| PrefaceThe structure of adrenal gland is complex. The adrenal gland is small and in the retroperitoneal, the connection of adrenal and surrounding organs is close. Adrenal gland masses consist of multi - kinds tumor, different age patients can occur adrenal tumor. Metastatic lesions often occur in adrenal. The remedy of different adrenal masses is distinct. In the previously study regularly differentiate an adenoma from non - adenoma, lack of detailed classifying. The aim of our study was to evaluate the characteristic of hyperfunctioning adrenal tumor by multi — phase enhanced multislice spiral CT ( MSCT) and MPR.Materials and MethodsFrom March 2004 to March 2005,113 patients performed enhanced MSCT because of different seasons. The group comprised 59 female and 54 male, who ranged in age from 13 to 84 years ( mean, 43.9 years). Proof of individual case was based on clinic diagnosis and pathology, in six months patients within primary malignant tumor was found new adrenal masses as proof of metastases. All cases performed enhanced MSCT using GE lightspeed 16 CT, to look into images and perform MPR in AW4. 1 or 4.2 station. To measure the diameter and CT attenuation value of adrenal masses, calculate percentage enhancement washout and relatively percentage enhancement washout. Using independent sample t test compared the multi - phase enhanced CT attenuation value, percentage enhancement washout and relatively percentage enhancement washout.0Result26 patients with aldosteronomas (28 masses) , two patients with unilateral multi - masses. 10 patients with cortisolomas. Unenhanced and enhanced CT attenuation value of aldosteronomas less than cortisolomas, there was no difference between the percentage enhancement washout of the two groups, the relatively percentage enhancement washout of aldosteronomas was significantly greater than cortisolomas. 13 patients with non - hyperfunctioning adrenal adenomas ( 14 masses) , one case with multi - masses. Non - hyperfunctioning compared with cortisolomas, there was not significantly difference between the two groups in the unenhanced CT attenuation value percentage enhancement washout and relatively percentage enhancement washout, but the difference of the attenuation value of Artery - phase Vein - phase enhanced CT and delayed - enhanced CT is little. 6 patients with metastatic carcinomas, 3 cases with multi - masses. No difference between metastatic carcinomas and non - hyperfunctioning adrenal adenomas in unenhanced CT attenuation values Vein - phase enhanced CT attenuation value. Compared with non - hyperfunctioning adrenal adenomas, the Artery - phase enhanced CT and delayed - enhanced CT attenuation value of metastatic carcinomas was higher than non - hyperfunctioning adrenal adenomas. The percentage enhancement washout and the relatively percentage enhancement washout of non - hyperfunctioning adrenal adenomas was higher than metastatic carcinomas. 12 patients with pheochromocytomas, compared with metastatic carcinomas the difference of attenuation value of Artery - phase Vein - phase enhanced CT is little. No difference between the two groups in the other parameters. For cortisolomas and pheochromocytomas, there was significantly difference between the two groups.DiscussionAdrenal gland diseases are very complex, whose diagnoses include determination of the nature, pathogeny factors, and the location of tumor. Adrenalgland tumor is relative often seen in the statistics of epidemic, with the broad clinical application of abdomen CT examination, the detection ratio of adrenal gland tumor is increasing gradually. The exact determination of nature and location diagnosis of adrenal gland tumor is very important to the treatment and prognosis. Due to the small cubage of the adrenal gland itself, some tumors like aldosteronomas is also in small cubage, thin slice images and MPR are advantageous to the tumor s detection and accurate location, and at the same time, reduce the false positive ratio in the diagnosis. MPR coronary and sagittal images could show clearly the relationship between adrenal gland tumor and its surrounding orangs and vascular, this information could help in plan establishment of the laparoscopic adrenalectomy operation and the choice of operative route. The cubage of adrenal gland is small, but with complex blood supply, 3D images could help in improving the show of artery and vena in adrenal gland.The unenhanced CT attenuation value of aldosteronomas is evenly low. With enhanced CT. it shows uniform, dotted and short stripped intensification change, classic edge thin - slice circle intensification is caused by the abundant vascular under the adenoma's fine layer - fibrous capsule. In this research, two groups - aldosteronomas and cortisolomas are compared. No difference between them in percentage enhancment washout, aldosteronomas group is higher than cortisolomas group in relative percentage enhancement washout, considered to be caused by the reason that the fat ingredient in aldosteronomas is higher than cortisolomas, and the