简化计算CT增强廓清率在鉴别小于4 cm的肾上腺转移瘤与肾上腺腺瘤中的价值

doi:10.12114/j.issn.1007-9572.2021.00.571

摘要/Abstract

摘要： 背景　肾上腺偶发瘤中，肾上腺转移瘤需要与肾上腺最常见的良性肿瘤（肾上腺腺瘤）进行鉴别，推荐延迟15 min的扫描方式计算绝对廓清率与相对廓清率，然而扫描时间过长。目的　探讨简化计算CT增强廓清率鉴别小于4 cm的肾上腺转移瘤与肾上腺腺瘤的价值。方法　选取2014年1月—2019年12月台州市第一人民医院经临床随访证实或拟诊非肾上腺腺瘤病变后手术病理证实并行CT增强扫描的肾上腺转移瘤患者78例和肾上腺腺瘤患者50例。依据纳入和排除标准最终本研究纳入肾上腺转移瘤患者37例（肾上腺转移瘤组）和肾上腺腺瘤患者47例（肾上腺腺瘤组）；其中肾上腺转移瘤包含原发灶为肺癌患者16例、原发灶为其他肿瘤患者21例（肝癌患者4例、胃肠道肿瘤患者14例、胰腺癌患者1例、膀胱癌患者1例、涎腺癌患者1例），肾上腺腺瘤包含肾上腺乏脂腺瘤患者15例、肾上腺富脂腺瘤患者32例。收集患者年龄、性别、高血压发生情况、病灶部位（左侧/右侧）、肿瘤大小，并测量平扫、动脉期及静脉期的CT值，计算简化绝对廓清率及相对廓清率。采用受试者工作特征曲线（ROC曲线）分别分析肾上腺转移瘤与肾上腺腺瘤组、肾上腺转移瘤与肾上腺乏脂腺瘤组、肾上腺转移瘤与肾上腺富脂腺瘤组、肺癌肾上腺转移瘤与肾上腺乏脂腺瘤组中差异有统计学意义的变量的效能。结果　肾上腺转移瘤组与肾上腺腺瘤组患者、肾上腺转移瘤组与肾上腺乏脂腺瘤组患者、肾上腺转移瘤组与肾上腺富脂腺瘤组患者、肺癌肾上腺转移瘤组与肾上腺乏脂腺瘤组患者年龄、性别、高血压发生率、病灶部位及肿瘤大小比较，差异均无统计学意义（P>0.05）。肾上腺转移瘤组患者的平扫CT值高于肾上腺腺瘤组（P<0.001）。肾上腺转移瘤组平扫CT值高于肾上腺乏脂腺瘤组，绝对廓清率和相对廓清率低于肾上腺乏脂腺瘤组（P<0.05）。肾上腺转移瘤组平扫CT值及相对廓清率高于肾上腺富脂腺瘤组（P<0.05）；肾上腺转移瘤组与肾上腺富脂腺瘤组患者的绝对廓清率比较，差异无统计学意义（P>0.05）。肺癌肾上腺转移瘤组平扫CT值高于肾上腺乏脂腺瘤组，绝对廓清率和相对廓清率低于肾上腺乏脂腺瘤组（P<0.05）。在肾上腺转移瘤与肾上腺腺瘤ROC曲线分析中，平扫CT值的截断值为21.00 HU，ROC曲线下面积（AUC）、灵敏度、特异度分别为0.894、81.1%、89.4%。在肾上腺转移瘤与肾上腺乏脂腺瘤ROC曲线分析中，平扫CT值的截断值为28.50 HU，AUC、灵敏度、特异度分别为0.746、64.9%、86.7%；绝对廓清率的截断值为-21.54%，AUC、灵敏度、特异度分别为0.733、80.0%、83.8%；相对廓清率的截断值为-9.65%，AUC、灵敏度、特异度分别为0.760、73.3%、89.2%。在肾上腺转移瘤与肾上腺富脂腺瘤ROC曲线分析中，平扫CT值的截断值为11.50 HU，AUC、灵敏度、特异度分别为0.964、91.9%、100%；相对廓清率的截断值为-64.10%，AUC、灵敏度、特异度分别为0.677、89.2%、53.1%。在肺癌肾上腺转移瘤与肾上腺乏脂腺瘤ROC曲线分析中，平扫CT值的截断值为29.50 HU，AUC、灵敏度、特异度分别为0.881、81.3%、93.3%；绝对廓清率的截断值为-24.89%，AUC、灵敏度、特异度分别为0.721、80.0%、81.3%；相对廓清率的截断值为-10.58%，AUC、灵敏度、特异度分别为0.733、73.3%、87.5%。结论　简化计算CT增强绝对廓清率及相对廓清率在鉴别小于4 cm的肾上腺转移瘤与肾上腺腺瘤间有重要价值。

