肾上腺
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Homogeneous masses with more than 60% APW or more than 40% RPW, in conjunction with portal phase absolute enhancement levels of less than 100 HU, likely are adenomas.
• 绝对廓清率＝（峰值－延时强化值）/（峰值－ 平扫值）×100％ • 相对廓清率＝ （峰值－延时强化值）/峰值 ×100％ • 相对廓清率的准确性为86％，特异性为100％ • 绝对廓清率的准确性为88％，特异性为90％ • 主要用于鉴别腺瘤和非腺瘤
• The RPW and APW were calculated as follows: RPW = 100 · (EA − DA)/EA and APW = 100 · ([EA − DA]/[EA − PA]), where EA is attenuation on contrastenhanced scans, DA is attenuation on delayed contrast-enhanced scans, PA is precontrast attenuation, and all attenuation measurements are in Hounsfield units.
一.肾上腺腺瘤
• 最常见的肾上腺肿瘤（51%），好发于40-50岁女性 • 功能性腺瘤（cushing腺瘤、conn腺瘤）
非功能性腺瘤
• 病理：有包膜，表面光滑，切面黄色或褐色，质软。较大 肿瘤可有出血、坏死及囊变
Figure 4 Drawing shows washout characteristics typical of an adrenal adenoma. Precontrast attenuation is 4 HU, venous phase postcontrast attenuation is 50 HU, and delayed attenuation is 12.5 HU. The corresponding APW and RPW are 82% and 75%, respectively. (Courtesy of Frank M. Corl, MS, the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Md.)
肾上腺腺瘤
Drawing shows the enhancement pattern of a lipid-poor adenoma.
Regardless of lipid content, adenomas typically wash out more than 60% (APW) or 40% (RPW), whereas metastases, adrenocortical carcinomas, and some pheochromocytomas usually wash out to a lesser degree
双侧病变
The size of an adrenal mass contributes to the diagnosis, but by itself it is not a definitive indicator of malignancy. In patients with no history of malignancy, benign-appearing masses that are smaller than 3 cm likely are benign, whereas those larger than 5 cm often are resected. Precontrast attenuation of less than 10 HU is used by many authors to identify lipid-rich adenomas.
A mass with washout of more than 60% APW or more than 40% RPW, but with absolute enhancement of more than 110–120 HU, is suggestive of pheochromocytoma. Bilaterality is more common in metastases, lymphoma, infection, hyperplasia, and hemorrhage, whereas adenomas, pheochromocytomas, adrenocortical carcinomas, and myelolipomas are bilateral in less than 30% of cases.
肾上腺病变的分类
肿瘤性 1. 腺瘤（功能性、非功能性） 2. 转移瘤 3. 皮质癌
4. 嗜铬细胞瘤
5. 神经母细胞瘤 6. 髓脂瘤
以及淋巴瘤、脂肪瘤、神经节瘤等
非肿瘤性病变 肾上腺增生/萎缩、囊肿、血肿、肉芽肿性病变等
正常CT影像表现
• 位置
右侧：右肾上极上方，下腔静脉后方，肝内缘与膈肌脚之间 左侧：肾上极前方偏内侧，前方为胰腺体尾，内侧为膈肌脚 和腹主动脉 右侧：逗号状、线条形或人字形 左侧：倒Y字形、V字形、三角形 边缘平直或稍有内凹 头部、分歧部、内侧枝、外侧枝 侧枝厚度小于10mm；面积小于150mm2 软组织密度，类似肾脏；+C均一强化，不能辨别皮髓质
肾上腺疾病
肾上腺的解剖
肾上腺的功能
内部结构：
包膜
皮质 球状带：醛固酮 束状带：皮质醇 网状带：性激素
髓质 儿茶酚胺
adrenal masses will be identified in 4%–5% of abdominal CT studies Barzon et al reviewed 26 studies of 3868 patients and reported that among incidentally identified masses, 71.2% were nonfunctioning adenomas, 5.6% were pheochromocytomas, 4.4% were adrenocortical carcinomas, 2.1% were metastases, and 1.2% were functioning adenomas.