cubage of aldosteronomas is relative smaller in this research. The report to the aldosteronomas s changes near cortex and opposite side adrenal gland has different sayings in the literature, according to our observation in this research, the aldosteronomas near and opposite side adrenal gland body has no notable thinning changes.The unenhanced CT attenuation value of cortisolomas is even, enhanced CT shows slight to medium intensification, surrounding and opposite side adrenal atrophy. In this research, vein - phase enhanced CT tumor shows obviously uniform intensification, with means of enhanced attenuation value 104.38Hu. Nonfunctional adenoma mostly originate from normal functional cortex and have no cortisol increase appearance, hence tumor's characteristic of CT and contrastcleanup rule show similarities with cortisolomas, but no surrounding and opposite side adrenal gland atrophy appearance. Although some difference in two groups'enhanced CT attenuation values of in each phase, p values are all near 0. 05, which could not been excluded from the point that this difference is caused by the small amount of cases. Cortisolomas and pheochromocytoma originate greatly different, hence have different blood supply, their difference are obvious.Pheochromocytoma has abundant blood supply and the enhanced CT shows notable intensification. In this research the average diameter of pheochromocytoma is 51. 84mm (27.2 - 113mm) , Artery - phase enhanced CT attenuation values average in 90. 89Hu (51. 96 - 141. 37Hu) , Vein - phase enhanced CT attenuation values average in 90. 07Hu (76.42 - 102. 48Hu). There exist great difference between cortisolomas and pheochromocytoma, which relates with their different histology origins and vascular configuration. There are miner differences between pheochromocytoma and metastatic tumor. The writer thinks that pheochromocytoma originates from medulla, and metastatic tumor forms tubercle also firstly from medulla, there exist common place in blood supply, but pheochromocytoma has abundant vessels, so it shows obvious intensification in tremulous pulse.Adrenal gland metastatic tumor mostly shifts from blood circulation. According to the statistic, tumor locks pervading from blood channels to adrenal gland, stay mostly in medulla and form primitive transfer tubercle, hence there exists difference between metastatic tumors blood supply and nonfunctional adenomas that originates from adrenal cortex. In this research, nonfunctional adenomas group in both absolute and relative percentage enhancement washout were higher than the metastatic tumor group. Szolor etc. has mentioned in the literature that, adenoma contrast medium's primitive premature and fast expurgation may have relationship with adenoma's different vascular configuration, cytomem-brane integrity, and the changes of extra vascular space, but details are not reported.In our research, the sample sizes in cortisolomas, pheochromocytoma, and metastatic tumor are relative small. The effect of functional adrenal gland tumorto near and opposite side gland has not been evaluated in quantification. Besides , due to the relative small amount of adrenal hyperplasia cases, further a-nalysis has not been investigated.Conclusion1. MSCT thin slice images and MPR can improve the detect ratio of the little adrenal tumor and reduce the false positive ratio. We suggest performing CT with 2mm thickness and regularly using MPR. It need to strictly control breathing.2. The unenhanced CT attenuation value of aldosteronomas was lower, Artery - phase enhanced CT attenuation value heightened little, Vein - phase enhanced CT attenuation value heightened remarkably, but lower than normal adrenal , delayed enhanced CT attenuation value descended rapidly. The surrounding adrenal gland of mass changed little.3. The unenhanced CT attenuation value of cortisolomas was similar to adrenal gland. Enhanced CT tumor enhanced equably. The percentage enhancement washout of cortisolomas was similar to non - hyperfunctioning adrenal adenomas, but the surrounding gland of tumor was atrophy.4. The size of pheochromocytomas was large, unenhanced attenuation value was similar to adrenal gland or higher. Artery - phase enhanced CT enhanced obviously; Vein - phase enhanced CT attenuation value was similar to Atery -phase; Delayed enhanced CT attenuation value declined slowly. Percentage enhancement washout and relatively percentage enhancement washout was lower.5. Non - hyperfunctioning adrenal adenomas and metastatic carcinomas unenhanced CT attenuation value was similar to adrenal gland. The Artery - phase enhanced CT attenuation value of metastatic carcinomas was greater than non -hyperfunctioning adrenal adenomas, it's percentage enhancement washout and relatively percentage enhancement washout was lower than non - hyperfunctioning adrenal adenomas.In conclusion, there is little value for hyperfunctioning adrenal masses with the characteristic of single - phase enhanced CT and single parameter. It has... |
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