腹膜后肾上腺外副神经节瘤与神经鞘瘤的临床及MRI特征比较  

Comparison of clinical and MRI characteristics between retroperitoneal extra-adrenal paraganglioma and schwannoma

作　　者：史平安 杜松良 李锐[3] 李萌[3] 许伟 李金锋[3] SHI Ping'an;DU Songliang;LI Rui;LI Meng;XU Wei;LI Jinfeng(Department of Endocrinology,Tianjin Hospital,Tianjin 300211,China;Department of Urology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Radiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]天津医院内分泌科,天津300211 [2]解放军总医院第一医学中心泌尿外科,北京100853 [3]解放军总医院第一医学中心放射诊断科,北京100853

出　　处：《解放军医学院学报》2021年第9期934-939,共6页Academic Journal of Chinese PLA Medical School

摘　　要：背景腹膜后肾上腺外副神经节瘤较为少见,需要与腹膜后神经鞘瘤相鉴别,其MRI特征的报道也较少。目的分析腹膜后肾上腺外副神经节瘤和神经鞘瘤的临床表现及MRI影像学特征,探讨MRI对两者的鉴别价值。方法回顾性分析2016年1月-2020年12月解放军总医院第一医学中心经手术切除且病理证实的腹膜后肾上腺外副神经节瘤37例和神经鞘瘤17例的临床表现和MRI图像特征。结果37例副神经节瘤患者中21例高血压,5例腹痛和腹部不适,11例为偶然发现;17例神经鞘瘤中2例高血压,15例为偶然发现。腹膜后副神经节瘤与神经鞘瘤病灶的位置、大小、直径比、边界、形态、质地、平均ADC值及T1WI预扫描信号强度等差异无统计学意义(P>0.05);而病变动脉期的强化程度及动脉期信号增强百分比差异有统计学意义(P<0.05)。副神经节瘤增强扫描表现为两类强化方式,动脉期轻度或中度至明显强化,静脉期及延迟期为持续性强化或强化降低,而神经鞘瘤表现为动脉期轻度至中度强化,静脉期及延迟期表现为持续强化。副神经节瘤3例出现液-液平面、4例瘤体内或瘤周可见血管流空影或纡曲血管影。结论腹膜后肾上腺外副神经节瘤和神经鞘瘤MRI表现各有其特点,肿瘤内部液-液平面、瘤内或瘤周可见血管流空影或纡曲血管影及动脉期强化模式有助于鉴别两者,结合临床特点可提高诊断效率。Background Retroperitoneal extra-adrenal paraganglioma is relatively uncommon,which needs to be differentiated from retroperitoneal schwannoma,and its MRI features are relatively limited.Objective To analyze the clinical characteristics and MR imaging features of retroperitoneal extra-adrenal paraganglioma and schwannoma,and explore the diagnostic value of MRI.Methods From January 2016 to December 2020,clinical data and MRI features of 37 cases with retroperitoneal extra-adrenal paragangliomas and 17 cases with schwannomas confirmed by pathology admitted to the First Medical Center of Chinese PLA General Hospital were retrospectively reviewed.Results Of the 37 patients with paraganglioma,21 cases had hypertension,5 cases had abdominal pain and abdominal discomfort,and 11 cases were discovered incidentally.Of the 17 patients with schwannoma,2 cases had hypertension and 15 cases were discovered incidentally.There was no statistically significant difference between retroperitoneal extra-adrenal paraganglioma and schwannoma in lesion location,size,diameter ratio,boundary,shape,texture and average ADC value or signal intensity on Pre-LAVA T1WI(all P>0.05),while they had significant differences in enhancement degree in arterial phase and percentage arterial enhancement(PAE)(P<0.05,respectively).Paraganglioma showed two main contrast enhancement patterns,including mild or moderate to obvious enhancement in arterial phase,and persistent or“wash-out”enhancement in venous and delayed phase,while schwannomas presented mild to moderate enhancement in the arterial phase and showed persistent enhancement in the venous and delayed phases.Fluid-liquid level was found in 3 cases,and flow void or tortuous vascular shadows were found in or around the tumor in 4 cases.Conclusion Retroperitoneal extra-adrenal paraganglioma and schwannoma show different MR imaging characteristics.Fluid-fluid level,flow void or tortuous vascular shadows,and arterial phase enhancement pattern are helpful in distinguishing the two tumors,and the diag

关 键 词：腹膜后肿瘤 副神经节瘤 神经鞘瘤 临床特点 MRI表现 

分 类 号：R445[医药卫生—影像医学与核医学] R447[医药卫生—诊断学]