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目的分析原发性肾上腺皮质腺癌(ACC)的 CT 表现及其动态增强特征,以提高其诊断准确性。方法回顾性分析经手术病理证实的 ACC 11例,术前均经 CT 平扫、动脉期(30 s)和门静脉期(70～80 s)扫描,复习 CT 扫描表现并和手术病理作对照。结果 11例 ACC 中,右侧5例,左侧6例。直径4.1～16.0 cm,其中,<5.0 cm 者2例,5.0～10.0 cm 者4例,>10.0 cm 5例;肿瘤境界清楚3例,邻近脂肪间隙见条索状异常密度影3例,邻近实质脏器受侵犯5例。肿瘤实质成分平扫、动脉期和门静脉期 CT 值分别为21.9～46.7 HU(平均35.3 HU)、30.5～65.8 HU(平均47.1 HU)和52.6～97.0 HU(平均74.2 HU)。肿瘤中央坏死形成假囊肿4例,网络状改变6例,实质为主伴小囊变1例;6例网络状改变者动脉期可见显著强化的不规则肿瘤血管。结论 ACC 具有较明显的形态学和血液动力学特征,动态增强扫描尤其是动脉期扫描有明显的诊断价值。
Objective To analyze the CT features and dynamic enhancement features of primary adrenocortical adenocarcinoma (ACC) in order to improve its diagnostic accuracy. Methods A retrospective analysis of 11 patients with pathologically confirmed ACC was performed. All patients underwent CT scan, arterial phase (30 s) and portal vein phase (70-80 s) before operation. The CT findings were reviewed and compared with the surgical pathology. Results In the 11 cases of ACC, there were 5 cases on the right side and 6 cases on the left side. The diameter of the tumor ranged from 4.1 to 16.0 cm. Among them, 2 cases were less than 5.0 cm, 5 cases were 5.0-10.0 cm, and 5 cases were> 10.0 cm. The tumor was clear in 3 cases, and 3 cases were adjacent to the fat gap. Organ invasion of 5 cases. The CT features of the tumor were 21.9 ~ 46.7 HU (average 35.3 HU), 30.5 ~ 65.8 HU (average 47.1 HU) and 52.6 ~ 97.0 HU (average 74.2 HU), respectively. Central tumor necrosis in 4 cases of pseudocyst formation, network changes in 6 cases, in essence, accompanied by small capsule change in 1 case; 6 cases of network changes were visible in the arterial phase was significantly enhanced irregular tumor blood vessels. Conclusion ACC has obvious morphological and hemodynamic characteristics, dynamic enhanced scanning, especially arterial phase scanning has obvious diagnostic value.