肾上腺囊肿的CT诊断及误诊分析  

CT diagnosis and misdiagnosis analysis of adrenal cyst

作　　者：夏青[1] 余秋月 黎斌 王珊珊[2] 何玉麟[1] XIA Qing;YU Qiuyue;LI Bin;WANG Shanshan;HE Yulin(Department of Imaging,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Pathology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院影像科,江西南昌330006 [2]南昌大学第一附属医院病理科,江西南昌330006

出　　处：《实用放射学杂志》2020年第4期611-614,共4页Journal of Practical Radiology

摘　　要：目的提高肾上腺囊肿的术前CT诊断准确率.方法回顾性分析46例经手术病理证实的肾上腺囊肿的临床及CT影像资料,分析总结肾上腺囊肿的CT误诊原因.结果①CT表现:46例病例中,左侧21例,右侧25例;类圆形40例,分叶状4例,葫芦形1例,不规则形1例;病灶直径约1.4~12.4 cm,平均5.0 cm;病灶边界清楚;囊肿单房36例,多房10例;囊肿无钙化14例,囊壁或内部钙化32例;囊内CT值5~73 HU,平均16.9 HU.薄壁肾上腺囊肿增强扫描未见强化,而厚壁或有厚分隔的肾上腺囊肿其囊壁及分隔有不同程度的强化.②CT诊断结果:诊断为肾上腺囊肿17例;定位正确定性不正确26例,其中诊断为肾上腺原发肿瘤17例(2例为肿瘤合并出血),肾上腺良性囊性病变9例(未明确是囊肿还是良性肿瘤囊变);定位不准确3例,其中2例诊断为腹膜后囊肿,1例诊断为右肾囊肿.结论肾上腺囊肿的CT表现具有一定特征:肾上腺假性、内皮性及上皮性囊肿在CT上表现比较典型,呈肾上腺区圆形或类圆形水样密度结节或肿块,囊壁或分隔多有钙化,增强扫描无强化;肾上腺寄生虫性囊肿形态多不规则,呈多个囊状病灶聚集,囊壁及分隔亦可见钙化,增强囊内一般无强化.提高对肾上腺囊肿CT表现的认识对减少误诊非常重要,合理地结合其他临床资料对肾上腺囊肿的诊断有一定帮助.Objective To improve the diagnostic accuracy of preoperative CT examination of adrenal cysts.Methods The CT and clinical data of 46 cases with adrenal cyst confirmed by operation and pathology were analyzed retrospectively.Results① CT findings:out of 46 cases,21 on the left side and 25 on the right.The shape of the cyst was round like on 40 cases,while 4 of them were tabulated,1 was gourd shaped and 1 irregular shaped.The cyst presented with a clear boundary with a diameter ranging from 1.4 to 12.4 cm,with an average of 5.0 cm.While 10 cases were septated with multiple chambers,36 cases were single chambered.14 cases were non-calcificd and 32 cases were with calcified wall or septum.The CT value of cysts ranged from 5 to 73 HU,with an average of 16.9 HU.Thin-walled adrenal cysts showed no enhancement,while thick-wall or thick-septum of adrenal cysts had different degrees of enhancement.②CT diagnosis results:17 cases were diagnosed as adrenal cysts.26 cases were diagnosed as incorrect pathological types,including 17 cases of primary adrenal tumor(2 cases of primary tumor combined with hemorrhage)and 9 cases of benign cystic lesions of the adrenal gland(unclear cyst or benign tumor cyst).3 cases were not accurately positioned,2 cases were diagnosed as retroperitoneal cysts,and 1 case was diagnosed as right renal cyst.Conclusion The CT features of adrenal cysts are follows:the pseudo cyst,endothelial cyst and epithelial cyst of adrenal gland arc typical of round or quasi round water-like density nodules or masses in the adrenal region,with calcification on the wall or septum of the cyst without enhancement.Adrenal parasite cyst is irregular in shape,and the lesions arc made up of multiple cystic lesions.Calcification could be seen in the walls and septum,and there was generally no strengthening in the cyst.Improving the understanding of CT findings along with the help of clinical data could be helpful for the diagnosis of adrenal cysts.

关 键 词：肾上腺 囊肿 计算机体层成像 

分 类 号：R586[医药卫生—内分泌] R814.42[医药卫生—内科学]