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目的回顾性比较肾细胞癌(RCC)和肝细胞癌(HCC)病人肾上腺转移瘤与肾上腺腺瘤的绝对及相对廓清率。材料与方法本研究经机构审查委员会批准(免除知情同意),自1994年11月—2011年8月期间收集16例病人的19个肾上腺转移瘤(16个来源于13例RCC病人,3个来源于3例HCC病人)及20例病人的21个肾上腺腺瘤(16个来源于15例RCC病人,5个来源于5例HCC病人),所有病人均采用专用肾上腺扫描参数,包括平扫、增强后1min和15min延迟增强CT扫描。计算衰减值及增强廓清百分比,包括绝对廓清百分比(APW)和相对廓清百分比(RPW)。信息可用的情况下对肾上腺病灶的组织学结果及大小改变进行评估。采用广义估计方程和变异系数进行统计学分析。结果观察者1发现转移瘤与腺瘤的平均APW[(67±11)%∶(73±9)%]差异无统计学意义,而观察者2发现两者间差异有统计学意义[(63±12)%∶(72±12)%;P=0.029]。转移瘤的平均RPW[观察者1,(46±11)%;观察者2,(43±12)%]显著低于腺瘤[观察者1,(62±19)%;观察者2,(60±17)%](均P<0.001)。当APW阈值为60%或RPW阈值为40%时,95%(18/19)及89%(17/19)的转移瘤分别被两个观察者误诊为乏脂性腺瘤。经CT随访的共9个转移瘤均有体积的显著增大。结论对RCC和HCC病人的已知肾上腺病灶行肾上腺专用CT成像,肾上腺转移瘤的增强廓清百分比与乏脂性肾上腺腺瘤类似。详细的影像随访或病理组织学确诊是必要的。
Objective To retrospectively compare the absolute and relative clearance rates between adrenal metastases and adrenal adenomas in patients with renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC). Materials and Methods The study was approved by the Institutional Review Board (informed consent was waived) and 19 adrenal metastases from 16 patients (16 from 13 RCC patients and 3 sources from November 1994 to August 2011 were collected In 3 HCC patients) and 21 adrenal adenomas in 20 patients (16 from 15 RCC patients and 5 from 5 HCC patients). All patients underwent adrenalectomy scan parameters including plain scan, enhanced Post-1min and 15min delayed enhancement CT scan. The attenuation values and enhanced clearance percentages were calculated, including absolute clearance percentage (APW) and relative clearance percentage (RPW). Histological findings and size changes of adrenal lesions were evaluated with information available. The generalized estimation equation and coefficient of variation were used for statistical analysis. Results Observer 1 found no significant difference between the mean APW of metastases and adenomas (67 ± 11% vs 73 ± 9%), while observer 2 found a statistically significant difference [(63 ± 12)%: (72 ± 12)%; P = 0.029]. The mean RPW of metastases [observer 1 (46 ± 11)%; observer 2 (43 ± 12)%] was significantly lower than that of adenomas [observer 1 (62 ± 19)%; observer 2, ( 60 ± 17)%] (all P <0.001). When APW threshold was 60% or RPW threshold was 40%, 95% (18/19) and 89% (17/19) metastases were misdiagnosed as lazy lip adenoma by two observers respectively. A total of 9 metastases by CT follow-up showed a significant increase in volume. CONCLUSIONS: Adrenal CT imaging of adrenal lesions of known adrenal lesions in patients with RCC and HCC is associated with an enhanced percentage clearance of adrenal metastases similar to that of a deficient adrenal adenoma. Detailed imaging follow-up or histopathological diagnosis is necessary.