肾上腺皮质腺瘤和皮质增生结节的超声造影特征分析
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摘要
目的·探讨最大径>10 mm肾上腺皮质腺瘤和皮质增生结节的超声造影图像特征及其诊断价值。方法·回顾性分析经病理证实的50例最大径>10 mm的肾上腺皮质腺瘤和22例皮质增生结节,记录常规超声及超声造影图像特征,包括大小、边界等,造影剂到达时间,达峰时间,消退时间,增强程度[低、高(等)增强],增强方式(周边向中央增强、整体增强、无特殊形式)等。结果·2组结节在常规超声特征中未见显著差异。超声造影多参数分析结果表明,消退时间在2组间的差异有统计学意义(P=0.002),其受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.694,诊断阈值42 s的灵敏度为75.7%,特异度为53.3%。结论·肾上腺皮质腺瘤和皮质增生结节的超声造影图像未能提示显著鉴别诊断模式,但可为鉴别诊断提供一定信息。
Objective · To explore the features of contrast-enhanced ultrasound(CEUS) image of adrenal cortical adenoma and cortical hyperplasia nodules(size greater than 10 mm) and its diagnostic value. Methods · Fifty cases of adrenal cortical adenoma and 22 cases of cortical hyperplasia nodules which were confirmed by pathology were retrospectively analyzed. The conventional ultrasound and CEUS features were recorded, including the size,border,arrival time, peak time, wash-out time, enhancement degree [hypo, hyper(iso-)],enhancement pattern(peripheral to central,overall,and nonspecific), etc. Results · There was no significant differences between two groups among conventional ultrasonic features. Multi-parameters of CEUS images analysis results showed that the wash-out time of cortical adenomas were significantly longer than the cortical hyperplasia nodules(P=0.002),the under area of the receiver operating characteristic(ROC) curve was 0.694, had the 75.7% sensitivity and 53.3% specificity with the cutoff of 42 s.Conclusion · There is no significant difference between the adrenal cortical adenoma and cortex hyperplasia nodules in CEUS pattern, but it still can provide certain information for differentiation.
Objective · To explore the features of contrast-enhanced ultrasound(CEUS) image of adrenal cortical adenoma and cortical hyperplasia nodules(size greater than 10 mm) and its diagnostic value. Methods · Fifty cases of adrenal cortical adenoma and 22 cases of cortical hyperplasia nodules which were confirmed by pathology were retrospectively analyzed. The conventional ultrasound and CEUS features were recorded, including the size,border,arrival time, peak time, wash-out time, enhancement degree [hypo, hyper(iso-)],enhancement pattern(peripheral to central,overall,and nonspecific), etc. Results · There was no significant differences between two groups among conventional ultrasonic features. Multi-parameters of CEUS images analysis results showed that the wash-out time of cortical adenomas were significantly longer than the cortical hyperplasia nodules(P=0.002),the under area of the receiver operating characteristic(ROC) curve was 0.694, had the 75.7% sensitivity and 53.3% specificity with the cutoff of 42 s.Conclusion · There is no significant difference between the adrenal cortical adenoma and cortex hyperplasia nodules in CEUS pattern, but it still can provide certain information for differentiation.
引文
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[11]Friedrich-Rust M,Glasemann T,Polta A,et al.Differentiation between benign and malignant adrenal mass using contrast-enhanced ultrasound[J].Ultraschall Med,2011,32(5):460-471.
[12]Park SY,Park BK,Park JJ,et al.Differentiation of adrenal hyperplasia from adenoma by use of ct densitometry and percentage washout[J].AJR,2016,206(1):106-112.
[13]Becker-Weidman D,Kalb B,Mittal PK,et al.Differentiation of lipid-poor adrenal adenomas from non-adenomas with magnetic resonance imaging:Utility of dynamic,contrast enhancement and single-shot T2-weighted sequences[J].Eur J Radiol,2015,84(11):2045-2051.
[14]Yip L,Tublin,ME,Falcone JA,et al.The adrenal mass:correlation of histopathology with imaging.Ann Surg Oncol,2010,17(3):846-852.
[2]杨筱,姜玉新,孟华,等.超声诊断ACTH非依赖性肾上腺皮质大结节样增生[J].中国医学影像技术,2011,27(2):349-352.
[3]Dietrich CF,Ignee A,Barreiros AP,et al.Contrast-enhanced ultrasound for imaging of adrenal masses[J].Ultraschall Med,2010,31(2):163-168.
[4]Fan J,Tang J,Fang JB,et al.Ultrasound imaging in the diagnosis of benign and suspicious adrenal lesions[J].Med Sci Monit,2014,20:2132-2141.
[5]Inan N,Arslan A,Akansel G,et al.Dynamic contrast enhanced MRI in the differential diagnosis of adrenal adenomas and malignant adrenal masses[J].Eur J Radiol,2008,65(1):154-162.
[6]Wale DJ,Wonga KK,Viglianti BL,et al.Contemporary imaging of incidentally discovered adrenal masses[J].Biomed Pharmacother,2017,87:256-262.
[7]Slapa RZ,Jakubowski WS,Dobruch-Sobczak K,et al.Standards of ultrasound imaging of the adrenal glands[J].J Ultrason,2015,15(63):377-387.
[8]伍瑛,杜联芳,李凡,等.超声造影在肾上腺肿瘤的应用价值[J].临床超声医学杂志,2008,10(1):16-18.
[9]Slapa ZA,Kasperlik-Zaluska AA,Migda B,et al.Application of parametric ultrasound contrast agent perfusion studies for differentiation of hyperplastic adrenal nodules from adenomas-initial study[J].Eur J Radiol,2015,84(8):1432-1435.
[10]Friedrich-Rust M,Schneider G,Bohle RM,et al.Contrast-enhanced sonography of adrenal masses:differentiation of adenomas and nonadenomatous lesions[J].AJR,2008,191(6):1852-1860.
[11]Friedrich-Rust M,Glasemann T,Polta A,et al.Differentiation between benign and malignant adrenal mass using contrast-enhanced ultrasound[J].Ultraschall Med,2011,32(5):460-471.
[12]Park SY,Park BK,Park JJ,et al.Differentiation of adrenal hyperplasia from adenoma by use of ct densitometry and percentage washout[J].AJR,2016,206(1):106-112.
[13]Becker-Weidman D,Kalb B,Mittal PK,et al.Differentiation of lipid-poor adrenal adenomas from non-adenomas with magnetic resonance imaging:Utility of dynamic,contrast enhancement and single-shot T2-weighted sequences[J].Eur J Radiol,2015,84(11):2045-2051.
[14]Yip L,Tublin,ME,Falcone JA,et al.The adrenal mass:correlation of histopathology with imaging.Ann Surg Oncol,2010,17(3):846-852.