肾上腺影像与临床PPT.ppt

Adrenal lymphomas Secondary adrenal lymphomatous involvement occurs in up to 25% of patients with lymphoma at some stage of their disease and may present as bilateral adrenal masses . Primary lymphoma of the adrenal glands is rare, and !100 cases have been reported in the world literature. It most commonly affects elderly men, is bilateral, and 50% present with symptoms of adrenal insufficiency, fever and weight loss . On CT, they are usually large solid masses with variable necrosis and enhancement after contrast administration. On MRI, they have intermediate softtissue signal intensity and a high T2 signal intensity. On CSI, no loss of signal intensity is demonstrated on the out-of-phase imaging. Their appearance is therefore indistinguishable from that of other malignant adrenal tumours and biopsy of the mass is required to establish the diagnosis . 肾上腺神经源性肿瘤 少见的肾上腺良性肿瘤 以神经节细胞瘤最常见，其次为神经纤维瘤 神经节细胞瘤好发于儿童或青少年；神经纤维瘤好发于中青年人，女性多见 一般无临床症状，少数神经节细胞瘤分泌儿茶酚胺而出现高血压 肾上腺神经源性肿瘤 CT MR CT： 体积一般较大，边缘常呈分叶状 平扫边缘清晰，密度均匀，密度较低 增强后呈轻度强化，强化可不均匀 延迟扫描廓清延迟 MR: T2WI上呈显著高信号，具有特征性 病例简介 11岁女孩，体检发现右肾上腺病变；无任何临床症状和异常体征（血压正常） 各项实验室检查（包括24h CA、VMA、皮质醇、醛固酮等）正常 T2WI T1WI*+FS 同反相位 T1WI*+FS 动态增强 诊 断 术前影像诊断：右侧肾上腺良性肿瘤，神经源性肿瘤可能性大 病理诊断：右肾上腺神经节细胞瘤 肾上腺增生 双侧肾上腺增大称为肾上腺增生，少数为单侧性 大多数无症状，由CT检查时发现 有症状的多表现为Cushing综合征，少数为Conn综合征， 80％的Cushing综合征由肾上腺增生引起 30％的Conn综合征由肾上腺增生引起 肾上腺大小正常不能除外增生 由腺瘤所致的症状，手术治疗；增生所致的症状，手术治疗无效，应采用内科药物治疗 肾上腺增生 影像 肾上腺内侧支和外侧支10mm或面积150mm2，可以确立诊断 分为弥漫性增生和结节样增生（12－15％） 弥漫性通常看不到确切的肿物或结节，表现为肾上腺弥漫性增大，仍保持肾上腺正常形态 结节性较少见，在（增大）肾上腺边缘可有一些小结节影，单发结节样增生与腺瘤鉴别困难，但很少见 极少数Cushing综合征表现为肾上腺巨结节样增生：双侧肾上腺体积增大，伴5－40mm巨大结节 肾上腺结节样增生 肾上腺巨结节样增生 Imaging findings were available in only one case of AIMAH and were characteristic, with massively enlarged adrenal glands bilaterally, in this case retaining the normal adreniform shape. The adrenal limb width and maximum nodule size were 30 mm. Unlike with the adrenal