本文選題：腎上腺嗜鉻細胞瘤 + X線計算機斷層攝影術(shù)�。� 參考：《山西醫(yī)科大學》2013年碩士論文

【摘要】：目的：探討腎上腺無功能嗜鉻細胞瘤的CT表現(xiàn)特征,結(jié)合其手術(shù)病理結(jié)果進行對照研究,以提高對其診斷的準確性；分析腎上腺無功能嗜鉻細胞瘤與其他無功能腎上腺腫瘤的鑒別診斷問題。 研究對象與方法：收集山西醫(yī)科大學第一醫(yī)院2009年10月—2013年2月期間經(jīng)病理證實并臨床資料完整的無功能嗜鉻細胞瘤14例(均經(jīng)手術(shù)病理證實),腎上腺神經(jīng)源性腫瘤18例(腎上腺節(jié)細胞瘤15例、神經(jīng)鞘瘤2例,神經(jīng)纖維瘤1例),腎上腺無功能腺瘤28例,轉(zhuǎn)移瘤10例,其中4例為雙側(cè)病灶,共70例,74個病灶,其中男性患者31例,女性患者39例,年齡8-82歲,中位年齡44歲。使用Light Speed VCT64層螺旋CT掃描儀掃描,層厚0.625mm,螺距0.984mm；對所有病例均行CT平掃及隨后30s、70s、3min動態(tài)增強掃描,所有病例均經(jīng)手術(shù)或腹腔鏡病理證實,或動態(tài)隨訪觀察得以確診。分析各組病灶影像表現(xiàn),包括腫瘤大小、形態(tài)、邊緣、位置、鈣化、出血、囊變、密度均勻性等。測量各期腫瘤實質(zhì)平均CT值,各組間比較并繪制成時間-密度(T-D)曲線并歸類。采用SPSS13.0統(tǒng)計軟件包對上述數(shù)據(jù)進行方差分析和卡方檢驗,統(tǒng)計學意義標準為P0.05。 結(jié)果：腎上腺無功能嗜鉻細胞瘤一般為類圓形,邊界清楚,實質(zhì)密度不均勻,部分病灶內(nèi)可出現(xiàn)囊性變及血管穿行征與其他無功能性腎上腺腫瘤比較有統(tǒng)計學意義(P0.05)。腎上腺無功能嗜鉻細胞瘤與其他無功能性腎上腺腫瘤在平掃及增強掃描各期CT值比較均有統(tǒng)計學意義(P0.05),腎上腺無功能嗜鉻細胞瘤平掃密度高于節(jié)細胞神經(jīng)瘤和無功能腺瘤,而在增強掃描3期均高于腎上腺節(jié)細胞神經(jīng)瘤。無功能嗜鉻細胞瘤的T-D曲線類型分布存在統(tǒng)計學差異(P0.05)。嗜鉻細胞瘤多表現(xiàn)為D型,腎上腺節(jié)細胞瘤多表現(xiàn)為A型曲線,其他無功能性腫瘤表現(xiàn)為B、C、D型。 結(jié)論：腎上腺無功能嗜鉻細胞瘤無特異性兒茶酚胺增高的臨床表現(xiàn)。其MSCT多期掃描具有一定的特點,尤其是腎上腺無功能嗜鉻細胞瘤的時間-密度曲線類型對其診斷及鑒別具有重要價值；腫瘤形態(tài)、邊界及瘤內(nèi)囊變壞死對腫瘤鑒別診斷也可以起到一定的幫助。MSCT多期掃描能夠為腎上腺無功能嗜鉻細胞瘤定性診斷及治療提供必要的影像學支持和建議。
[Abstract]:Objective: to investigate the CT features of adrenal nonfunctional pheochromocytoma and to improve the accuracy of diagnosis. To analyze the differential diagnosis between adrenal nonfunctional pheochromocytoma and other non-functional adrenal tumors. Participants and methods: 14 cases of nonfunctional pheochromocytoma confirmed by pathology and complete clinical data were collected from the first Hospital of Shanxi Medical University from October 2009 to February 2013. 18 cases of sex tumors (15 cases of adrenal ganglionoma, 15 cases of adrenal ganglioma) There were 2 cases of schwannoma, 1 case of neurofibroma, 28 cases of adrenal nonfunctional adenoma, 10 cases of metastatic tumor. Among them, 4 cases were bilateral lesions, 70 cases were bilateral lesions, 74 lesions were found, among which 31 cases were male and 39 cases were female, aged 8-82 years. The median age was 44 years. Light Speed VCT64 slice spiral CT scanner was used, the slice thickness was 0.625 mm and the pitch was 0.984mm. All cases were examined by plain CT scan and dynamic enhanced CT scan for 30 s (70 s / 3 min). All cases were confirmed by operation or laparoscopy pathology or dynamic follow-up observation. The size, shape, edge, location, calcification, hemorrhage, cystic degeneration and density homogeneity of the lesions were analyzed. The mean CT value of tumor parenchyma in each stage was measured and compared and plotted into time-density curve and classified. The variance analysis and chi-square test of the above data were carried out by SPSS13.0 statistical software package, and the statistical significance standard was P0.05. Results: the adrenal nonfunctional pheochromocytoma was generally round with clear boundary and uneven density. Cystic degeneration and vascularization sign were found in some lesions compared with other nonfunctional adrenal tumors (P 0.05). The CT values of non-functional pheochromocytoma and other non-functional adrenal tumors were significantly higher than those of ganglioneuroma and nonfunctional adenoma on plain scan and contrast-enhanced scanning (P 0.05), and the density of non-functional pheochromocytoma was higher than that of ganglioneuroma and nonfunctional adenoma. In contrast, it was higher in contrast enhanced scan than that in adrenal ganglioneuroma. There was a statistical difference in the distribution of T-D curve types in nonfunctional pheochromocytoma (P0.05). Most pheochromocytoma showed type D, adrenal ganglionoma showed type A curve, and other nonfunctional tumors showed type D. Conclusion: there is no specific elevation of catecholamine in adrenal nonfunctional pheochromocytoma. The MSCT multiphase scanning has some characteristics, especially the time-density curve type of adrenal non-functional pheochromocytoma has important value in diagnosis and differentiation. Boundary and intratumoral cystic necrosis may also be helpful for differential diagnosis. MSCT multiphase scanning can provide necessary imaging support and advice for the qualitative diagnosis and treatment of adrenal nonfunctional pheochromocytoma.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R816.7;R736.6

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