CT features for the differential diagnosis of the hidden pheochromocytoma and cortical adenoma

doi:10.3877/cma.j.issn.1674-3253.2021.01.004

Abstract

Abstract:

Objective

To investigate the differential diagnosis of hidden pheochromocytoma and adrenal cortical adenoma according to their CT features.

Methods

A total of 177 patients with adrenal tumors admitted to the First Affiliated Hospital of China Medical University from January 2010 to January 2020 were collected for retrospective analysis, and the general clinical data and CT features of patients in each group were compared.

Results

There were 56 cases of hidden pheochromocytoma, 32 cases of cortisol adenoma, 44 cases of aldosterone adenoma, 45 cases of non-functional adenoma. There were statistically significant differences between the group of hidden pheochromocytoma and the group of non-functional adenoma. The tumor diameter, scan CT value, and delay arterial enhancement CT value on hidden pheochromocytoma group were significantly greater than three adrenal adenoma groups. When the tumor diameter ≥2.95 cm was used to diagnose the hidden pheochromocytoma, AUC was 0.872, sensitivity was 87.5%, specificity was 76.0%. When the CT value of plain scan was ≥24.5 Hu, the AUC, sensitivity and specificity were 0.929, 94.0% and 82.5% respectively. When the arterial enhanced CT value ≥89.5 Hu, AUC was 0.886, sensitivity was 72.7%, and specificity was 90.6%. When the enhanced CT value in the delay period was ≥82.5 Hu, the AUC, sensitivity and specificity were 0.937, 84.6% and 95.3% respectively. When combined with the above four indicators, the AUC was 0.981, the threshold was ≥0.118, the sensitivity was 100%, and the specificity was 90.6%.

Conclusion

The value of 24.5 Hu in plain scan, 89.5 Hu in arterial enhanced CT and 82.5 Hu in delayed enhanced CT with tumor diameter of 2.95 cm is useful for the differential diagnosis of adrenal hidden pheochromocytoma.

Key words: Adrenal pheochromocytoma, Adrenocortical adenoma, CT texture, I-MIBG, Differential diagnosis, AUC, ROC

Rui Zhong, Qiguang Chen, Dan Sun, Cuize Kong, Zeliang Li. CT features for the differential diagnosis of the hidden pheochromocytoma and cortical adenoma[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(01): 12-16.

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References 16

[1]	徐烈雨. 嗜铬细胞瘤的诊断和治疗进展[J]. 国际泌尿系统杂志, 2014, 34(4): 580-585.
[2]	谭磊, 秦自科, 郑付甫, 等. 667例肾上腺偶发瘤的临床分析[J]. 中国肿瘤临床, 2017, 44(14): 722-725.
[3]	田杰, 孔昊, 李楠, 等. 肾上腺偶发嗜铬细胞瘤术中血流动力学不稳定的危险因素分析[J]. 中华泌尿外科杂志, 2019, 40(4): 262-266.
[4]	刘屹立, 徐彪, 孙强, 等. 不典型肾上腺嗜铬细胞瘤[J]. 中华泌尿外科杂志, 2006(11): 725-727.
[5]	曾鹏, 吴小伟, 曾健文, 等. 腹腔镜下经肠系膜途径左侧肾上腺巨大嗜铬细胞瘤切除术五例报告[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(3): 215-218.
[6]	杨华, 吴红花, 布楠, 等. 寂静性嗜铬细胞瘤临床特点分析[J]. 中华医学杂志, 2018, 98(34): 2727-2731.
[7]	潘东亮, 李汉忠, 曾正陪. 嗜铬细胞瘤临床功能分级与术前准备标准的探讨[J]. 中华外科杂志, 2004, 42(18): 4-7.
[8]	陈微, 谷伟军, 刘颖姝, 等. 肾上腺区嗜铬细胞瘤与肾上腺皮质腺瘤CT特征对比分析[J]. 解放军医学院学报, 2020, 41(2): 151-155.
[9]	Gu-Mu-Yang Zhang, Bing Shi, Hao Sun，et al. Differentiating pheochromocytoma from lipid-poor adrenocortical adenoma by CT texture analysis: feasibility study[J]. Abdom Radiol (NY), 2017, 42(9): 2305-2313.
[10]	张培丽, 张玲艳, 张学凌,等. 能谱CT鉴别诊断不典型肾上腺嗜铬细胞瘤与肾上腺瘤[J]. 中国医学影像技术, 2017, 33(4): 576-580.
[11]	Lafont M, Fagour C, Haissaguerre M, et al. Per-operative hemodynamic instability in normotensive patients with incidentally discovered pheochromocytomas[J]. J Clin Endocrinol Metab, 2015, 100(2): 417-421.
[12]	Plouin PF, Amar L, Dekkers OM, et al. European Society of Endocrinology Clinical Practice Guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma[J]. Eur J Endocrinol, 2016, 174(5): G1-g10.
[13]	胡卫列. 肾上腺肿瘤诊断的新思路[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2013, 7(4): 1-3.
[14]	姚睿, 胡卫列, 钱民, 等. 肾上腺皮质腺瘤、嗜铬细胞瘤的CT影像与生化指标的相关性[J]. 南方医科大学学报, 2015, 35(12): 1792-1796.
[15]	Lenders Jacques WM, Duh Quan-Yang, Eisenhofer Graeme, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2014, 99(6): 1915-42.
[16]	Zeiger Martha A, Thompson Geoffrey B, Duh Quan-Yang, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations[J]. Endocr Pract, 2009, 15(5): 450-453.

