腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)課件

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

腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)2024/8/12腎上腺左右各一，位于腎的上方，共同為腎筋膜和脂肪組織所包裹。左腎上腺呈半月形，右腎上腺為三角形。腎上腺兩側(cè)共重約30g。從側(cè)面觀察，腺體分腎上腺皮質(zhì)和腎上腺髓質(zhì)兩部分，周圍部分是皮質(zhì)，內(nèi)部是髓質(zhì)。兩者在發(fā)生、結(jié)構(gòu)與功能上均不相同，實(shí)際上是兩種內(nèi)分泌腺。腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)2024/8/12球狀帶：醛固酮束狀帶：皮質(zhì)醇網(wǎng)狀帶：性激素髓質(zhì)：腎上腺素、去甲腎上腺素腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)adenomascontainabundantintracytoplasmiclipid,andthusapproximately70%-----10HUAdrenalAdenomaapproximately30%ofadrenaladenomasarelipid-poor--------greaterthan10HUWashoutCTcharacterizestheselipid-pooradenomaswithsensitivityofalmost100%Chemical-shiftMRIisalsousefulincharacterizingadrenaladenomasthesensitivityformorethan30HUispoorfordifferentiatingadenomasfromnonadenomas腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)WashoutCTexaminationsTwo-phasecontrast-enhancedCTperformedat1minute(earlycontrast-enhancedCT)and15minutes(delayedcontrast-enhancedCT)afteradministrationofcontrastmaterial腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)73-year-oldwomanwithhistoryofbreastcancerandleftadrenallipid-pooradenomaUnenhancedCTscanshowsleftadrenalmassthatmeasured29HEnhancedCTscanshowsleftadrenalmassthatmeasured73HDelayedenhancedCTscanshowsleftadrenalmassthatmeasured44HEnhancementwashout=29H(73H–44H)enhancement=44H(73H–29H)Percentageenhancementwashout=66%[(enhancementwashout/enhancement)=(29/44)×100]增強(qiáng)后定量參數(shù)：腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)MeanEnhancementEnhancementWashout平均增強(qiáng)排泄率腎上腺富脂，乏脂腺瘤和非腺瘤增強(qiáng)參數(shù)比較腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)直方圖腎上腺富脂，乏脂腺瘤和非腺瘤增強(qiáng)參數(shù)比較富脂乏脂非腺瘤腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)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.腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)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腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)GraphshowsMRIsensitivityforlipid-pooradenomas隨著腺瘤CT值增加MRI敏感性逐漸下降MRIsensitivityforlipid-pooradenomasmeasuringgreaterthan10HUand20HUorlessonunenhancedCTis100%,whereassensitivitiesforlipid-pooradenomasmeasuringgreaterthan20,greaterthan30,andgreaterthan40HUdecreasesto64.0%,61.5%,and40%,respectively腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)GraphshowsCTandMRIsensitivitiesforlipid-pooradenomas直方圖顯示乏脂類腺瘤MRI和CT診斷靈敏性

腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)Unenhanced20HU腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)

平掃16HU早期50HU延遲期19HU同相位反相位Lipid-pooradenomain77-year-oldmanAdrenal-to-spleenratioandsignalintensityindexoflesionare0.463and50.1%,respectively,consistentwithadenoma腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)Lipid-pooradenomain70-year-old

平掃34HU123HU延遲期45HU同相位反相位Adrenal-to-spleenratioandsignalintensityindexoflesionare1.139and?10.3%,respectively,whicharenotconsistentwithadenoma腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)2024/8/127O-year-oldmanwithadrenaladenoma.-5HUOninitialenhanced52HU15-mmdelayedenhancedCT10HU腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)2024/8/12腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)2024/8/12ExclusionofPheochromocytomaUsingCTAttenuationandWashoutCriteria腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)2024/8/121、plasmaandurinarymetanephrinesorcatecholamines血漿和尿腎上腺素和兒茶酚胺2、1-minuteenhancedattenuationminusunenhancedattenuationpheochromocytoma3、Noadenomawasmorethan85-HUenhancinginthearterialphase.Morethanonehalf(7/12,58%)ofpheochromocytomasexceeded110HUinthearterialphase,thesamenumberexceeding110HUinthevenousphase.腎上腺解剖及腎上腺腺瘤快速排泄性CT和MRI的化學(xué)移位的特點(diǎn)2024/8/12unenhancedCT(35HU)

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