肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点课件

CharacterizationofLipid-PoorAdrenalAdenoma:Chemical-ShiftMRIandWashoutCT魏江漫2015-05

肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/12肾上腺左右各一，位于肾的上方，共同为肾筋膜和脂肪组织所包裹。左肾上腺呈半月形，右肾上腺为三角形。肾上腺两侧共重约30g。从侧面观察，腺体分肾上腺皮质和肾上腺髓质两部分，周围部分是皮质，内部是髓质。两者在发生、结构与功能上均不相同，实际上是两种内分泌腺。肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/12球状带：醛固酮束状带：皮质醇网状带：性激素髓质：肾上腺素、去甲肾上腺素肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点adenomascontainabundantintracytoplasmiclipid,andthusapproximately70%-----10HUAdrenalAdenomaapproximately30%ofadrenaladenomasarelipid-poor--------greaterthan10HUWashoutCTcharacterizestheselipid-pooradenomaswithsensitivityofalmost100%Chemical-shiftMRIisalsousefulincharacterizingadrenaladenomasthesensitivityformorethan30HUispoorfordifferentiatingadenomasfromnonadenomas肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点WashoutCTexaminationsTwo-phasecontrast-enhancedCTperformedat1minute(earlycontrast-enhancedCT)and15minutes(delayedcontrast-enhancedCT)afteradministrationofcontrastmaterial肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点73-year-oldwomanwithhistoryofbreastcancerandleftadrenallipid-pooradenomaUnenhancedCTscanshowsleftadrenalmassthatmeasured29HEnhancedCTscanshowsleftadrenalmassthatmeasured73HDelayedenhancedCTscanshowsleftadrenalmassthatmeasured44HEnhancementwashout=29H(73H–44H)enhancement=44H(73H–29H)Percentageenhancementwashout=66%[(enhancementwashout/enhancement)=(29/44)×100]增强后定量参数：肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点MeanEnhancementEnhancementWashout平均增强排泄率肾上腺富脂，乏脂腺瘤和非腺瘤增强参数比较肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点直方图肾上腺富脂，乏脂腺瘤和非腺瘤增强参数比较富脂乏脂非腺瘤肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点Chemical-shiftMRIForallmassesidentifiedonMRimages,theadrenal-to-spleenratio(ASR)wascalculatedasASR=(SIAO/SISO)/(SIAI/SISI),whereSIAOwasthesignaltensityoftheadrenalmassonopposed-phaseimages,SISOwasthesignalintensityofthespleenonopposed-phaseimages,SIAIwasthesignalintensityoftheadrenalmassonin-phaseimages,andSISIwasthesignalintensityofthespleenonin-phaseimages.Thesignalintensityindex(SII)wascalculatedasSII=(SIAI−SIAO)·100/SIAI.肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/12ASRandSIIoflipid-pooradenomasrangedfrom0.35to1.33(0.79±0.24)andfrom−38.7%(−24,000/620)to71.8%(11,700/163)(30.8±25.5%),SIIwasbetterthanASRforcharacterizingadenomas肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点GraphshowsMRIsensitivityforlipid-pooradenomas随着腺瘤CT值增加MRI敏感性逐渐下降MRIsensitivityforlipid-pooradenomasmeasuringgreaterthan10HUand20HUorlessonunenhancedCTis100%,whereassensitivitiesforlipid-pooradenomasmeasuringgreaterthan20,greaterthan30,andgreaterthan40HUdecreasesto64.0%,61.5%,and40%,respectively肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点GraphshowsCTandMRIsensitivitiesforlipid-pooradenomas直方图显示乏脂类腺瘤MRI和CT诊断灵敏性

肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点Unenhanced20HU肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点

平扫16HU早期50HU延迟期19HU同相位反相位Lipid-pooradenomain77-year-oldmanAdrenal-to-spleenratioandsignalintensityindexoflesionare0.463and50.1%,respectively,consistentwithadenoma肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点Lipid-pooradenomain70-year-old

平扫34HU123HU延迟期45HU同相位反相位Adrenal-to-spleenratioandsignalintensityindexoflesionare1.139and−10.3%,respectively,whicharenotconsistentwithadenoma肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/127O-year-oldmanwithadrenaladenoma.-5HUOninitialenhanced52HU15-mmdelayedenhancedCT10HU肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/12肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/12ExclusionofPheochromocytomaUsingCTAttenuationandWashoutCriteria肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/121、plasmaandurinarymetanephrinesorcatecholamines血浆和尿肾上腺素和儿茶酚胺2、1-minuteenhancedattenuationminusunenhancedattenuationpheochromocytoma3、Noadenomawasmorethan85-HUenhancinginthearterialphase.Morethanonehalf(7/12,58%)ofpheochromocytomasexceeded110HUinthearterialphase,thesamenumberexceeding110HUinthevenousphase.肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/12unenhancedCT(35HU)

1-minutecontrast-enhancedCT(221HU)15-minutecontrast-enhancedCT(93HU).Masswashistologicallyconfirmedpheochromocytoma肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/1255-year-oldmanwithlipid-richadenoma.-3HU30HUinarterialphase62HUinvenousphase肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/1254-year-oldmanwithpathologicallyprovenpheochromocytoma.121HUinarterialphaseand113HUinvenousphase.Thisenhancementlevelandpatternwereseenwith25%(3/12)ofpheochromocytomasandnoadenoma.肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/1251-year-oldwomanwith2.6-cmfunctioningadenomainrightadrenalarterialphase(A)enhancementof81HUandvenousphase(B)enhancementof133HU.Venousphaseenhancementgreaterthan110HUwasidentifiedin7%(3/41)ofadenomas.肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/12arterialphaseenhancementof42HUandvenousphaseenhancementof68HU.Thispatternwasseenwith42%(5/12)ofpheochromocytomasand85%(35/41)ofadenomas.66-year-oldmanwith3.2-cmhomogeneous-appearingleftadrenalpheochromocytomathatmimicsadenomaenhancementlevelsandpattern肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/12adrenalmetastasis90%ofadenomasexhibitahomogeneousorringenhancementpatternand60%ofmalignantlesionshaveaheterogeneouspattern.chemicalshiftimaging(CSI)肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/12肾上腺解剖及肾上腺腺瘤快速排泄性CT和MRI的化学移位的特点2024/8/12adrenaladenomaadrenalmetastasi