• 形态
• 分布 • 大小 • 密度
大小
Wajchenberg et al reported that ―lesions <3 cm are probably benign, whereas lesions >5 cm probably are malignant.‖
密度
Many investigators use a cutoff of less than 10 HU to diagnose an adenoma, a technique supported by the American College of Radiology appropriateness criteria. Despite variable sensitivity with this cutoff, adenomas with higher precontrast attenuation may still be identified as such by performing delayed contrast material–enhanced CT to measure washout characteristics
One PowerPoint slide of each figure may be downloaded and used for educational not promotional purposes by an author for slide presentations only. The ATS citation line must appear in at least 10-point type on all figures in all presentations. Pharmaceutical and Medical Education companies must request permission to download and use slides, and authors and/or publishing companies using the slides for new article creations for books or journals must apply for permission. For permission requests, please contact the Publisher at .
延迟
10–15-minute delay was recommended by most authors
门脉期 腺瘤vs嗜铬细胞瘤
Venous phase postcontrast findings remain important because they are used to calculate washout and because absolute enhancement levels can be used to distinguish a pheochromocytoma from an adenoma. Pheochromocytomas may display high levels of enhancement and generally enhance to a greater degree than adenomas do, findings that were described in two investigations that compared adenomas to pheochromocytomas during the dynamic phase
RadioGraphics, http://pubs.rsna.org/doi/abs/10.1148/rg.295095026
Published in: Pamela T. Johnson; Karen M. Horton; Elliot K. Fishman; RadioGraphics 2009, 29, 1319-1331. © RSNA, 2009
Lipid-rich adenoma in a 46-year-old man. (a) Axial unenhanced CT image shows a well-defined, 2-cm, low-attenuation, right adrenal mass (arrow). (b) Axial unenhanced CT image shows that the attenuation in the region of interest (ROI) is 0 HU, a finding indicative of a lipid-rich adenoma.
腺瘤vs非腺瘤
There are two ways to measure percentage washout: absolute percentage washout (APW), which incorporates precontrast attenuation, and relative percentage washout (RPW),
Homogeneous masses with more than 60% APW or more than 40% RPW, in conjunction with portal phase absolute enhancement levels of less than 100 HU, likely are adenomas.
• 绝对廓清率＝（峰值－延时强化值）/（峰值－ 平扫值）×100％ • 相对廓清率＝ （峰值－延时强化值）/峰值 ×100％ • 相对廓清率的准确性为86％，特异性为100％ • 绝对廓清率的准确性为88％，特异性为90％ • 主要用于鉴别腺瘤和非腺瘤
• The RPW and APW were calculated as follows: RPW = 100 · (EA − DA)/EA and APW = 100 · ([EA − DA]/[EA − PA]), where EA is attenuation on contrastenhanced scans, DA is attenuation on delayed contrast-enhanced scans, PA is precontrast attenuation, and all attenuation measurements are in Hounsfield units.
一.肾上腺腺瘤
• 最常见的肾上腺肿瘤（51%），好发于40-50岁女性 • 功能性腺瘤（cushing腺瘤、conn腺瘤）
非功能性腺瘤
• 病理：有包膜，表面光滑，切面黄色或褐色，质软。较大 肿瘤可有出血、坏死及囊变
Figure 4 Drawing shows washout characteristics typical of an adrenal adenoma. Precontrast attenuation is 4 HU, venous phase postcontrast attenuation is 50 HU, and delayed attenuation is 12.5 HU. The corresponding APW and RPW are 82% and 75%, respectively. (Courtesy of Frank M. Corl, MS, the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Md.)
肾上腺腺瘤
Drawing shows the enhancement pattern of a lipid-poor adenoma.
Regardless of lipid content, adenomas typically wash out more than 60% (APW) or 40% (RPW), whereas metastases, adrenocortical carcinomas, and some pheochromocytomas usually wash out to a lesser degree
双侧病变
The size of an adrenal mass contributes to the diagnosis, but by itself it is not a definitive indicator of malignancy. In patients with no history of malignancy, benign-appearing masses that are smaller than 3 cm likely are benign, whereas those larger than 5 cm often are resected. Precontrast attenuation of less than 10 HU is used by many authors to identify lipid-rich adenomas.
