The Use Of Diffusion Weighted Imaging In The Differential Diagnosis Of Adrenal Tumor

Objective The adrenal gland is located in the retroperitoneal endocrine organ, composed of cortex and medulla, due to their anatomical location is deep, constitute a special structure, primary and secondary tumor types and more complex, making the diagnosis of the tumors is difficult.Before operation, if can accurately differentiate adrenal tumor character, operation scheme, the scheme for the treatment of postoperative formulation and evaluation of prognosis has important significance. According to the characteristics of the tumor, adrenal tumors were divided into benign and malignant tumors in two categories, X-ray diagnosis of tradition, are often unable to qualitative analysis of the nature of the tumor. According to previous reports in the literature, the accuracy of CT diagnosis of adrenal tumors was 65%, the accuracy rate of diagnosis of MRI tumor properties 85%.With the development of imaging technology, especially the wide application of MRI chemical shift imaging, diffusion and Popper and other functional imaging technique, which makes the rates continue to improve the diagnosis of adrenal tumors.Diffusion weighted magnetic resonance imaging diffusion reaction is movement of water molecules in the living tissue of water molecules, cells and blood perfusion is mainly caused by the different macroscopic diffusion state change.Through DWI and ADC worth of quantitative analysis, the value of magnetic resonance imaging in differential diagnosis of adrenal tumors.Materials and Methods Shangdong Province-owned Hospital in 2010 January to 2014 June were collected to accept 84 adrenal tumor patients with MR examination in the patients, including 2 cases of patients with ADC not included in the study because of missing image;Medullary lipoma and teratoma in 1 case, nerve sheath tumor in 2 cases, because of less number of cases is ruled out.A total of 78 patients were included in the study, in which 65 cases confirmed by surgery pathology, confirmed by follow-up of 13 cases;57 cases of benign tumors, according to the pathologic types are divided into different sub groups,28 cases of adrenocortical adenoma,22 cases of benign pheochromocytoma, ganglioneuroma in 7 cases;21 cases of malignancy, confirmed by follow-up of 6 months or more for metastases 13 cases (including 6 cases from lung cancer metastasis,3 cases of liver cancer metastasis,4 cases of renal carcinoma metastasis),8 cases of cortical adenocarcinoma;Male 38 cases, female 40 cases, age 13-74 years old, the average age of (47.1+14.6).Clinical manifestations or symptoms:13 cases with no obvious symptoms, the physical examination,28 patients with high blood pressure symptoms,16 cases of patients with symptoms of headache, heart palpitations, sweat, and anxiety,7 cases of patients with lumbar discomfort, physical examination, found that for 14 patients with malignant tumor in the rest of the check.Using Siemens 3.0T Verio magnetic resonance scanner, RF coil with body coil, surface coil for receiving abdominal phased array coil.The patients were breathing exercises before scanning, in order to ensure the successful completion of the scan. Patients take supine, head of advanced, scanning range includes to diaphragmatic level down to the renal hilum.Start with coronary scanning line positioning FIESTA sequence, then (1) routine T2WI (TR:3000-4000 ms, TE:70-90 ms, thick:4 mm, layer interval:0.5 mm).The axial T1WI dual echo fast spoiled gradient echo sequence (GRE) (in phase TR:130ms, TE:2.3ms,4mm thickness, spacing 1mm; reverse phase TR:130ms, TE:3.7ms, slice thickness 4mm, interval LMM);The trigger DWI sequences by respiration (TR 4000ms, TE75ms, slice thickness 4mm, interval 0.5mm) b values of 0 and 800sec/mm2.The obtained image has two imaging radiology physicians (in the imaging diagnosis of 3 years or more) radiographic diagnosis, diagnosis differ from a high level doctor reading film analysis draw the last conclusion.All images were confirmed by Siemens Syngo workstation for image post-processing and measurement.ADC figure by DWI image processing can get, ROI draw reference scan weighted T2WI images and enhance image, ADC values in solid tumor component selected minimum area, try to avoid the degeneration and necrosis, capsule hemorrhage, calcification, part, in order to avoid interference, partial volume effect and artifact ROI for polygon, ADC images for three layers in the polygon area (ROI) interested in measuring ADC values, area or an average of 100 was interested in area, three groups of ADC values averaged, and final solid tumor component ADC values.Data were analyzed statistically by SPSS 19 software, adrenal gland neoplasms are divided into two groups (benign tumor, malignant tumor), based on the statistical differences between the two groups of the values of ADC for independent samples t test analysis, drawing ROC curve and calculated the area under the curve, benign and malignant adrenal tumors ADC optimum threshold is determined by sensitivity, diagnosis specificity and Youden index; according to the single factor analysis of variance (ANOVA) statistical analysis of differences between groups of different pathological types of benign tumor of ADC value.Results In this study, adrenal benign and malignant tumors. The ADC value has significant difference in tumor, benign tumor group and adenoma, adrenal ganglion cells in benign pheochromocytoma ADC value had significant difference, there was significant difference between benign adrenal adenoma and pheochromocytoma ADC.Thus, diffusion weighted magnetic resonance imaging in differential diagnosis of wide application in adrenal tumors, ADC value of different pathological types of tumors to identify and provide valuable information.