关键词: 肾上腺转移瘤；肾上腺腺瘤；体层摄影术, X线计算机；廓清率；诊断, 鉴别

Abstract: Background　Among incidental adrenal tumors，adrenal metastases need to be distinguished from the most common benign adrenal tumors （adrenal adenomas）.It is recommended to delay the scan for 15 minutes to calculate the absolute percentage washout and relative percentage washout，but the scanning time is too long.Objective　To explore the value of simplified calculation of CT enhanced washout rate in distinguishing adrenal metastases and adrenal adenomas less than 4 cm.Methods　78 patients with adrenal metastasis and 50 patients with adrenal adenoma who were confirmed by clinical follow-up or suspected to be diagnosed as non-adrenal adenoma lesions followed by surgical pathology and enhanced CT scanning in Taizhou First People's Hospital from January 2014 to December 2019 were selected.According to the inclusion and exclusion criteria，37 patients with adrenal metastasis（adrenal metastasis group） and 47 patients with adrenal adenoma （adrenal adenoma group） were finally included in this study；among them，patients with adrenal metastases included 16 patients with lung cancer as the primary tumor and 21 patients with other tumors as the primary tumor （4 patients with liver cancer，14 patients with gastrointestinal cancer，1 patient with pancreatic cancer，1 patient with bladder cancer，1 patient with salivary gland cancer），and patients with adrenal adenomas included 15 patients with lipid-poor adrenal adenoma and 32 patients with lipid-rich adrenal adenoma.The age，sex，occurrence of hypertension，lesion location （left/right） and tumor size of patients were collected and CT attenuation value of plain scan，arterial phase and portal venous phases were measured to calculate simplified absolute percentage washout and relative percentage washout.Receiver operating characteristic curves （ROC） were used to assess the efficacy of statistically significant variables between groups including adrenal metastasis and adrenal adenoma groups，adrenal metastasis and lipid-poor adrenal adenoma groups，adrenal metastasis and lipid-rich adrenal adenoma groups，adrenal metastasis of lung cancer and lipid-poor adrenal adenoma groups respectively.Results　There were no statistical differences in age，gender，occurrence of hypertension，and the location and size of lesions between groups including adrenal metastasis and adrenal adenoma groups，adrenal metastasis and lipid-poor adrenal adenoma groups，adrenal metastasis and lipid-rich adrenal adenoma groups，adrenal metastasis of lung cancer and lipid-poor adrenal adenoma groups（P>0.05）.The plain CT value of patients in the adrenal metastasis group was higher than the adrenal adenoma group （P<0.001）.The plain CT value of patients in the adrenal metastasis group was higher than the lipid-poor adrenal adenoma group and the absolute percentage washout and relative percentage washout of patients in the adrenal metastasis group was lower than the lipid-poor adrenal adenoma group （P<0.05）.The plain CT value and relative percentage washout of patients in the adrenal metastasis group were higher than the lipid-rich adrenal adenoma group（P<0.05） and there was no significant difference in the absolute percentage washout between the adrenal metastasis group and the lipid-rich adrenal adenoma group （P>0.05）.The plain CT value of patients in the lung cancer adrenal metastasis group was higher than the lipid-poor adrenal adenoma group，and the absolute percentage washout and relative percentage washout of patients in lung cancer adrenal metastasis group were lower than the lipid-poor adrenal adenoma group （P<0.05）.In the ROC curve analysis of adrenal metastasis and adrenal adenoma，the cut-off value of plain CT value was 21.00 HU，and the AUC，sensitivity，and specificity were 0.894，81.1%，and 89.4%，respectively.In the ROC curve analysis of adrenal metastasis and lipid-poor adrenal adenoma，the cut-off value of plain CT value was 28.50 HU，and the AUC，sensitivity，and specificity were 0.746，64.9%，and 86.7%，respectively.The cut-off value of the absolute percentage washout was -21.54%，and the AUC，sensitivity，and specificity were 0.733，80.0%，and 83.8%，respectively.The cut-off value for the relative percentage washout was -9.65%，and the AUC，sensitivity，and specificity were 0.760，73.3%，and 89.2%，respectively.In the ROC curve analysis of adrenal metastasis and lipid-rich adrenal adenoma，the cut-off value of plain CT value was 11.50 HU，and the AUC，sensitivity and specificity were 0.964，91.9% and 100.0%，respectively.The cut-off value of the relative percentage washout was -64.10%，and the AUC，sensitivity and specificity were 0.677，89.2% and 53.1%，respectively.In the ROC curve analysis of lung cancer adrenal metastasis and lipid-poor adrenal adenoma，the cut-off value of plain CT value was 29.50 HU，and the AUC，sensitivity，and specificity were 0.881，81.3%，and 93.3%，respectively.The cut-off value of the absolute percentage washout was -24.89%，the AUC，sensitivity，and specificity were 0.721，80.0%，and 81.3%，respectively.The cut-off value for relative percentage washout was -10.58%，the AUC，sensitivity，and specificity were 0.733，73.3%，and 87.5%，respectively.Conclusion　 Simplified calculation of CT enhanced absolute percentage washout and relative percentage washout is of great value in distinguishing adrenal metastases and adrenal adenomas less than 4 cm.

Key words: Kidney neoplasms；Adrenal metastasis；Adrenal adenoma；Tomography, X-Ray Computed；Washout rate；Diagnosis, differential

戴国娇,郑海澜,郑永飞,等. 简化计算CT增强廓清率在鉴别小于4 cm的肾上腺转移瘤与肾上腺腺瘤中的价值[J]. 中国全科医学, 2021, 24(20): 2607-2613. DOI: 10.12114/j.issn.1007-9572.2021.00.571.
DAI Guojiao,ZHENG Hailan,ZHENG Yongfei, et al. The Value of Simplified Calculation of CT Enhanced Washout Rate in Distinguishing Adrenal Metastasis and Adrenal Adenoma Less Than 4 cm　[J]. Chinese General Practice, 2021, 24(20): 2607-2613. DOI: 10.12114/j.issn.1007-9572.2021.00.571.

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