变量	例数	性别（例）		年龄（岁，±s）	肿瘤侧别（例）		肿瘤最大径（cm，±s）	平扫CT值（Hu，±s）	增强CT值（动脉期）（Hu，±s）	增强CT值（延迟期）（Hu，±s）
变量	例数	男	女	年龄（岁，±s）	左	右	肿瘤最大径（cm，±s）	平扫CT值（Hu，±s）	增强CT值（动脉期）（Hu，±s）	增强CT值（延迟期）（Hu，±s）
隐匿型嗜铬细胞瘤	56	26	30	48.82±11.71	24	32	4.75±2.08	31.76±11.66	109.57±35.580	96.46±21.30
皮质醇腺瘤	32	14	18	48.44±9.63	20	12	2.88±0.86	16.19±16.23	63.00±30.65	59.67±21.98
醛固酮瘤腺瘤	44	18	26	49.20±9.92	28	16	1.79±0.54	9.95±9.83	51.31±21.53	41.50±17.29
无功能腺瘤	45	13	32	51.67±9.98	22	23	2.59±0.88	09.20±14.63	55.58±20.79	48.59±14.24
P¹值		0.80		0.88	0.076		<0.01	<0.01	<0.01	<0.01
P²值		0.58		0.93	0.039		<0.01	<0.01	<0.01	<0.01
P³值		0.07		0.22	0.545		<0.01	<0.01	<0.01	<0.01

变量	例数	性别（例）		年龄（岁，±s）	肿瘤侧别（例）		肿瘤最大径（cm，±s）	平扫CT值（Hu，±s）	增强CT值（动脉期）（Hu，±s）	增强CT值（延迟期）（Hu，±s）
变量	例数	男	女	年龄（岁，±s）	左	右	肿瘤最大径（cm，±s）	平扫CT值（Hu，±s）	增强CT值（动脉期）（Hu，±s）	增强CT值（延迟期）（Hu，±s）
隐匿型嗜铬细胞瘤	56	26	30	48.82±11.71	24	32	4.75±2.08	31.76±11.66	109.57±35.580	96.46±21.30
皮质醇腺瘤	32	14	18	48.44±9.63	20	12	2.88±0.86	16.19±16.23	63.00±30.65	59.67±21.98
醛固酮瘤腺瘤	44	18	26	49.20±9.92	28	16	1.79±0.54	9.95±9.83	51.31±21.53	41.50±17.29
无功能腺瘤	45	13	32	51.67±9.98	22	23	2.59±0.88	09.20±14.63	55.58±20.79	48.59±14.24
P¹值		0.80		0.88	0.076		<0.01	<0.01	<0.01	<0.01
P²值		0.58		0.93	0.039		<0.01	<0.01	<0.01	<0.01
P³值		0.07		0.22	0.545		<0.01	<0.01	<0.01	<0.01

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