 嗜铬细胞瘤组108例,其中男46例,女62例,平均年龄47.92±1.45岁;皮质腺瘤50例,其中男24例,女26例,平均年龄48.28±1.77岁,两组在年龄、性别比例方面无统计学差异。嗜铬细胞瘤组体质量指数(body mass index,BMI)小于皮质腺瘤[(23.89±0.37) kg/m^2 vs (25.76±0.54) kg/m^2,P<0.001];嗜铬细胞瘤左侧居多(63.8%),皮脂腺瘤右侧居多(56%)(P=0.001);嗜铬细胞瘤最大径显著大于皮质腺瘤[(6.46±0.24) cm vs(4.55±0.28) cm,P<0.001]。嗜铬细胞瘤平扫及增强CT值均大于皮质腺瘤[(32.26±2.07 vs 12.11±4.25) HU,(58.57±3.62 vs40.35±5.10) HU,P均<0.05]。以肿瘤直径为检验变量建立ROC曲线,诊断嗜铬细胞瘤的最佳截断值为5.05 cm,AUC为0.744,敏感度为70.21%,特异度为67.59%。平扫CT值最佳截断值为17.5 HU,AUC为0.823,敏感度为96.3%,特异度为58.3%。增强CT值最佳截断值为48.5 HU,曲线下面积0.696,敏感度为85.7%,特异度为64.7%。平扫CT值和增强CT值两个指标的联合应用以及上述3个指标的联合应用诊断效果较好,敏感度均为100.0%,特异度分别为84.6%和90.9%,显著高于单一指标。结论 肾上腺区占位中,肿瘤若在左侧,BMI<24 kg/m^2,肿瘤直径5.05 cm,平扫CT值17.5 HU,增强后CT值达到48.5 HU以上时诊断嗜铬细胞瘤的可能性更大,指标联合应用的诊断效果较单一指标好。
Objective To analyze and compare CT features of adrenal pheochromocytoma versus adrenal cortical adenoma,and improve the diagnosis accuracy.Methods From January 2008 to January 2018,clinical data about patients diagnosed as adrenal space-occupying lesions in the endocrinology department of the first medical center of Chinese PLA General Hospital were retrospectively analyzed.According to pathological results,patients were divided into adrenal pheochromocytoma group and adrenal cortical adenoma group.The CT imaging data including tumor location,density,diameter,plain CT value and enhanced CT value were compared between the two groups.ROC curves were established to examine the diagnostic value of each indicator.Results Of the 108 cases in the pheochromocytoma group,there were 46 males and 62 females,with an average age of 47.92±1.45 years.Of the 50 cases with cortical adenoma,there were 24 males and 26 females,with an average age of 48.28±1.77 years;There was no significant difference in age and sex between the two groups.However,BMI of the pheochromocytoma group was significantly lower than that of the cortical adenoma group ([23.89±0.37] kg/m^2 vs [25.76±0.54] kg/m^2,P<0.001).Most pheochromocytoma (63.8%) was found in the left side and most cortical adenoma (56%) was in the right side (P=0.001).The volume of the pheochromocytoma was significantly larger than that of the cortical adenoma ([6.46±0.24] cm vs [4.55±0.28] cm,P<0.001).Both plain and enhanced CT values (HU) of the pheochromocytoma were greater than those of the cortical adenoma ([32.26±2.07] vs [12.11±4.25],[58.57±3.62] vs [40.35±5.10],P<0.05,respectively).ROC analysis revealed a threshold of 5.05 cm for tumor diameter in the diagnosis of pheochromocytoma (AUC 0.744,sensitivity 70.21%,specificity 67.59%);threshold of 17.5 HU for CT value (AUC 0.823,sensitivity 96.3%,specificity 58.3%);and threshold of 48.5 HU for enhanced CT value (AUC 0.696,sensitivity 85.7%,specificity 64.7%).The combinations of the three indicators or the plain CT value and the enhanced CT value had better diagnostic efficiency,with sensitivity of 100.0% for both,and specificities of 90.9% and 84.6%,respectively,which were superior to each of the single indicator.Conclusion For adrenal space-occupying lesions,patient’s with BMI<24 kg/m^2,tumor on the left,tumor diameter>5.05 cm,plain CT value>17.5 HU and enhanced CT value>48.5 HU are more likely to be diagnosed as pheochromocytoma.The diagnostic efficiency of combined application of indicators is better than the single indicators.
作者
陈微
谷伟军
刘颖姝
刘义欣
彭璐
李乐乐
杨国庆
杜锦
巴建明
吕朝晖
母义明
窦京涛
林阑
CHEN Wei;GU Weijun;LIU Yingshu;LIU Yixin;PENG Lu;LI Lele;YANG Guoqing;DU Jin;BA Jianming;LYU Zhaohui;MU Yiming;DOU Jingtao;LIN Lan(Department of Endocrinology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Internal Medicine,Xing An Meng People's Hospital,Ulan Hot 137400,Inner Mongolia Autonomous Region,China;Department of Endocrinology,Dalian Central Hospital,Dalian 116021,Liaoning Province,China;Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Endocrinology,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;Department of Radiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)
出处
《解放军医学院学报》
CAS
2020年第2期151-155,共5页
Academic Journal of Chinese PLA Medical School