A mass with washout of more than 60% APW or more than 40% RPW, but with absolute enhancement of more than 110–120 HU, is suggestive of pheochromocytoma. Bilaterality is more common in metastases, lymphoma, infection, hyperplasia, and hemorrhage, whereas adenomas, pheochromocytomas, adrenocortical carcinomas, and myelolipomas are bilateral in less than 30% of cases.
肾上腺病变的分类
肿瘤性 1. 腺瘤（功能性、非功能性） 2. 转移瘤 3. 皮质癌
4. 嗜铬细胞瘤
5. 神经母细胞瘤 6. 髓脂瘤
以及淋巴瘤、脂肪瘤、神经节瘤等
非肿瘤性病变 肾上腺增生/萎缩、囊肿、血肿、肉芽肿性病变等
正常CT影像表现
• 位置
右侧：右肾上极上方，下腔静脉后方，肝内缘与膈肌脚之间 左侧：肾上极前方偏内侧，前方为胰腺体尾，内侧为膈肌脚 和腹主动脉 右侧：逗号状、线条形或人字形 左侧：倒Y字形、V字形、三角形 边缘平直或稍有内凹 头部、分歧部、内侧枝、外侧枝 侧枝厚度小于10mm；面积小于150mm2 软组织密度，类似肾脏；+C均一强化，不能辨别皮髓质
肾上腺疾病
肾上腺的解剖
肾上腺的功能
内部结构：
包膜
皮质 球状带：醛固酮 束状带：皮质醇 网状带：性激素
髓质 儿茶酚胺
adrenal masses will be identified in 4%–5% of abdominal CT studies Barzon et al reviewed 26 studies of 3868 patients and reported that among incidentally identified masses, 71.2% were nonfunctioning adenomas, 5.6% were pheochromocytomas, 4.4% were adrenocortical carcinomas, 2.1% were metastases, and 1.2% were functioning adenomas.
• 形态
• 分布 • 大小 • 密度
大小
Wajchenberg et al reported that ―lesions <3 cm are probably benign, whereas lesions >5 cm probably are malignant.‖
密度
Many investigators use a cutoff of less than 10 HU to diagnose an adenoma, a technique supported by the American College of Radiology appropriateness criteria. Despite variable sensitivity with this cutoff, adenomas with higher precontrast attenuation may still be identified as such by performing delayed contrast material–enhanced CT to measure washout characteristics
One PowerPoint slide of each figure may be downloaded and used for educational not promotional purposes by an author for slide presentations only. The ATS citation line must appear in at least 10-point type on all figures in all presentations. Pharmaceutical and Medical Education companies must request permission to download and use slides, and authors and/or publishing companies using the slides for new article creations for books or journals must apply for permission. For permission requests, please contact the Publisher at .
延迟
10–15-minute delay was recommended by most authors
门脉期 腺瘤vs嗜铬细胞瘤
Venous phase postcontrast findings remain important because they are used to calculate washout and because absolute enhancement levels can be used to distinguish a pheochromocytoma from an adenoma. Pheochromocytomas may display high levels of enhancement and generally enhance to a greater degree than adenomas do, findings that were described in two investigations that compared adenomas to pheochromocytomas during the dynamic phase
RadioGraphics, http://pubs.rsna.org/doi/abs/10.1148/rg.295095026
Published in: Pamela T. Johnson; Karen M. Horton; Elliot K. Fishman; RadioGraphics 2009, 29, 1319-1331. © RSNA, 2009
Lipid-rich adenoma in a 46-year-old man. (a) Axial unenhanced CT image shows a well-defined, 2-cm, low-attenuation, right adrenal mass (arrow). (b) Axial unenhanced CT image shows that the attenuation in the region of interest (ROI) is 0 HU, a finding indicative of a lipid-rich adenoma.
腺瘤vs非腺瘤
There are two ways to measure percentage washout: absolute percentage washout (APW), which incorporates precontrast attenuation, and relative percentage washout (RPW),