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CharacterizationofLipid-PoorAdrenalAdenoma:Chemical-ShiftMRIandWashoutCT魏江漫2015-05
12022/10/30肾上腺左右各一，位于肾的上方，共同为肾筋膜和脂肪组织所包裹。左肾上腺呈半月形，右肾上腺为三角形。肾上腺两侧共重约30g。从侧面观察，腺体分肾上腺皮质和肾上腺髓质两部分，周围部分是皮质，内部是髓质。两者在发生、结构与功能上均不相同，实际上是两种内分泌腺。
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32022/10/30球状带：醛固酮束状带：皮质醇网状带：性激素髓质：肾上腺素、去甲肾上腺素
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23adenomascontainabundantintracytoplasmiclipid,andthusapproximately70%-----10HUAdrenalAdenomaapproximately30%ofadrenaladenomasarelipid-poor--------greaterthan10HUWashoutCTcharacterizestheselipid-pooradenomaswithsensitivityofalmost100%Chemical-shiftMRIisalsousefulincharacterizingadrenaladenomasthesensitivityformorethan30HUispoorfordifferentiatingadenomasfromnonadenomas
24WashoutCTexaminationsTwo-phasecontrast-enhancedCTperformedat1minute(earlycontrast-enhancedCT)and15minutes(delayedcontrast-enhancedCT)afteradministrationofcontrastmaterial
2573-year-oldwomanwithhistoryofbreastcancerandleftadrenallipid-pooradenomaUnenhancedCTscanshowsleftadrenalmassthatmeasured29HEnhancedCTscanshowsleftadrenalmassthatmeasured73HDelayedenhancedCTscanshowsleftadrenalmassthatmeasured44HEnhancementwashout=29H(73H–44H)enhancement=44H(73H–29H)Percentageenhancementwashout=66%[(enhancementwashout/enhancement)=(29/44)×100]增强后定量参数：
26MeanEnhancementEnhancementWashout平均增强排泄率肾上腺富脂，乏脂腺瘤和非腺瘤增强参数比较
27直方图肾上腺富脂，乏脂腺瘤和非腺瘤增强参数比较富脂乏脂非腺瘤
28Chemical-shiftMRIForallmassesidentifiedonMRimages,theadrenal-to-spleenratio(ASR)wascalculatedasASR=(SIAO/SISO)/(SIAI/SISI),whereSIAOwasthesignaltensityoftheadrenalmassonopposed-phaseimages,SISOwasthesignalintensityofthespleenonopposed-phaseimages,SIAIwasthesignalintensityoftheadrenalmassonin-phaseimages,andSISIwasthesignalintensityofthespleenonin-phaseimages.Thesignalintensityindex(SII)wascalculatedasSII=(SIAI−SIAO)·100/SIAI.
292022/10/30ASRandSIIoflipid-pooradenomasrangedfrom0.35to1.33(0.79±0.24)andfrom−38.7%(−24,000/620)to71.8%(11,700/163)(30.8±25.5%),SIIwasbetterthanASRforcharacterizingadenomas
30GraphshowsMRIsensitivityforlipid-pooradenomas随着腺瘤CT值增加MRI敏感性逐渐下降MRIsensitivityforlipid-pooradenomasmeasuringgreaterthan10HUand20HUorlessonunenhancedCTis100%,whereassensitivitiesforlipid-pooradenomasmeasuringgreaterthan20,greaterthan30,andgreaterthan40HUdecreasesto64.0%,61.5%,and40%,respectively
31GraphshowsCTandMRIsensitivitiesforlipid-pooradenomas直方图显示乏脂类腺瘤MRI和CT诊断灵敏性
32Unenhanced20HU
33平扫16HU早期50HU延迟期19HU同相位反相位Lipid-pooradenomain77-year-oldmanAdrenal-to-spleenratioandsignalintensityindexoflesionare0.463and50.1%,respectively,consistentwithadenoma
34Lipid-pooradenomain70-year-old平扫34HU123HU延迟期45HU同相位反相位Adrenal-to-spleenratioandsignalintensityindexoflesionare1.139and−10.3%,respectively,whicharenotconsistentwithadenoma
352022/10/307O-year-oldmanwithadrenaladenoma.-5HUOninitialenhanced52HU15-mmdelayedenhancedCT10HU
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372022/10/30ExclusionofPheochromocytomaUsingCTAttenuationandWashoutCriteria
382022/10/301、plasmaandurinarymetanephrinesorcatecholamines血浆和尿肾上腺素和儿茶酚胺2、1-minuteenhancedattenuationminusunenhancedattenuationpheochromocytoma3、Noadenomawasmorethan85-HUenhancinginthearterialphase.Morethanonehalf(7/12,58%)ofpheochromocytomasexceeded110HUinthearterialphase,thesamenumberexceeding110HUinthevenousphase.
392022/10/30unenhancedCT(35HU)1-minutecontrast-enhancedCT(221HU)15-minutecontrast-enhancedCT(93HU).Masswashistologicallyconfirmedpheochromocytoma
402022/10/3055-year-oldmanwithlipid-richadenoma.-3HU30HUinarterialphase62HUinvenousphase
412022/10/3054-year-oldmanwithpathologicallyprovenpheochromocytoma.121HUinarterialphaseand113HUinvenousphase.Thisenhancementlevelandpatternwereseenwith25%(3/12)ofpheochromocytomasandnoadenoma.
422022/10/3051-year-oldwomanwith2.6-cmfunctioningadenomainrightadrenalarterialphase(A)enhancementof81HUandvenousphase(B)enhancementof133HU.Venousphaseenhancementgreaterthan110HUwasidentifiedin7%(3/41)ofadenomas.
432022/10/30arterialphaseenhancementof42HUandvenousphaseenhancementof68HU.Thispatternwasseenwith42%(5/12)ofpheochromocytomasand85%(35/41)ofadenomas.66-year-oldmanwith3.2-cmhomogeneous-appearingleftadrenalpheochromocytomathatmimicsadenomaenhancementlevelsandpattern
442022/10/30adrenalmetastasis90%ofadenomasexhibitahomogeneousorringenhancementpatternand60%ofmalignantlesionshaveaheterogeneouspattern.chemicalshiftimaging(CSI)
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462022/10/30adrenaladenomaadrenalmetastasis
47InconclusionwashoutCTismoreaccuratethanchemical-shiftMRIforlipid-pooradenomacharacterizationMRIisquivalenttoCTincharacterizingadenomasmeasuring10–20HUonunenhancedCTCTisrecommendedinpatientswithlipid-pooradrenaladenomasthatmeasuregreaterthan20HUMRImaybeconsideredasthefirst-lineexaminationforpatientswithincidentaladrenaladenomasmeasuring20HUorlessifcontrast-enhancedCTiscontraindicated
482022/10/30谢谢大家
4944-year-oldwomanwithlipid-pooradenoma.30HUonunenhanced72HUonarterialphase127HUonvenousphaseimages
