| Objective: To investigate the value of MSCT and 3.0 MRI in the diagnosis and differential diagnosis of common adrenal tumors.Research object and method We prospectively collected 54 cases of adrenal tumors from October 2017 to August 2018 in the First Affiliated Hospital of Guangxi Medical University,with a total of 55 lesions.Allcas eswereconfirmed by operation and pathology or clinic.Among the adrenoc ortical adenomas confirmed by pathology,combined with clinical data,18 cases were diagnosed as aldosterone adenomas,8 males and 10 females,with an average age of 43 years,clinical manifestations of hypokalemia,hypertension,limb weakness,and elevated aldosterone level by laboratory examination;(2)5 cases of cortisol adenomas,2 males and 3 females,with an average age of 46 years,clinical manifestations of obesity,increa sed hair,and the experiment The level of serum cortisol was elevated by laboratory examination;(3)20 cases of adrenal pheochromocytoma,8 males and 12 females,aged 28 to 61 years,with an average age of 44 year s,and the level of catecholamine increased by laboratory examination;(4)5 cases of adrenal metastases,3 males and 2 females,with an average a ge of 54 years,3 cases of lung cancer metastases and 2 cases of liver cancer metastases,2 of which were confirmed by surgery and 3 cases were confirmed by follow-up.(5)There were 6 cases of cortical cancer,3 cases of male and 3 cases of female,aged from 2 to 56 years,with an aver age age of 32 years.Five kinds of adrenal tumors were analyzed,including the diameter,shape,boundary,calcification,cystic degeneration and ne crosis of the tumors;the mean values of arterial and venous phases in plain CT scan and dual-phase enhanced CT scan of the tumors;the signal characteristics of five kinds of tumors on plain MRI scan;the SII and A SR values of fat quantitative index in chemical shift imaging of the tumo rs on MR;and the DWI values of the five kinds of tumors were measur ed.ADC value on sequence(b = 800).SPSS24 was used to analyze the single factor variance(ANOVA)of the above measurement data.Chi-square test was used to test the above counting data.The statistical significance standard was p < 0.05.Results: 1.The comparison of tumor size showed that the size of ald osterone adenoma,cortisol adenoma and metastasis was significantly differ ent from that of pheochromocytoma and cortisol adenoma(P < 0.05).The size of cortical cancer and the diameter of pheochromocytoma were also significantly different(P < 0.05).By ROC curve analysis,the sensitivity and specificity of adrenal benign and malignant tumors were 91.7% and46.5% respectively,and the area under the curve was 0.742.(P<0.05).The sensitivity and specificity were 90.6% and 100% respectively,and the area under curve was 0.987.(P<0.05).2.Analysis of MSCT plain scan and dual-phase enhancement effect of tumors: The CT value of adrenal aldosterone adenoma on plain scan was lower than that of other adrenal tumors,and the difference was statistically significant(P<0.05).The CT value of pheochromocytoma on arterial and venous phase was significantly higher than that of other adrenal tumors(P<0.05).The CT value of adrenal ald osterone adenoma on arterial and venous phase was also significantly diff erent from that of cortisol adenoma(P<0.05).Different CT value of cortis ol adenoma in arterial and venous phase was higher than that of metastas is(P < 0.05).According to ROC curve analysis,the sensitivity and specificity of diagnosing adrenal adenoma and non-adrenal adenoma were 100%and 76.9% respectively,and the area under the curve was 0.877.(P < 0.05).The sensitivity and specificity were 93.7% and 100% respectively,and the area under curve was 0.995.(P < 0.05)The sensitivity and specificity of adrenal aldosterone adenoma and cortisol adenoma were 100% and the area under curve was 1.3.Contrast of routine plain scan signal on MRI: Aldosterone adenoma and cortisol adenoma showed homogeneous signal,equal or slightly low signal on T1 WI and equal or slightly high signal on T2 WI.Adrenal pheochromocytoma showed low and mixed signal on T1 WI,high signal on T2 WI and high signal in cystic necrosis area.M etastatic tumors showed slightly low signal on T1 WI and slightly high sig nal on T2 WI.Adrenal cortical carcinoma showed low and mixed signal o n T1 WI,mixed high signal on T2 WI,heterogeneous signal and necrosis on T2 WI.4.The results of MR chemical shift imaging showed that there were statistical differences between aldosterone adenoma SII,ASR and ot her adrenal tumors(P < 0.05),cortisol adenoma SII,ASR and pheochrom ocytoma,metastasis(P < 0.05),cortisol adenoma ASR.There was a partial overlap between metastasis and cortical cancer(P > 0.05).The sensitivity and specificity of SII for diagnosis of adrenal tumors and non-adenomas were 100% and 100%,respectively,according to ROC curve analysis.The sensitivity and specificity of diagnosing adrenal adenoma and non-adenoma with ASR of 0.66 were 96.8% and 82.6% respectively.5.The results of DWI evaluation showed that there were significant differences among aldosterone adenoma,cortisol adenoma,pheochromocytoma,metastasis and cortical cancer.Adrenal tumors were classified into benign and maligna nt tumors.By ROC curve analysis,ADC value of 0.97 *10-3 mm2/s was the best threshold for benign and malignant adrenal tumors.The sensitivi ty and specificity of this threshold point for the diagnosis of benign and malignant adrenal tumors were 81.8% and 95.3% respectively.Conclusion: 1)The sensitivity and specificity of diagnosing adrenal a denomas and non-adenomas with SII of 12.7 were 100% and 100%,respectively,and the area under curve was 1.0.The diagnostic efficiency was the greatest;(2)The sensitivity and specificity of ADC of 0.97 *10-3 mm2/s were 81.8% and 95.3% respectively,and the diagnostic efficiency was the greatest;(3)The plain scan value,arterial CT value and venous CT value were used as the diagnostic threshold for adrenal benign and malign ant tumors.The sensitivity and specificity of adrenal aldosterone adenoma and cortisol adenoma were 100% and the area under curve was 1.The diagnostic efficiency was the highest. |
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