肾上腺损伤的影像学诊断特点  

Imaging diagnostic features of adrenal injury

作　　者：赵振国[1] 隋海晶[1] 谢秀海[1] 刘全明 盛畅[2] 吕福华[2] 谢平[2] 王锦文[1] 汪勤勇[1] 严正专[1] 

机构地区：[1]上海市浦东新区人民医院放射影像科,201200 [2]上海市浦东新区人民医院泌尿外科,201200 [3]浙江省温岭市中医院泌尿外科

出　　处：《中华泌尿外科杂志》2009年第2期85-89,共5页Chinese Journal of Urology

基　　金：基金项目：上海浦东卫生重点学科基金资助项目（PWZXK2007-14）

摘　　要：目的总结肾上腺损伤的影像学诊断特点。方法回顾性分析29例外伤性肾上腺挫伤及形成血肿患者的影像学表现。男20例，女9例。平均年龄37岁。患者临床表现腰背部疼痛、局部叩痛及伴发伤症状。右侧肾上腺损伤25例（86％）、左侧2例（7％）、双侧2例（7％）。相关内分泌检查均未见明显异常。行CT检查29例、MRI检查5例、超声检查6例，CT随访观察23例，MRI及超声复查各1例。结果29例患者中CT、MRI及超声首次检查符合率分别为97％（28／29）、100％（5／5）和50％（3／6）。1例单纯性右侧肾上腺血肿CT未确诊，经MRI检查确诊。肾上腺挫伤CT表现为肾上腺局限性或弥漫性肿大及灶性高密度出血影；急性期血肿表现为类圆形无强化高密度影，直径1～3cm，周围脂肪组织内可见不同程度的高密度索条影；1～26周CT复查示血肿密度逐渐减低，体积逐渐缩小至消失，无假性囊肿形成。5例亚急性及慢性期血肿MRI表现为T1WI、T2WI及DWI呈典型高信号，T2WI周边呈环形低信号，CT或MRI增强扫描时血肿不强化，与周边形成的环状高密度或高信号强化影形成特征性“坚果”样影像改变。3例肾上腺血肿超声表现为肾上腺低回声肿块，未见血流信号。结论CT是肾上腺挫伤及血肿首选的影像学检查方法，在患者病情发展转归中有其不同的影像学特点。对CT和超声诊断困难的病例MRI检查有助于正确诊断。Objective To discuss the imaging diagnostic features of adrenal injury. Methods The imaging features of the 29 patients of adrenal bruise and hematoma （20 male and 9 females, average age 37） were retrospectively analyzed. The clinical appearances were all flank and back pain, local sensitive to percus- sion and associated injury appearance. Among the 29 Cases, 25 cases（86%） had adrenal injuries on right side, 2 eases（7%） on left side, and 2 cases（7%） on both sides, and no apparent abnormality was found in the relevant endocrine examination after injury. CT （n= 29）, MRI （n= 5） and ultrasonography （n= 6） were checked. CT follow-up were taken in 23 cases. MRI （n= 1） and ultrasonography （n= 1） were followed as well. Results The first-time exam coincidences of CT, MRI and sonography were 28/29 （97%）, 5/5 （100%） and 3/6 （50%） respectively. One case of simple right-side adrenal hematoma 3 weeks after injury wasn＇t clearly diagnosed by CT, which was later diagnosed by MRI. The CT features of adrenal bruise were local or diffuse intumescence and focus high-density hemorrhage shadow. The CT appearances of acute stage adrenal hematoma were round-like high-density shadow without enhancement and the diameters were 1 -- 3cm. MRI appearances of 5 cases of subacute and chronic phase hematoma were typical high signal of TIWI, T2WI and DWI and toroid low signal around T2WI. Hematoma was not be enhanced when CT or MRI enhancement scanning, and formed characteristic ＂trot＇like＂ image feature with toroid high-density or high sighal enhanced shadow forming around. Ultrasonography appearances of 3 cases of hematoma were abnormal shadow of the adrenal gland. Conclusions CT is the prior imaging method for adrenal bruise and hemato- ma. MRI has the characteristic appearance for the few cases which are difficult to be identified by CT and ul- trasonography. Characteristic ＂nut-like＂ image feature is helpful for the diagnosis and differential diagnosis.

关 键 词：肾上腺 损伤 诊断显像 

分 类 号：R445[医药卫生—影像医学与核医学] R699[医药卫生—诊断学]